摘要
目的探讨P波指数与阵发性心房颤动(房颤)合并缺血性脑卒中的相关性。方法收集2017年1月至2019年10月临床资料完整的阵发性房颤患者141例,根据是否合并缺血性脑卒中分为对照组(无脑梗死)55例、合并腔隙性脑梗死(腔梗)组37例、合并急性脑梗死组49例,急性脑梗死组中有41例患者在急性脑梗死前有心电图记录。比较阵发性房颤患者发生急性脑梗死前后P波时限、V1导联P波终末电势(PTFV1)及P波电轴差异及3组间P波时限、PTFV1及P波电轴差异。结果阵发性房颤患者发生急性脑梗死后P波时限较急性脑梗死前显著延长[(122.80±12.40)ms对(109.53±12.32)ms,P<0.001]。P波时限延长为阵发性房颤合并腔梗的独立危险因素(OR=1.090,95%CI 1.039~1.142,P<0.001);P波时限延长为阵发性房颤合并急性脑梗死的独立危险因素(OR=1.129,95%CI 1.066~1.196,P<0.001);PTFV1为阵发性房颤合并急性脑梗死的独立危险因素(OR=1.090,95%CI 1.042~1.140,P<0.001)。P波时限以112.0 ms为截断点预测阵发性房颤合并腔梗的曲线下面积(AUC)为0.722,敏感性为80.8%,特异性为57.9%;P波时限以118.5 ms为截断点预测阵发性房颤合并急性脑梗死的AUC为0.852,敏感性为81.6%,特异性为81.8%;PTFV1以40.55 mm·ms为截断点预测阵发性房颤合并急性脑梗死的AUC为0.833,敏感性为81.6%,特异性为71.5%。结论窦性心律P波增宽提示阵发性房颤患者可能容易并发腔梗和急性脑梗死,PTFV1值增大提示阵发性房颤患者可能容易并发急性脑梗死。
Objective To investigate the correlation between P wave indices and paroxysmal atrial fibrillation(PAF)with ischemic stroke.Methods One hundred and forty-one PAF patients with complete clinical data were enrolled from January 2017 to October 2019.They were divided into control group(without cerebral infarction,n=55),PAF with lacuna infarction group(n=37)and PAF with acute cerebral infarction group(n=49).In the acute cerebral infarction group,electrocardiogram was recorded in 41 cases before acute cerebral infarction.The P-wave duration,PTFV1,P-wave axis were compared before and after acute cerebral infarction in PAF patients.The P-wave duration,PTFV1 and P-wave axis were compared among the three groups.Results In patients with PAF,the P wave duration after acute cerebral infarction was significantly longer than that before acute cerebral infarction[(122.80±12.40)ms vs.(109.53±12.32)ms,P<0.001].P-wave duration was an independent risk factor for PAF with lacuna infarction(OR=1.090,95%CI 1.039-1.142,P<0.001,);P-wave duration was an independent risk factor for PAF with acute cerebral infarction(OR=1.129,95%CI 1.066-1.196,P<0.001).PTFV1 was an independent risk factor for PAF with acute cerebral infarction(OR=1.090,95%CI 1.042-1.140,P<0.001).The area under curve(AUC)of P-wave duration in predicting PAF with lacuna infarction and PAF with acute cerebral infarction was 0.722 and 0.852.The sensitivity was 80.8%and 81.6%.The specificity was 57.9%and 81.8%,and the cut-off points were 112.0 ms and 118.5 ms,respectively.PTFV1 predicted AUC of PAF with acute cerebral infarction was 0.833,cut-off point was 40.55 mm·ms,sensitivity was 81.6%,and specificity was 71.5%.Conclusion Sinus rhythm P-wave duration prolongation and suggests that patients with PAF may be prone to complicated with lacuna infarction and acute cerebral infarction.Increased PTFV1 suggests that patients with PAF may be prone to acute cerebral infarction.
作者
陶依娆
李芳
杨岩
张钧博
杜婕
许振
赵云飞
杨东辉
Tao Yirao;Li Fang;Yang Yan;Zhang Junbo;Du Jie;Xu Zhen;Zhao Yunfei;Yang Donghui
出处
《中华心律失常学杂志》
2020年第5期467-471,共5页
Chinese Journal of Cardiac Arrhythmias
关键词
心房颤动
缺血性脑卒中
P波时限
P波指数
Atrial fibrillation
Ischemic stroke
P-wave duration
P-wave indices
