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左心房内径与非瓣膜性房颤患者缺血性脑卒中风险的相关性分析

Relationship between left atrial diameter and ischemic stroke in the elderly patients with non-valvular atrial fibrillation

    摘要
  • 摘要:
      目的  探讨左房内径（LAD）与老年非瓣膜性房颤患者缺血性脑卒中风险的关系。
      方法  将325例非瓣膜性房颤患者根据缺血性脑卒中史分为房颤伴脑卒中组（n=127）和房颤不伴脑卒中组（n=198），比较2组血糖、肌酐清除率、血脂、合并疾病、LAD等临床资料，采用Logistic回归分析评估LAD与缺血性脑卒中风险的相关性，并绘制受试者工作特征（ROC）曲线，评估LAD对缺血性脑卒中的预测价值。
      结果  房颤伴脑卒中组的平均年龄、女性患者比率、合并心力衰竭及高血压患者比率、房颤血栓危险度（CHA2DS2-VASc）评分、LAD、肌酐（Cr）、尿酸（UA）均高于房颤不伴脑卒中组，阵发性房颤患者比率及估算的肾小球滤过率（eGFR）水平低于房颤不伴脑卒中组（P < 0.05或P < 0.01）。多因素Logistic回归分析结果显示，LAD与缺血性脑卒中风险呈正相关（P < 0.01）。ROC分析表明，LAD对缺血性脑卒中风险有一定的预测价值（P < 0.01），LAD联合CHA2DS2-VASc评分的ROC曲线下面积（AUC）为0.904。
      结论  LAD与非瓣膜性房颤患者缺血性脑卒中风险呈正相关，LAD联合CHA2DS2-VASc评分可以更好预测非瓣膜性房颤缺血性脑卒中风险。

     

    Abstract:
      Objective  To investigate the relationship between left atrial diameter (LAD) and ischemic stroke in the elderly patients with non-valvular atrial fibrillation.
      Methods  According to the history of ischemic stroke, 325 patients with non-valvular atrial fibrillation were divided into atrial fibrillation with stroke group (n=127) and atrial fibrillation without stroke group (n=198). Blood glucose, creatinine clearance rate, blood lipid, comorbidities, LAD and other clinical data were compared between the two groups.Logistic regressions were used to analyze the correlation between LAD and the risk of ischemic stroke.Receiver Operating Characteristic (ROC) curve was drew and used to evaluate the predictive value of LAD in ischemic stroke.
      Results  The average age, the proportion of female patients, the proportion of patients complicating with heart failure and hypertension, the CHA2DS2-VASc score, LAD, creatinine (Cr) and uric acid (UA) levels in the atrial fibrillation with stroke group were significantly higher than those in the atrial fibrillation without stroke group, the proportion of patients with paroxysmal atrial fibrillation and the level of estimated glomerular filtration rate (eGFR) were significantly lower than those in patients with atrial fibrillation without stroke group (P < 0.05 or P < 0.01). Multivariate Logistic regression analysis showed LAD was positively correlated with ischemic stroke(P < 0.01). ROC curve showed LAD could predict the risk of ischemic stroke (P < 0.01).The area under the curve (AUC) of LAD combined with CHA2DS2-VASC score was 0.904.
      Conclusion  LAD is positively correlated with the risk of ischemic stroke in patients with non-valvular atrial fibrillation, and LAD combined with CHA2DS2-VASc score can better predict the risk of ischemic stroke in patients with non-valvular atrial fibrillation.

     

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