左心房内径与高龄心房颤动并缺血性卒中的相关性分析

目的 左心房内径与高龄心房颤动并缺血性卒中的相关性。方法 选取2015.01~2018.08在南部战区总医院干部病房住院的高龄患者共524例，房颤患者264例，其中持续性房颤132例(25.2%)，阵发性房颤132例(25.2%)，非房颤患者260例(49.6%)。通过病历资料，调取超声心动图检查结果，比较左心房内径在房颤组与非房颤组之间、房颤卒中组与非房颤卒中组之间是否存在差异。结果 与非房颤组相比，房颤组左心房左右内径(43.87±8.20mm vs 38.06±4.50mm, P=0.001)、左心房前后内径(37.96±7.24mm vs 33.54±4.51mm, P=0.001)、左心房上下内径(44.98±7.25mm vs 43.00±7.59mm, P=0.001)、右心房前后内径(53.09±6.65mm vs 48.71±7.14mm, P=0.001)、肌酐(124.42±88.20umol/L vs 110.01±48.39umol/L, P=0.023)、胱抑素C(1.97±1.22mgl/L vs 1.63±0.62mgl/L, P=0.001)、尿酸(400.13±121.34umol/L vs 378.71±118.47umol/L, P=0.043)、同型半胱氨酸(16.80±11.58umol/L vs 14.87±5.84umol/L, P=0.017)、低密度脂蛋白(1.79±0.65mmol/L vs 2.01±0.76mmol/L, P=0.001)、甘油三酯(3.38±0.88mmol/L vs 3.66±0.99mmol/L, P=0.001)、缺血性卒中(136/128 vs 78/182, P=0.001)、慢性心力衰竭(141/123 vs 69/191, P=0.001)等指标在两组之间差异有统计学意义。房颤卒中组尿酸(385.65±122.37umol/L vs 415.28±118.83umol/L, P=0.047)、左心房左右内径(44.71±7.83mm vs 42.72±8.47mm, P=0.049)、左心房上下内径(45.45±6.87mm vs 43.18±7.69mm, P=0.012)、慢性心力衰竭(81/55 vs 60/68, P=0.048)等指标与非房颤卒中组比较，差异有统计学意义。通过Logistic回归分析发现，左心房左右内径、左心房上下径、慢性心力衰竭可能与高龄房颤并缺血性卒中存在关联性，左心房左右内径、左心房上下径可作为高龄房颤并缺血性卒中的预测因子，ROC曲线下面积分别为0.596、0.588。结论 左心房内径不仅与高龄房颤并发缺血性卒中存在关联性，也可作为高龄房颤并发缺血性卒中的预测因子。

The relationship between left atrial diameter and elderly atrial fibrillation with ischemic stroke

Objective To investigate the relationship between left atrial diameter and elderly patients in atrial fibrillation and ischemic stroke. Methods From January 2015 to August 2018, 524 elderly patients were hospitalized in cadre ward of General Hospital of Southern Theater Command, including 264 patients with atrial fibrillation, 132 patients with persistent(25.2%), 132 patients with paroxysmal atrial fibrillation(25.2%) and 260 patients with non-atrial fibrillation(49.6%). The left atrial diameter was compared between atrial fibrillation group and non-atrial fibrillation group, and between atrial fibrillation stroke group and non-atrial fibrillation stroke group. Results Compared with non-elderly atrial fibrillation group, there were significant differences in left and right diameter of left atrial(43.87±8.20mm vs 38.06±4.50mm, P=0.001), front and rear diameter of left atrial(37.96±7.24mm vs 33.54±4.51mm, P=0.001), upper and lowe diameter of left atrial(44.98±7.25mm vs 43.00±7.59mm, P=0.001), front and rear diameter of right atrial(53.09±6.65mm vs 48.71±7.14mm, P=0.001), creatinine(124.42±88.20umol/L vs 110.01±48.39umol/L, P=0.023), cystatin C(1.97±1.22mgl/L vs 1.63±0.62mgl/L, P=0.001), uric acid(400.13±121.34umol/L vs 378.71±118.47umol/L, P=0.043), homocysteine(16.80±11.58umol/L vs 14.87±5.84umol/L, P=0.017), low density lipoprotein(1.79±0.65mmol/L vs 2.01±0.76mmol/L, P=0.001), triglyceride(3.38±0.88mmol/L vs 3.66±0.99mmol/L, P=0.001), ischemic strok(136/128 vs 78/182, P=0.001), chronic heart failure(141/123 vs 69/191, P=0.001) between the two groups. There were statistical differences in uric acid(385.65±122.37umol/L vs 415.28±118.83umol/L, P=0.047), left and right diameter of left atrial(44.71±7.83mm vs 42.72±8.47mm, P=0.049), upper and lowe diameter of left atrial(45.45±6.87mm vs 43.18±7.69mm, P=0.012) , chronic heart failure(81/55 vs 60/68, P=0.048) between AF stroke group and AF non-stroke group. Logistic regression analysis showed that left atrial diameter(upper and lower diameter, left and right diameter), chronic heart failure may be associated with elderly atrial fibrillation and ischemic stroke. Left atrial diameter(upper and lower diameter, left and right diameter) can be used as predictors of elderly patients with atrial fibrillation and ischemic stroke, the area under ROC curve is 0.596 and 0.588. Conclusion Left atrial diameter is not only associated with ischemic stroke in elderly patients with atrial fibrillation, but also can be used as a predictor of ischemic stroke in elderly patients with atrial fibrillation.