西安地区伴心房颤动老年急性缺血性卒中患者临床特征及1年预后分析

目的 探讨西安地区伴心房颤动老年急性缺血性卒中（acute ischemic stroke，AIS）患者临床特征及1年预后情况。方法 通过西安卒中数据库平台，收集西安市4所三级甲等医院2015年1-12月连续入院的老年AIS（年龄≥65岁）患者的临床资料，比较分析伴心房颤动老年AIS患者的临床特征；登记随访1年的结局事件（包括卒中复发、死亡和预后不良），通过多因素Logi sti c回归分析，探讨西安地区伴心房颤动老年AIS患者1年不良预后的独立危险因素。结果 研究最终纳入老年AIS患者1239例，其中伴心房颤动者133例（10.7%）。与不伴心房颤动组相比，伴心房颤动老年AIS患者的年龄大（[ 77.7±6.3）岁 vs（74.0±6.1）岁，P=0.019]、出院mRS评分高（2.0分 vs 1.0分，P <0.001）、出院NIHSS评分≥14分比例高（16.5% vs 3.1%，P <0.001）、合并肺炎患者比例高（21.1% vs 5.8%，P <0.001）、入院48 h不能行走的患者比例高（63.0% vs 36.1%，P <0.001）、空腹血糖水平高[（6.3±3.0）mmol/L vs（5.8±2.0）mmol/L，P =0.037]、LDL-C水平低[（2.4±0.7）mmol/L vs（2.5±0.8）mmol/L，P =0.031]。伴心房颤动老年AIS患者1年卒中复发率高（15.8% vs 5.9%，P =0.020）、死亡率高（32.3% vs 9.2%，P <0.001）、预后不良率高（51.9% vs 25.9%，P <0.001）。校正相关混杂因素后，多因素Logistic回归分析显示，心房颤动是老年AIS患者1年死亡风险的独立影响因素（OR 2.45，95%CI 1.26～4.78，P =0.008），但不是1年卒中复发和预后不良的独立影响因素（P >0.05）。结论 相比不伴心房颤动组，西安地区伴心房颤动老年AIS患者年龄更大、卒中所致残障及神经功能缺损更重、合并肺炎和入院48 h不能行走的患者比例较高；伴心房颤动老年AIS患者1年死亡风险显著升高。

Clinical Characteristics and 1-Year Prognosis in Elderly Acute Ischemic Stroke Patients with Atrial Fibrillation in Xi'an Area

Objective To investigate the clinical characteristics and 1-year prognosis of elderly acute ischemic
stroke (AIS) patients with atrial fibrillation (AF) in Xi'an area.
Methods Clinical data of elderly patients with AIS (≥65 years) who were consecutively admitted
to four tertiary-grade A class hospitals from January 2015 to December 2015 in Xi'an Stroke Data
Bank were collected. The clinical characteristics of elderly AIS patients with and without AF were
compared, and the outcome events of 1 year follow-up (including stroke recurrence, death and poor
prognosis) were analyzed. Multivariate logistic regression analysis was used to find the independent
risk factors for poor prognosis of 1 year in elderly AIS patients with AF in Xi'an area.
Results Total 1239 elderly AIS patients were enrolled in this study, including 133 (10.7%) patients
with AF. Comparing with the non-AF group, the elderly AIS patients in AF group showed older
[(77.7±6.3) years vs (74.0±6.1) years, P =0.019], higher mRS score at discharge (median 2.0vs 1.0, P <0.001), higher rate of NIHSS score ≥14 at discharge (16.5% vs 3.1%, P <0.001), higher
rate of patients with pneumonia (21.1% vs 5.8%, P <0.001), more patients unable to walk within
48 h at admission (63.0% vs 36.1%, P <0.001), higher fasting blood glucose level [6.3±3.0) mmol/
L vs (5.8±2.0) mmol/L, P =0.037] and lower LDL-C level [(2.4±0.7) mmol/L vs (2.5±0.8) mmol/L,
P =0.031] at admission. At 1 year follow-up, the elderly AIS patients in AF group had higher stroke
recurrence rate (15.8% vs 5.9%, P =0.020), higher mortality (32.3% vs 9.2%, P <0.001) and higher
rate of poor prognosis (51.9% vs 25.9%, P <0.001) than that in non-AF group. After adjustment
for the related confounders, multivariate logistic regression analysis result showed that AF was
an independent risk factor for 1 year mortality in elderly AIS patients (OR 2.45, 95%CI 1.26-4.78,
P =0.008), but not an independent risk factor for stroke recurrence and poor prognosis at 1 year
(P >0.05).
Conclusions Comparing with the elderly AIS patients without AF, the elderly AIS patients with AF
in Xi'an area were older, had more severe stroke, higher rate of pneumonia and higher rate of losing
the ability to walk within 48h at admission, and higher risk of death at 1 year.