老年心房颤动患者合并缺血性脑卒中相关危险因素分析

摘要

目的 探讨老年心房颤动患者合并缺血性脑卒中的相关危险因素.方法 选择2011年1月至2012年12月于北京老年医院住院的268例既往无脑卒中的老年心房颤动患者为研究对象,收集患者的一般临床资料,对患者进行随访观察,以发生脑卒中为终点事件,评估心房颤动患者发生缺血性脑卒中的相关危险因素.结果 随访2年,268例患者中有36例发生缺血性脑卒中,总发生率为13.4％,＞75岁老年心房颤动患者缺血性脑卒中发生率明显高于≤75岁患者[20.7％ (24/116)比7.9％(12/152),x2=9.26,P ＜0.05],此外合并糖尿病、血脂紊乱的患者缺血性脑卒中发生率均明显高于非糖尿病和血脂正常的患者[25.0％ (23/92)比7.4％(13/176),18.8％(22/117)比9.3％(14/151),x2=16.12、5.94,均P＜0.05].持续性心房颤动患者缺血性脑卒中的发生率明显高于阵发性心房颤动患者[19.1％ (31/162)比4.7％(5/106),x2=11.45,P＜0.01];瓣膜性心房颤动患者脑卒中的发生率明显高于非瓣膜性患者[18.2％(28/154)比7.0％ (8/114),x2=7.02,P ＜0.01].多因素Logistic回归分析结果显示,年龄、糖尿病、吸烟史、周围血管疾病和未抗凝治疗是心房颤动患者缺血性脑卒中发生的独立危险因素(比值比=1.308、2.227、1.554、2.704、3.248).结论 年龄、糖尿病、吸烟史、周围血管疾病和未抗凝治疗是心房颤动患者缺血性脑卒中发生的独立危险因素.%Objective To investigate the risk factors of ischemic stroke in elderly patients with atrial fibrillation.Methods Totally 268 elderly patients with atrial fibrillation who had no history of stroke from January 2011 to December 2012 were enrolled.The general data were collected.Taking stroke as endpoint event,all patients were followed up to the endpoint.The risk factors of ischemic stroke were analyzed.Results After 2 years of follow-up,ischemic stroke occurred in 36 patients,with overall incidence of 13.4％.The incidence of ischemic stroke in ＞ 75 years old patients was obviously higher than that in ≤75 years old patients [20.7％ (24/116) vs 7.9％ (12/152),x2 =9.26,P ＜0.05].The incidence of ischemic stroke in patients with diabetes and dyslipidemia were obviously higher than that in patients without diabetes and dyslipidemia [25.0％ (23/92) vs 7.4％ (13/176),18.8％ (22/117) vs 9.3％ (14/151)] (x2 =16.12,5.94,P ＜ 0.05).The incidence rates of ischemic stroke in patients with persistent atrial fibrillation was significantly higher than that in patients with paroxysmal atrial fibrillation [19.1％ (31/162) vs 4.7％ (5/106)] (x2 =11.45,P ＜0.01) ; the incidence of ischemic stroke in patients with valvular atrial fibrillation was obviously higher than in patients with nonvalvular atrial fibrillation [18.2％ (28/154) vs 7.0％ (8/114)] (x2 =7.02,P ＜ 0.01).Multivariate Logistic analysis showed that the age,diabetes,peripheral vascular disease,smoking and without anticoagulation therapy were independent risk factors of ischemic stroke in elderly patients with atrial fibrillation (OR =1.308,2.227,2.704,1.554,3.248).Conclusions Age,diabetes,peripheral vascular disease,smoking and without anticoagulation therapy were independent risk factors of ischemic stroke in elderly patients with atrial fibrillation.