非瓣膜性心房颤动患者脑卒中危险因素的临床分析

目的回顾性分析非瓣膜性心房颤动患者发生脑卒中的危险因素。方法调查2002年6月至2003年9月在天坛医院住院的非瓣膜性心房颤动患者,通过比较心房颤动合并脑卒中与心房颤动无脑卒中患者的临床特征,筛选心房颤动发生脑卒中的危险因素。结果1)单因素危险因素分析中,与脑卒中相关的危险因素有:年龄>75岁、高血压病史、糖尿病病史、心力衰竭病史;年龄、血糖、血清总胆固醇、血压(收缩压和舒张压);左室收缩功能障碍左室射血分数(EF)<50%]。2)多因素Logistic分析显示:年龄、高血压病史、左室收缩功能障碍(EF<50%)是脑卒中的独立危险因素。3)438例患者中66.5%接受了抗血栓治疗,其中抗血小板治疗占64.7%,长期抗凝治疗者仅1.8%。结论非瓣膜性心房颤动患者发生脑卒中的独立危险因素为年龄、高血压病史、左室收缩功能障碍(EF<50%)。

Clinical Analysis of Risk Factors for Stroke in Patients with Nonvalvular Atrial Fibrillation

Objective To identify risk factors in patients with nonvalvular atrial fibrillation(NVAF). Methods Retrospective analysis of our hospital records were performed from patients with primary diagnosis of AF, discharged from Jun. 2002 to Sep. 2003. Results The data of the patients with stroke in NVAF (n=159) was compared with those in NVAF without stroke ( n= 279). The effect of each variable on stroke was assessed with a logistic regression analysis. A total of 438 cases in NVAF were enrolled. Mean age was 69.4 years old. Univariate analysis showed that significant risk factors for stroke in patients with AF were age>75, hypertension, diabetes mellitus, history of congestive heart failure; old age, increased serum total cholesterol and glucose, high systolic and diastolic blood pressure, left ventricular dysfunction. In multivariate analysis, old age, history of hypertension, left ventricular dysfunction was independently associated with stroke. It was 66.5% of our patients who received antithrombotic therapy with dominated use of antiplatelet agents. Conclusion Our analysis suggests that old age, history of hypertension, left ventricular dysfunction (EF<50%)are independent risk factors, which should be considered when decision of long-term anticoagulation therapy to prevent stroke in NVAF is to be made. It was 66.5% of our patients who received antithrombotic therapy with dominated use of antiplatelet agents. Therefore it is advisable to enforce the control of AF.