风湿性心脏病患者栓塞危险因素的探讨

Clinical study on systemic embolism in patients with rheumatic heart disease

目的 探讨风湿性心脏病 (RHD)患者栓塞发生率及栓塞的危险因素。方法 统计了我院 14 6例RHD患者的栓塞发生率。发生栓塞者 34例及无栓塞者 112例 ,根据有无栓塞进行单因素分析 ,最后用Logistic回归分析RHD发生栓塞的危险因素。结果 自然病程 (未换瓣 )的RHD患者栓塞发生率为 2 5 .6 % ,伴心房纤颤 (Af)栓塞发生率是 30 .4 % ,窦性心律者栓塞发生率是 9.7%。栓塞组年龄、左房内径 ,伴发Af比例较无栓塞组高 (P <0 .0 1～0 .0 5 )。Logistic回归分析显示高龄、左房内径大是栓塞的独立危险因素 (P <0 .0 5 )。接受换瓣手术和抗凝治疗是栓塞的保护因素 (OR =0 .0 3)。结论 RHD患者应给予抗凝治疗。

Objective To study the risk factors and incidence of systemic embolism in patients with rheumatic heart disease (RHD). Methods The incidence of systemic embolism in 146 patients with RHD who had ever been in our hospital was calculated, and the risk factors of systemic embolism were analyzed. Of 146 cases, 34 cases had systemic embolism and 112 cases had no systemic embolism. Then, the data were analyzed by binary logistic regression. Results The incidence of systemic embolism is 25.6% in RHD cases of natural course. Systemic embolism occurred in 30.4% of cases with atrial fibrillation (Af) and in 9.7% of cases with sinus rhythm. Unvaried analysis revealed that cases in group Ⅰ had older age, larger left atrium and higher incidence of Af than those in group Ⅱ (P< 0.01 or 0.05). Logistic regression analysis revealed that older age and bigger left atrium were the independent risk factors for systemic embolism in cases with RHD (P< 0.05).The surgical procedure and the treatment of warfarin were protective factors for systemic embolism. Conclusion The antithrombotic therapy should be given to all cases with RHD.