蔡家晟,张佑俊,曲新凯

• 1:复旦大学附属华东医院心内科

摘要(Abstract)：

目的分析高龄非瓣膜性心房颤动(NVAF)患者发生缺血性卒中(IS)的临床特点。方法收集2016年1月至2020年1月复旦大学附属华东医院住院的高龄NVAF患者158例,根据是否发生IS,分为单纯NVAF组77例,NVAF+IS组81例,对两组的临床特征、超声心动图、实验室资料及治疗现状进行比较,随访患者1年内预后状况。结果 NVAF+IS组的年龄[85.00(82.00,89.50)岁比84.00(81.00,87.00)岁,P=0.009],非阵发性心房颤动(77.78%比46.75%,P<0.001)、高血压病(77.78%比62.34%,P=0.034)、糖尿病(34.57%比19.48%,P=0.033)、外周血管疾病(14.81%比5.19%,P=0.045)、D-二聚体>0.55 mg/L(81.48%比58.44%,P=0.002)、纤维蛋白原>4.0 g/L (38.27%比18.18%,P=0.004)所占比例及CHA_2DS_2-VASc评分[5(4.00,6.00)分比4(4.00,6.00)分,P=0.010]均明显高于单纯NVAF组,他汀类药物服用率(8.64%比23.38%,P=0.011)及抗凝药物服用率(6.17%比16.88%,P=0.034)均明显低于单纯NVAF组,差异均有统计学意义。Logistic多因素回归分析显示,非阵发性心房颤动(95%CI 2.273～15.585,P<0.001)、外周血管疾病(95%CI 1.225～23.402,P=0.026)、纤维蛋白原>4.0 g/L(95%CI 1.202～9.635,P=0.021)、D-二聚体>0.55 mg/L(95%CI 1.057～1.888,P=0.020)、抗凝药物(95%CI 0.007～0.327,P=0.002)及他汀类药物(95%CI 0.077～0.986,P=0.048)与高龄NVAF患者发生IS显著相关。抗凝治疗可降低卒中复发率。结论非阵发性心房颤动、外周血管疾病、纤维蛋白原、D-二聚体、抗凝及他汀类药物服用率低均与高龄NVAF患者发生IS相关,IS发病时病情重,抗凝治疗可降低卒中复发风险。

关键词(KeyWords)： 高龄;非瓣膜性心房颤动;缺血性卒中;抗凝治疗

Abstract:

Keywords:

基金项目(Foundation):

作者(Author): 蔡家晟,张佑俊,曲新凯

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