缺血性脑卒中合并非瓣膜性房颤患者相关因素的回顾性研究

发布时间：2018-08-15 14:30

【摘要】：研究目的:通过比较缺血性脑卒中合并非瓣膜性房颤患者和无房颤的缺血性脑卒中患者的相关临床资料,分析二者之间相关危险因素的差异性,以期为临床的相关诊疗工作提供参考依据。方法:病例组为2012年1月-2016年11月于天津医科大学第二医院神经内科住院治疗的缺血性脑卒中合并非瓣膜性房颤患者311例,对照组为同期我科收治的无房颤急性缺血性脑卒中患者2610例。通过单因素分析的方法比较两组患者在一般临床资料(性别、年龄、高血压病史、糖尿病史、缺血性心脏病史、吸烟史)、相关化验指标(红细胞分布宽度、高密度脂蛋白、总胆固醇、甘油三酯、低密度脂蛋白、尿酸、纤维蛋白原、超敏C反应蛋白、同型半胱氨酸、血小板分布宽度)及NIHSS评分的差异;进一步将存在差异的指标进行多因素逻辑回归分析,以筛选出缺血性脑卒中合并非瓣膜性房颤患者的独立危险因素。根据病情严重程度将病例组患者分为轻度(NIHSS评分8分)和中重度(NIHSS评分≥8分)2个亚组;根据CHADS_2评分标准将病例组患者分为中低危(CHADS_2评分2分)和高危(CHADS_2评分≥2分)2个亚组。通过统计分析,分别比较上述各亚组间相关因素的差异。结果:①病例组患者平均年龄高于对照组[(75.32±9.67)岁对(67.82±10.82)岁],且病例组女性患者所占比例大于对照组(45.34%对35.86%),差异均具有统计学意义(P0.05)。②按年龄分组,病例组中以75~84岁的年龄段患者所占比例最大,为44.05%,且病例组各年龄段男性患者人数均略高于女性患者,但差异无统计学意义(P0.05)。③病例组患者在高血压(71.70%对64.56%)、糖尿病(33.12%对25.94%)、缺血性心脏病史(56.59%对34.64%)及吸烟史(47.91%对41.07%)常见合并症方面的患病率均高于对照组患者,且差异具有统计学意义(P0.05)。④患者的相关化验指标分析示:病例组患者红细胞分布宽度、尿酸、同型半胱氨酸、超敏C反应蛋白、纤维蛋白原、血小板分布宽度水平高于对照组患者,而总胆固醇、高密度脂蛋白、甘油三酯、低密度脂蛋白水平低于对照组患者,且其差异均具有统计学意义(P0.05)。⑤多因素logistic回归分析显示,年龄(OR:1.068,95%CI:1.053~1.084)、女性(OR:1.360,95%CI:1.030~1.796)、糖尿病(OR:1.773,95%CI:1.326~2.371)、缺血性心脏病(OR:1.644,95%CI:1.248~2.167)、吸烟(OR:2.060,95%CI:1.565~2.710)、红细胞分布宽度(OR:1.404,95%CI:1.255~1.570)、血小板分布宽度(OR:1.193,95%CI:1.112~1.279)、尿酸(OR:1.003,95%CI:1.002~1.004)、超敏C反应蛋白(OR:1.006,95%CI:1.003~1.010)、总胆固醇(OR:0.788,95%CI:0.706~0.881)、甘油三酯(OR:0.760,95%CI:0.657~0.878)、高密度脂蛋白(OR:0.225,95%CI:0.136~0.372)、低密度脂蛋白水平(OR:0.323,95%CI:0.238~0.438)均有统计学意义。⑥病例组患者NIHSS评分均值高于对照组[(6.65±5.74)分对(4.38±4.20)分],且差异具有统计学意义(P0.05);中重度亚组患者红细胞分布宽度及纤维蛋白原水平显著高于轻度亚组患者,差异有统计学意义(P0.05),且Pearson相关分析显示红细胞分布宽度及纤维蛋白原水平均与NIHSS评分有统计学意义(P0.05);而两亚组在血小板分布宽度、尿酸、同型半胱氨酸、超敏C反应蛋白、总胆固醇、高密度脂蛋白、甘油三酯、低密度脂蛋白水平未见明显差异(P0.05)。⑦病例组患者CHADS_2评分平均得分为(2.31±1.26)分,CHADS_2评分=0分(低危组)占4.82%,CHADS_2评分=1分(中危组)占23.79%,CHADS_2≥2分(高危组)占71.38%,其中CHADS_2=2分的患者所占比例最大,为30.87%;按CHADS_2评分分组,高危组患者红细胞分布宽度、纤维蛋白原水平均显著高于中低危亚组患者,且Pearson相关分析显示红细胞分布宽度及纤维蛋白原水平均与CHADS_2评分有统计学意义(P0.05);但在血小板分布宽度、尿酸、同型半胱氨酸、超敏C反应蛋白、总胆固醇、高密度脂蛋白、甘油三酯、低密度脂蛋白未见明显差异,无统计学意义(P0.05)。结论:①与不伴有房颤的急性缺血性脑卒中患者相比,急性缺血性脑卒中合并非瓣膜性房颤患者高龄、女性的比例增高。②与不伴有房颤的急性缺血性脑卒中患者相比,急性缺血性脑卒中合并非瓣膜性房颤患者高血压、糖尿病、缺血性心脏病及吸烟患者所占比例增高。③高龄、女性、糖尿病、缺血性心脏病、吸烟、高红细胞分布宽度水平、高血小板分布宽度水平、高尿酸水平、高超敏C反应蛋白水平可能是缺血性脑卒中合并非瓣膜性房颤的独立危险性因素。④合并非瓣膜房颤的缺血性脑卒中患者可能发生更严重的神经功能损伤,且红细胞分布宽度增加或纤维蛋白原水平升高可能与缺血性脑卒中合并非瓣膜性房颤患者病情的严重程度有关。⑤CHADS_2评分的危险分层,高危组患者红细胞分布宽度、纤维蛋白原水平均显著增高,其可能与缺血性脑卒中合并非瓣膜性房颤患者危险程度有关。
[Abstract]:Objective: To compare the clinical data of ischemic stroke patients with non-valvular atrial fibrillation and non-valvular atrial fibrillation patients with ischemic stroke and non-atrial fibrillation patients with ischemic stroke, and analyze the differences of risk factors between them, so as to provide reference for clinical diagnosis and treatment. Objective To study 311 patients with ischemic stroke complicated with non-valvular atrial fibrillation in the Department of Neurology of the Second Hospital and 2610 patients without atrial fibrillation in the control group. History of heart disease, smoking history, related laboratory indices (red blood cell distribution width, high density lipoprotein, total cholesterol, triglyceride, low density lipoprotein, uric acid, fibrinogen, high sensitivity C-reactive protein, homocysteine, platelet distribution width) and NIHSS score differences; furthermore, multiple factor Logistic regression was used to analyze the differences. According to the severity of the disease, the patients were divided into mild (NIHSS score 8 points) and moderate (NIHSS score (> 8 points) subgroups; according to the CHADS_2 score, the patients were divided into low and moderate risk (CHADS_2 score 2 points) and high risk (CHADS_2 score 2 points). Results: The average age of the patients in the case group was higher than that of the control group [(75.32+9.67) years vs. (67.82+10.82) years], and the proportion of female patients in the case group was higher than that of the control group (45.34% vs. 35.86%). The difference was statistically significant (P 0.05). According to age group, the patients aged 75-84 accounted for the largest proportion, 44.05%, and the number of male patients in each age group was slightly higher than that of female patients, but the difference was not statistically significant (P 0.05). 3 In case group, hypertension (71.70% vs 64.56%), diabetes mellitus (33.12% vs 25.94%) and ischemic heart disease (56.59% vs 34.64%). The prevalence of common complications was higher than that of the control group (47.91% vs 41.07%) and the difference was statistically significant (P 0.05). The analysis of related laboratory indicators showed that the erythrocyte distribution width, uric acid, homocysteine, hypersensitive C-reactive protein, fibrinogen and platelet distribution width were higher in the case group than those in the control group (P 0.05). The levels of total cholesterol, high density lipoprotein, triglyceride and low density lipoprotein in the control group were lower than those in the control group, and the differences were statistically significant (P 0.05). _Multivariate logistic regression analysis showed that age (OR: 1.068, 95% CI: 1.053-1.084), female (OR: 1.360, 95% CI: 1.030-1.796), diabetes mellitus (OR: 1.773, 95% CI: 1.326-2.371). (OR: 1.644, 95% CI: 1.248-2.167), ischemic heart disease (OR: 1.644, 95% CI: 1.248-2.167), cigarette smok (OR: 2.060, 95% CI: 1.565-2.710), red blood cell distribution width (OR: 1.404, 95% CI: 1.404, 95% CI: 1.255-1.570), platelet distribution width (OR: 1.193, 95% CI: 1.193, 95% CI: 1.112-1.12-1.279), uriacid (OR: 1.003, 95% CI: 1.002-1.002-1.004), hypersensitive C reactive protein (OR: 1.006, 95% CI: 1.006, 95 Total cholesterol (OR: 0.788, 95% CI: 0.70) 6-0.881, triglyceride (OR: 0.760, 95% CI: 0.657-0.878), high-density lipoprotein (OR: 0.225, 95% CI: 0.136-0.372), low-density lipoprotein (OR: 0.323, 95% CI: 0.238-0.438) were statistically significant. _The NIHSS scores of the patients were significantly higher than those of the control group [(6.65 + 5.74) paired (4.38 + 4.20)], and the difference was statistically significant (P 0.05). The erythrocyte distribution width and fibrinogen level in severe subgroup were significantly higher than those in mild subgroup (P 0.05), and Pearson correlation analysis showed that the erythrocyte distribution width and fibrinogen level were statistically significant with NIHSS score (P 0.05), while the platelet distribution width, uric acid, homocysteine in the two subgroups were significantly higher than those in mild subgroup (P 0.05). There was no significant difference in the levels of amino acid, high-sensitivity C-reactive protein, total cholesterol, high-density lipoprotein, triglyceride, and low-density lipoprotein (P 0.05). _The average score of CHADS_2 in the case group was (2.31 +1.26), CHADS_2 score = 0 (low-risk group) was 4.82%, CHADS_2 score = 1 (medium-risk group) was 23.79%, CHADS_2 < 2 (high-risk group) was 71.38%. The proportion of patients with CHADS_2=2 was the largest, 30.87%; according to CHADS_2 score, the distribution width of erythrocyte and fibrinogen level in high-risk group were significantly higher than those in low-risk group, and Pearson correlation analysis showed that the distribution width of erythrocyte and fibrinogen level were statistically significant with CHADS_2 score (P 0.05). There was no significant difference in platelet distribution width, uric acid, homocysteine, high-sensitivity C-reactive protein, total cholesterol, high-density lipoprotein, triglyceride, low-density lipoprotein (P (2) The proportion of hypertension, diabetes, ischemic heart disease and smoking in patients with acute ischemic stroke and non-valvular atrial fibrillation was higher than that in patients without atrial fibrillation. High platelet distribution width, high uric acid and high-sensitivity C-reactive protein levels may be independent risk factors for ischemic stroke complicated with non-valvular atrial fibrillation. _The risk stratification of CHADS_2 score, the width of erythrocyte distribution and the level of fibrinogen in the high-risk group were significantly increased, which may be related to the risk of ischemic stroke with non-valvular atrial fibrillation.
【学位授予单位】：天津医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R743.3;R541.75

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