作者：刘仲仲，逯青丽，曹欢，王静，蔺雪梅，王芳，史亚玲，王清，刘国正，吴松笛

单位：

710002 陕西省西安市第一医院神经内科；通信作者：吴松笛，E-mail：wusongdi@gmail.com

单位（英文）：

Department of Neurology，the First Hospital of Xi'an，Xi'an 710002，China；Corresponding author：WU Songdi，E-mail：wusongdi@gmail.com

关键词：

脑梗死；心房颤动；预后；危险因素；影响因素分析；西安

关键词（英文）：

Brain infarction；Atrial fibrillation；Prognosis；Risk factors；Root cause analysis；Xi'an

中图分类号：

R 743.33　R 541.75

DOI：

DOI：10.3969/j.issn.1008-5971.2020.01.y07

基金项目：

陕西省重点研发计划项目（2017SF-163）；西安市科技计划项目〔201805104YX12SF38（2）〕

摘要：

背景　急性脑梗死合并心房颤动（AF）患者的临床特征及预后因地理环境、饮食习惯、经济发展水平等差异而不尽相同。目的　探讨西安地区急性脑梗死合并 AF 患者短期预后的影响因素。方法　通过西安脑卒中数据库纳入西安市第一医院、西安市中心医院、西安市第九医院和西安市中医医院 2015 年收治的急性脑梗死合并 AF 患者260例，根据随访90 d后改良Rankin量表（mRS）评分分为预后良好组（mRS评分0~2分）155例和预后不良组（mRS评分 3~6 分）105 例。比较两组患者临床特征，急性脑梗死合并 AF 患者短期预后影响因素分析采用多因素 Logistic 回归分析。结果　（1）预后不良组患者糖尿病发生率、肺炎发生率、入院时 NIHSS 评分 4~13 分及≥ 14 分者所占比例、白细胞计数高于预后良好组（P<0.05）；两组患者年龄、性别、体质指数、心率、文化程度、吸烟情况、饮酒率、有卒中病史者所占比例、高血压发生率及总胆固醇、三酰甘油、高密度脂蛋白、低密度脂蛋白、空腹血糖、丙氨酸氨基转移酶、天冬氨酸氨基转移酶、碱性磷酸酶、同型半胱氨酸、肌酐、尿素氮、尿酸水平比较，差异无统计学意义（P>0.05）。（2）多因素 Logistic 回归分析结果显示，糖尿病〔OR=2.47，95%CI（1.10，6.18）〕、肺炎〔OR=3.28，95%CI（1.17，9.22）〕、入院时 NIHSS 评分高〔OR=18.36，95%CI（4.93，72.74）〕及白细胞计数升高〔OR=1.12，95%CI（1.02，1.30）〕是西安地区急性脑梗死合并 AF 患者短期预后不良的独立危险因素（P<0.05）。结论　糖尿病、肺炎、入院时 NIHSS 评分高及白细胞计数升高是西安地区急性脑梗死合并 AF 患者短期预后不良的独立危险因素，临床应及早识别、筛查高危人群并给予有针对性的预防和干预措施，以降低患者短期预后不良发生风险。

英文摘要：

Background　Clinical characteristics and prognosis of acute cerebral infarction patients merged withatrial fibrillation（AF）may be different because of the differences in geographical environment，dietary habits，economicdevelopment level and so on. Objective　To investigate influencing factors for short-term prognosis of acute cerebral infarctionpatients merged with AF in Xi'an. Methods　A total of 260 acute cerebral infarction patients merged with AF who admittedto hospital in 2015 were enrolled according to Xi'an Stroke Data Bank，involved below four hospitals：the First Hospital ofXi'an，Xi'an Central Hospital，the Ninth Hospital of Xi'an and Xi'an Traditional Chinese Medicine Hospital. All of the260 patients were divided into good prognosis group（with mRS score ranged from 0 to 2，n=155）and poor prognosis group（with mRS score ranged from 3 to 6，n=105）according to the mRS score 90 days after followed-up. Clinical characteristicswere compared between the two groups，and influencing factors of short-term prognosis in acute cerebral infarction patientsmerged with AF were analyzed by multivariate Logistic regression analysis. Results　（1）Incidence of diabetes mellitus andpneumonia，proportion of patients with NIHSS score 4-13 and ≥ 14 at admission，and WBC in poor prognosis group werestatistically significantly higher than those in good prognosis group（P<0.05）；no statistically significant difference of age，gender，BMI，heart rate，educational level，smoking status，drinking rate，proportion of patients with stroke history，incidence of hypertension，TC，TG，HDL，LDL，FBG，ALT，AST，ALP，homocysteine，Cr，BUA or UA wasfound between the two groups（P>0.05）.（2）Multivariate Logistic regression analysis results showed that，diabetesmellitus〔OR=2.47，95%CI（1.10，6.18）〕，pneumonia〔OR=3.28，95%CI（1.17，9.22）〕，elevated NIHSS scoreat admission〔OR=18.36，95%CI（4.93，72.74）〕and elevation of WBC〔OR=1.12，95%CI（1.02，1.30）〕wereindependent risk factors of short-term poor prognosis in acute cerebral infarction patients merged AF in Xi'an（P<0.05）.Conclusion　Diabetes mellitus，pneumonia，elevated NIHSS score at admission and elevation of WBC are independent riskfactors of short-term poor prognosis in acute cerebral infarction patients merged with AF in Xi'an，thus we should early identify andscreen high-risk patients to conduct well-directed prevention and interventions，to reduce the risk of short-term poor prognosis.

参考文献：