摘要
目的探讨西安地区伴心房颤动(atrial fibrillation,AF)的首发脑梗死患者临床特征及1年预后情况。方法通过西安卒中登记研究,连续纳入2015年1-12月4所三级甲等医院确诊的首发脑梗死患者,根据是否伴AF分为非AF组和AF组。比较两组基本临床特征和1年不良预后[卒中复发(脑梗死和脑出血)、预后不良(mRS 2~5分)和全因死亡]发生率的差异。采用多因素logistic回归模型分析AF对首发脑梗死患者1年预后的影响。结果共1564例首发脑梗死患者纳入研究,其中AF组113例(7.2%),非AF组1451例(92.8%)。AF组平均年龄[71.18±12.66岁vs 63.25±12.46岁,P<0.001]、BMI[24.0(22.0~25.5)kg/m^(2)vs 23.4(21.1~24.6)kg/m^(2),P=0.004]、目前仍吸烟比例(11.5%vs 26.6%,P=0.002)、入院NIHSS评分[7(3~12)分vs 4(2~6)分,P<0.001]、继发肺炎比例(17.7%vs 3.7%,P<0.001)、入院48 h不能行走比例(54.0%vs 32.9%,P<0.001)、吞咽障碍比例(14.2%vs 6.4%,P=0.001)、LDL-C(2.44±0.71 mmol/L vs 2.65±0.86 mmol/L,P=0.016)、INR(1.21±0.52 vs 1.02±0.13,P<0.001)和血小板计数[(164.91±47.55)×10^(9)/L vs(192.58±59.98)×10^(9)/L,P<0.001]等指标与非AF组相比,差异均有统计学意义。多因素logistic回归分析显示,AF组患者的1年预后不良风险(OR 2.25,95%CI 1.10~5.23,P=0.022)和死亡风险(OR 3.28,95%CI 1.48~7.28,P=0.004)较非AF组升高,两组卒中复发风险差异无统计学意义(OR 1.14,95%CI 0.34~3.85,P=0.833)。结论西安地区伴AF的首发脑梗死患者部分临床特征显著区别于非AF组,1年预后不良风险和死亡风险均显著升高。建议开展区域内AF患者卒中风险评估,以规范高危患者的抗凝治疗。
Objective To investigate the clinical characteristics and 1-year prognosis of first-ever cerebral infarction patients with atrial fibrillation(AF)in Xi'an.Methods Based on the Xi'an Stroke Register database,the first-ever cerebral infarction patients admitted to four 3A-grade hospitals in Xi'an from January to December 2015 were included in this retrospective analysis.The patients were divided into non-AF group and AF group.The difference in basic clinical characteristics and 1-year poor outcome including stroke recurrence,poor functional outcome(mRS 2-5)and all-cause death between the two groups were compared.Multivariate logistic regression model was used to analyze the influence of AF on 1-year prognosis in first-ever cerebral infarction patients.Results A total of 1564 patients were included,including 113 patients(7.2%)with AF and 1451 patients(92.8%)without AF.Compared to the non-AF group,the patients in AF group showed elder age[(71.18±12.66)years vs(63.25±12.46)years,P<0.001],higher body mass index[24.0(22.0-25.5)kg/m^(2)vs 23.4(21.1-24.6)kg/m^(2),P=0.004],lower rate of current smoking(11.5%vs 26.6%,P=0.002),higher NIHSS score at admission[7(3-12)vs 4(2-6),P<0.001],higher rate of secondary pneumonia(17.7%vs 3.7%,P<0.001),more patients unable to walk within 48 hours after admission(54.0%vs 32.9%,P<0.001),higher rate of dysphasia(14.2%vs 6.4%,P=0.001),and lower LDL-C level(2.44±0.71 mmol/L vs 2.65±0.86 mmol/L,P=0.016),higher INR(1.21±0.52 vs 1.02±0.13,P<0.001)and lower platelet count[(164.91±47.55)×10^(9)/L vs(192.58±59.98)×10^(9)/L,P<0.001].Multivariate logistic regression analysis showed that the risks of poor functional outcome(OR 2.25,95%CI 1.10-5.23,P=0.022)and death(OR 3.28,95%CI 1.48-7.28,P=0.004)within 1 year in AF group were significantly higher than that in non-AF group,but there was no statistical difference in recurrent stroke risk between the groups(OR 1.14,95%CI 0.34-3.85,P=0.833).Conclusions The partial clinical characteristics of first-ever cerebral infarction patients with AF were
作者
逯青丽
王静
刘仲仲
刘佩
刘燕
常乔乔
蔺雪梅
史亚玲
王芳
吴松笛
LU Qing-Li;WANG Jing;LIU Zhong-Zhong;LIU Pei;LIU Yan;CHANG Qiao-Qiao;LIN Xue-Mei;SHI Ya-Ling;WANG Fang;WU Song-Di(Department of Neurology,the First Hospital of Xi’an,The First Affiliated Hospital of Northwestern University,Xi’an 710002,China)
出处
《中国卒中杂志》
2021年第11期1131-1136,共6页
Chinese Journal of Stroke
基金
陕西省科技计划项目(2017SF163)
西安市科技计划重大项目[201805104YX12SF38(2)]
西安市科技计划项目[20YXYJ0008(1)]
西安市卫健委科研项目(2020ms03,2020yb05)。
关键词
心房颤动
首发脑梗死
临床特征
预后
死亡
卒中复发
Atrial fibrillation
First-ever cerebral infarction
Clinical characteristics
Prognosis
Death
Stroke recurrence
