缺血性腦卒中合并非瓣膜性房顫患者相關(guān)因素的回顧性研究
發(fā)布時間：2018-08-15 14:30
【摘要】：研究目的:通過比較缺血性腦卒中合并非瓣膜性房顫患者和無房顫的缺血性腦卒中患者的相關(guān)臨床資料,分析二者之間相關(guān)危險因素的差異性,以期為臨床的相關(guān)診療工作提供參考依據(jù)。方法:病例組為2012年1月-2016年11月于天津醫(yī)科大學第二醫(yī)院神經(jīng)內(nèi)科住院治療的缺血性腦卒中合并非瓣膜性房顫患者311例,對照組為同期我科收治的無房顫急性缺血性腦卒中患者2610例。通過單因素分析的方法比較兩組患者在一般臨床資料(性別、年齡、高血壓病史、糖尿病史、缺血性心臟病史、吸煙史)、相關(guān)化驗指標(紅細胞分布寬度、高密度脂蛋白、總膽固醇、甘油三酯、低密度脂蛋白、尿酸、纖維蛋白原、超敏C反應蛋白、同型半胱氨酸、血小板分布寬度)及NIHSS評分的差異;進一步將存在差異的指標進行多因素邏輯回歸分析,以篩選出缺血性腦卒中合并非瓣膜性房顫患者的獨立危險因素。根據(jù)病情嚴重程度將病例組患者分為輕度(NIHSS評分8分)和中重度(NIHSS評分≥8分)2個亞組;根據(jù)CHADS_2評分標準將病例組患者分為中低危(CHADS_2評分2分)和高危(CHADS_2評分≥2分)2個亞組。通過統(tǒng)計分析,分別比較上述各亞組間相關(guān)因素的差異。結(jié)果:①病例組患者平均年齡高于對照組[(75.32±9.67)歲對(67.82±10.82)歲],且病例組女性患者所占比例大于對照組(45.34%對35.86%),差異均具有統(tǒng)計學意義(P0.05)。②按年齡分組,病例組中以75~84歲的年齡段患者所占比例最大,為44.05%,且病例組各年齡段男性患者人數(shù)均略高于女性患者,但差異無統(tǒng)計學意義(P0.05)。③病例組患者在高血壓(71.70%對64.56%)、糖尿病(33.12%對25.94%)、缺血性心臟病史(56.59%對34.64%)及吸煙史(47.91%對41.07%)常見合并癥方面的患病率均高于對照組患者,且差異具有統(tǒng)計學意義(P0.05)。④患者的相關(guān)化驗指標分析示:病例組患者紅細胞分布寬度、尿酸、同型半胱氨酸、超敏C反應蛋白、纖維蛋白原、血小板分布寬度水平高于對照組患者,而總膽固醇、高密度脂蛋白、甘油三酯、低密度脂蛋白水平低于對照組患者,且其差異均具有統(tǒng)計學意義(P0.05)。⑤多因素logistic回歸分析顯示,年齡(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)、缺血性心臟病(OR:1.644,95%CI:1.248~2.167)、吸煙(OR:2.060,95%CI:1.565~2.710)、紅細胞分布寬度(OR:1.404,95%CI:1.255~1.570)、血小板分布寬度(OR:1.193,95%CI:1.112~1.279)、尿酸(OR:1.003,95%CI:1.002~1.004)、超敏C反應蛋白(OR:1.006,95%CI:1.003~1.010)、總膽固醇(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)均有統(tǒng)計學意義。⑥病例組患者NIHSS評分均值高于對照組[(6.65±5.74)分對(4.38±4.20)分],且差異具有統(tǒng)計學意義(P0.05);中重度亞組患者紅細胞分布寬度及纖維蛋白原水平顯著高于輕度亞組患者,差異有統(tǒng)計學意義(P0.05),且Pearson相關(guān)分析顯示紅細胞分布寬度及纖維蛋白原水平均與NIHSS評分有統(tǒng)計學意義(P0.05);而兩亞組在血小板分布寬度、尿酸、同型半胱氨酸、超敏C反應蛋白、總膽固醇、高密度脂蛋白、甘油三酯、低密度脂蛋白水平未見明顯差異(P0.05)。⑦病例組患者CHADS_2評分平均得分為(2.31±1.26)分,CHADS_2評分=0分(低危組)占4.82%,CHADS_2評分=1分(中危組)占23.79%,CHADS_2≥2分(高危組)占71.38%,其中CHADS_2=2分的患者所占比例最大,為30.87%;按CHADS_2評分分組,高危組患者紅細胞分布寬度、纖維蛋白原水平均顯著高于中低危亞組患者,且Pearson相關(guān)分析顯示紅細胞分布寬度及纖維蛋白原水平均與CHADS_2評分有統(tǒng)計學意義(P0.05);但在血小板分布寬度、尿酸、同型半胱氨酸、超敏C反應蛋白、總膽固醇、高密度脂蛋白、甘油三酯、低密度脂蛋白未見明顯差異,無統(tǒng)計學意義(P0.05)。結(jié)論:①與不伴有房顫的急性缺血性腦卒中患者相比,急性缺血性腦卒中合并非瓣膜性房顫患者高齡、女性的比例增高。②與不伴有房顫的急性缺血性腦卒中患者相比,急性缺血性腦卒中合并非瓣膜性房顫患者高血壓、糖尿病、缺血性心臟病及吸煙患者所占比例增高。③高齡、女性、糖尿病、缺血性心臟病、吸煙、高紅細胞分布寬度水平、高血小板分布寬度水平、高尿酸水平、高超敏C反應蛋白水平可能是缺血性腦卒中合并非瓣膜性房顫的獨立危險性因素。④合并非瓣膜房顫的缺血性腦卒中患者可能發(fā)生更嚴重的神經(jīng)功能損傷,且紅細胞分布寬度增加或纖維蛋白原水平升高可能與缺血性腦卒中合并非瓣膜性房顫患者病情的嚴重程度有關(guān)。⑤CHADS_2評分的危險分層,高危組患者紅細胞分布寬度、纖維蛋白原水平均顯著增高,其可能與缺血性腦卒中合并非瓣膜性房顫患者危險程度有關(guān)。
[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.
【學位授予單位】：天津醫(yī)科大學
【學位級別】：碩士
【學位授予年份】：2017
【分類號】：R743.3;R541.75
本文編號：2184493
[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.
【學位授予單位】：天津醫(yī)科大學
【學位級別】：碩士
【學位授予年份】：2017
【分類號】：R743.3;R541.75
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