作者：徐建昌，饶盼盼，王晞

单位：

武汉大学人民医院心内科武汉大学心血管病研究所心血管病湖北省重点实验室

单位（英文）：

Department of Cardiology, Renmin Hospital of Wuhan University/Cardiovascular Research Institute of Wuhan University/Hubei Key Laboratory of Cardiology;

关键词：

心房颤动; 非瓣膜性心房颤动; 脑卒中; 危险因素;

关键词（英文）：

Atrial fibrillation;Non-valvular atrial fibrillation;Stroke;Risk factors;

中图分类号：

DOI：

10.12114/j.issn.1008-5971.2022.00.333

基金项目：

国家自然科学基金资助项目（81772044）；

摘要：

目的 探讨非瓣膜性心房颤动（NVAF）患者发生急性缺血性脑卒中的危险因素。方法 回顾性选取2020年1月至2022年9月武汉大学人民医院收治的合并急性缺血性脑卒中的130例NVAF患者作为观察组，另选取同期就诊于本院的未合并急性缺血性脑卒中的178例NVAF患者作为对照组。收集患者的基线资料、实验室检查指标及超声心动图检查结果。NVAF患者发生急性缺血性脑卒中的影响因素分析采用多因素Logistic回归分析。绘制ROC曲线以评估CHA2DS2-VASc评分、中性粒细胞与淋巴细胞比值（NLR）、游离脂肪酸及其联合对NVAF患者发生急性缺血性脑卒中的诊断价值。结果 观察组患者年龄、红细胞分布宽度（RDW）大于对照组，高血压发生率、CHA2DS2-VASc评分、NLR、糖化白蛋白、游离脂肪酸、空腹血糖、补体C1q、纤维蛋白原高于对照组，活化部分凝血活酶时间短于对照组，左心室直径（LVD）小于对照组（P<0.05）。多因素Logistic回归分析结果显示，CHA2DS2-VASc评分、NLR、游离脂肪酸是NVAF患者发生缺血性脑卒中的独立影响因素（P<0.05）。ROC曲线分析结果显示，CHA2DS2-VASc评分、NLR、游离脂肪酸诊断NVAF患者发生急性缺血性脑卒中的AUC分别为0.814[95%CI(0.766,0.862)]、0.788[95%CI(0.736,0.839)]、0.769[95%CI(0.715,0.823)];CHA2DS2-VASc评分+NLR、CHA2DS2-VASc评分+游离脂肪酸、NLR+游离脂肪酸及三者联合诊断NVAF患者发生缺血性脑卒中的AUC分别为0.885[95%CI(0.847,0.924)]、0.872[95%CI(0.831,0.914)]、0.823[95%CI(0.777,0.870)]、0.898[95%CI(0.862,0.934)]。结论 CHA2DS2-VASc评分、NLR、游离脂肪酸升高是NVAF患者发生急性缺血性脑卒中的危险因素，且三者联合对NVAF患者发生急性缺血性脑卒中具有中等诊断价值。

英文摘要：

Objective To investigate the risk factors for acute ischemic stroke in patients with non-valvular atrial fibrillation（NVAF）. Methods A total of 130 NVAF patients with acute ischemic stroke admitted to Renmin Hospital of Wuhan University from January 2020 to September 2022 were retrospectively selected as the observation group, and 178 NVAF patients without acute ischemic stroke admitted to the same hospital during the same period were selected as the control group. The baseline data, laboratory examination indexes and echocardiography results were collected. Multivariate Logistic regression analysis was used to analyze the influencing factors of acute ischemic stroke in NVAF patients. ROC curve was drawn to evaluate the diagnostic value of CHA2DS2-VASc score, neutrophil to lymphocyte ratio（NLR）, free fatty acid and their combination for acute ischemic stroke in NVAF patients. Results The age, red cell distribution width（RDW） in the observation group were higher than those in the control group, the incidence of hypertension, CHA2DS2-VASc score, NLR, glycosylated albumin, free fatty acid, fasting blood glucose, complement C1q and fibrinogen were higher than those in the control group, and the activated partial thromboplastin time was shorter than that in the control group, left atrial diameter（LAD） in the observation group was less than that in the control group（P < 0.05）. Multivariate Logistic regression analysis showed that CHA2DS2-VASc score, NLR and free fatty acid were independent influencing factors of acute ischemic stroke in NVAF patients（P < 0.05）. ROC curve analysis showed that the AUC of CHA2DS2-VASc score, NLR and free fatty acid in the diagnosis of acute ischemic stroke in NVAF patients was 0.814 [95%CI（0.766, 0.862） ], 0.788 [95%CI（0.736, 0.839） ] and 0.769 [95%CI（0.715, 0.823） ], respectively. The AUC of CHA2DS2-VASc score+NLR, CHA2DS2-VASc score+free fatty acid, NLR+free fatty acid and the combination of the three in the diagnosis of acute ischemic stroke in NVAF patients was 0.885 [95%CI（0.847, 0.924） ], 0.872 [95%CI（0.831, 0.914） ], 0.823 [95%CI（0.777, 0.870） ], 0.898 [95%CI（0.862, 0.934） ], respectively. Conclusion The elevated CHA2DS2-VASc score, elevated NLR, and elevated free fatty acids are risk factors for acute ischemic stroke in NVAF patients, and the combination of the three had moderate diagnostic value for acute ischemic stroke in NVAF patients.

参考文献：