隐源性卒中患者检出阵发性心房颤动的危险因素分析

戴晓蓉; 王浩; 代玲; 张瑞; 刘建平; 王锐; 魏青

doi:10.12025/j.issn.1008-6358.2017.20170598

摘要: 目的：探讨阵发性心房颤动（paroxysmal atrial fibrillation，PxAF）在隐源性卒中（cryptogenic stroke，CS）患者中检出的危险因素。方法：选择2015年3月至2017年2月住院治疗的缺血性卒中患者340例，完善心脏、血管超声，血常规、凝血常规、血脂、血糖、头颅CT、头颅磁共振成像（MRI）+磁共振扩散加权成像（DWI）、头颈磁共振血管成像（MRA）和（或）头颈CT血管成像（CTA）等检查，并根据既往病史、入院时12导联心电图、入院7 d内完成24 h动态心电图（Holter）或72 h Holter。将患者分为CS 组、PxAF相关性卒中组、持续性AF（permanent atrial fibrillation，PermAF）相关性卒中组，进而分析PxAF相关性卒中的临床特点及CS患者伴发PxAF的危险因素。结果：340例患者中，CS 251例、PxAF相关性卒中45例、PermAF相关性卒中44例。PxAF相关卒中与PermAF相关卒中组患者出院3~6个月后的改良Rankin量表评分（mRS）及病死率差异无统计学意义。多因素Logistic分析显示，年龄大(OR=1.142，95%CI 0.017~1.065)、入院美国国立卫生研究院卒中量表（National Institute of Health Stroke Scale, NIHSS）评分高(OR=1.351，95%CI 1.035~1.763)、AF鉴别评分（STAF）高(OR=3.945，95%CI 1.650~9.431)、伴频发房性早搏(OR=8.034，95%CI 1.014~63.646)、左房直径增大(OR=1.452，95%CI 1.109~1.901)、梗死灶数目多(OR=2.317，95%CI 1.289~4.163)、梗死累及左右侧(OR=10.362，95%CI 1.389~77.301)是CS患者检出PxAF的独立危险因素（P＜0.05）。结论：对于年龄大、入院NIHSS评分高、STAF评分高、伴频发房性早搏、左房直径增大、梗死灶数目多、梗死累及左右侧的CS患者，应延长心电监测时间，及时发现PxAF。

Abstract: Objective：To explore the risk factors of paroxysmal atrial fibrillation (PxAF) in patients with cryptogenic stroke (CS). Methods：Totally 340 cases of inpatients with ischemic stroke from March 2015 to February 2017 underwent cardiac and vascular ultrasound, blood routine examination, conventional coagulation examination, detection of blood lipid, and blood glucose, head CT, head MRI+DWI, head and neck MRA and (or) CTA, etc. These patients were divided into CS group, PxAF related stroke group, and permanent atrial fibrillation (PermAF) related stroke group, based on the past medical history, 12-channel electrocardiogram in admission and 24 or 72 h Holter in the first 7 days of admission. The clinical features of PxAF related stroke and the risk factors of PxAF in CS patient were analyzed. Results：There were 251 of CS, 45 of PxAF related stroke, and 44 of PermAF related stroke in total 340 cases; the modified Ranking Scale/score (mRS) and the death rate 3-6 months after discharge had no statistical significance between PxAF related stroke group and PermAF related stroke. Multi-factor Logistic analysis showed that the age (OR=1.142, 95%CI 0.017-1.065), National Institute of Health stroke scale (NIHSS) on admission (OR=1.351, 95%CI 1.035-1.763), score for the targeting of atrial fibrillation (STAF) (OR=3.945, 95%CI 1.650-9.431), frequent atrial premature beats (OR=8.034, 95%CI 1.014-63.646), left atrial dimension (OR=1.452, 95%CI 1.109-1.901), infarct number, left and right side both being involved were the independent risk factors of PxAF in CS patients (P＜0.05). Conclusions：For CS patients with older age, higher NIHSS score on admission, higher STAF score, frequent atrial premature beats, larger left atrial dimension, more infarctions, left and right side both being involved, ECG detection time should be prolonged so as to detect PxAF timely.