刘颖娴,廉慧,李剑,沈恺妮,陈未,林雪,方理刚

• 1:中国医学科学院北京协和医学院北京协和医院心内科
• 2:中国医学科学院北京协和医学院北京协和医院血液科

摘要(Abstract)：

目的探讨心脏淀粉样变性(CA)合并脑梗死患者的临床特征及预后。方法收集2010年1月至2017年1月在北京协和医院住院的46例CA患者,其中23例合并脑梗死为观察组(脑梗死组),其他为对照组(无脑梗死组)。结果 46例CA患者年龄57.0(51.5,64.0)岁,其中男性26例(56.5%),淀粉样轻链蛋白型淀粉样变性32例(69.7%),合并心房颤动/心房扑动/房性心动过速18例(39.1%),限制型心肌病14例(30.4%)。脑梗死组患者收缩压[(98.4±23.9)mm Hg比(121.7±19.2)mm Hg(1 mmHg=0.133 kPa),P=0.014]、κ型游离轻链(3/23比14/23,P=0.010)显著低于无脑梗死组,而沙利度胺(16/23比7/23,P=0.042)、螺内酯(15/23比5/23,P=0.026)及袢利尿药(19/23比9/23,P=0.035)显著高于无脑梗死组,差异均有统计学意义。46例患者随访10.5(3.0,30.8)个月,死亡26例(56.5%),其中脑梗死组21例。Cox多因素回归分析显示,脑梗死(OR12.7,95%CI 2.6～62.8,P=0.002)为全因死亡的独立预测因子,而口服抗凝药物(OR 0.3,95%CI0.1～0.9,P=0.036)则能显著降低全因死亡率。Kaplan-Meier生存分析示脑梗死组1、5、10年生存率为(91.3±5.9)%、(78.3±8.6)%及(47.8±10.4)%,脑梗死组生存率及生存时间显著低于无脑梗死组(Log-Rankχ2=22.8,P<0.001)。结论低灌注压、心房颤动、左心室腔大、左心功能下降、服用沙利度胺是CA合并脑梗死的可能易感因素。脑梗死增加CA的全因死亡风险。

关键词(KeyWords)： 淀粉样变性;心力衰竭;心肌病;脑梗死

Abstract:

Keywords:

基金项目(Foundation):

作者(Author): 刘颖娴,廉慧,李剑,沈恺妮,陈未,林雪,方理刚

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