非瓣膜性心房颤动患者脑卒中风险与肾功能的相关性研究

摘要

Objective To explore the relationship between renal dysfunction and stroke risk evaluated by estimated glomerular filtration rate(eGFR) and CHA2DS2-VASc score in patients with non-valvular atrial fibrillation(NVAF).Methods From January 2012 to December 2016,NVAF patients at the First Affiliated Hospital of Nanjing Medical University were identified using digital medical record retrieve system.eGFR and CHA2DS2-VASc score were calculated for each participant.Patients were stratified according to different levels of eGFR.Clinical characteristics were compared and described between groups.Correlation analysis was used to reveal the possible relationship between CHA2DS2-VASc score and eGFR.Multiple linear regression analysis was used to evaluate which item of the CHA2DS2-VASc score correlated with eGFR the most.Results A total of 2 298 patients were included in the study.The correlation analysis showed a negative correlation between eGFR and CHA2DS2-VASc score (Pearson's coefficient-0.357,P＜ 0.001).The multiple linear regression analysis demonstrated that congestive heart failure (unstandardizedβ-11.440,P＜0.001),hypertension (unstandardizedβ-6.504,P＜0.001),age ≥ 65 years (unstandardizedβ-8.666,P＜0.001),prior history of transient ischemic attack or thromboembolism(unstandardized β-4.411,P＜0.001) and female (unstandardized β -2.092,P =0.021)were most related to decreased eGFR among all the factors of CHA2DS2-VASc score.Diabetes and vascular diseases had no significant relationship with renal dysfunction.Conclusion eGFR has a negative correlation with CHA2DS2-VASc scores.%目的 探讨非瓣膜性心房颤动(房颤)患者中,CHA2DS2-VASc评分评估脑卒中风险与估测肾小球滤过率(eGFR)评估肾功能的关系.方法 应用数字化病案检索系统检索2012年1月至2016年12月首次于南京医科大学第一附属医院综合心脏病区住院治疗的非瓣膜性房颤患者.计算eGFR和CHA2DS2-VASc评分,根据eGFR将患者分为肾功能正常组和肾功能不良组,统计并描述各组临床特征.对CHA2DS2-VASc评分总分和eGFR进行相关性分析,对CHA2DS2-VASc评分内各项评分和eGFR进行多重线性回归分析.结果 本研究共纳入2 298例病例,相关分析结果显示eGFR和CHA2DS2-VASc评分呈负相关(Pearson相关系数-0.357,P＜0.001).多重线性回归分析结果显示,CHA2DS2-VASc评分中与eGFR相关的因素是充血性心力衰竭/左心室功能障碍(C,偏回归系数-11.440,P＜0.001)、高血压(H,偏回归系数-6.504,P＜0.001)、年龄≥65岁(A,偏回归系数-8.666,P＜0.001)、短暂性脑缺血发作(TIA)/脑卒中/体循环栓塞史(S2,偏回归系数-4.411,P＜0.001)、女性(Sc,偏回归系数-2.092,P=0.021).与eGFR无明显相关的是D(糖尿病)和V(血管疾病).结论 非瓣膜性房颤患者的CHA2DS2-VASc评分和eGFR呈负相关,即脑卒中危险度越高,肾功能不良概率越高.