冠心病患者并发缺血性脑卒中的影响因素及左心房大小对其的预测价值分析
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摘要
目的分析冠状动脉粥样硬化性心脏病(冠心病,CHD)患者伴发缺血性脑卒中的影响因素及左心房大小对其预测价值。方法于南石医院2013年6月至2017年6月收治的97例CHD患者作为研究对象,其中单纯CHD者为A组(46例),CHD伴发缺血性脑卒中者为B组(51例)。比较两组患者临床基线资料,采用Logistic回归分析影响CHD伴发缺血性脑卒中的相关因素,并通过绘制受试者工作特征(ROC)曲线以比较不同影响因素的预测价值。结果两组患者性别、吸烟史、用药状况、伴高脂血症史及糖尿病病史等基线资料的比较,均无明显差异(P均>0.05);B组患者年龄、颈动脉斑块发生率和伴有高血压病史较A组患者明显升高(P均<0.05)。两组患者左心室内径(LVD)的比较,无明显差异(P>0.05);但B组患者左心房内径(LAD)、左心房内径指数(LADi)较A组明显升高(P均<0.05),左心室射血分数(LVEF)较A组明显降低(P<0.05)。Logistic回归分析结果发现,颈动脉斑块、伴高血压病史、LAD和LADi均是CHD伴发缺血性脑卒中的影响因素(P均<0.05),其ROC曲线下面积分别为0.68、0.59、0.86、0.89。结论颈动脉斑块、伴高血压病史、LAD和LADi是影响CHD伴发缺血性脑卒中的相关因素,其中LAD和LADi的预测价值较高,临床可考虑将左心房大小纳入CHD伴发缺血性脑卒中的评估指标。
Objective To analyze the influencing factors in patients with coronary heart disease(CHD) and concomitant ischemic stroke and predictive value of left atrium size. Methods CHD patients(n=97) were chosen from Department of Cardiology of Nanshi Hospital of Nanyang City from June 2013 to June 2017. The patient with only CHD were chosen into group A(n=46) and those with CHD and concomitant ischemic stroke were chosen into group B(n=51). The clinical baseline data were compared in 2 groups. The relevant factors influencing CHD complicated by ischemic stroke were analyzed by using Logistic regression analysis. The predictive value of different influencing factors was compared through drawing receiver operating characteristic(ROC) curve.Results The comparisons in gender, smoking history, medication status, concomitant hyperlipidemia history and concomitant diabetes history had no significant differences between the two groups(all P>0.05). The age, carotid plaque incidence and concomitant hypertension history were significantly higher in group B than those in group A(all P<0.05). The comparison in left ventricular diameter(LVD) showed no significant difference between 2 groups(P>0.05). The left atrial diameter(LAD) and left atrial diameter index(LADi) increased significantly(all P<0.05),and left ventricular ejection fraction(LVEF) decreased significantly(P<0.05) in group B compared with group A.The results of Logistic regression analysis showed that carotid plaque, concomitant hypertension history, LAD and LADi were influencing factors of CHD with concomitant ischemia stroke(all P<0.05), and the area under ROC curve was 0.68, 0.59, 0.86 and 0.89 respectively. Conclusion Carotid plaque, concomitant hypertension history, LAD and LADi are influence factors of CHD with concomitant ischemic stroke, and LAD and LADi with higher predictive value. So the left ventricular size can be considered to be included in review indexes of CHD with concomitant ischemic stroke in clinical practice.
Objective To analyze the influencing factors in patients with coronary heart disease(CHD) and concomitant ischemic stroke and predictive value of left atrium size. Methods CHD patients(n=97) were chosen from Department of Cardiology of Nanshi Hospital of Nanyang City from June 2013 to June 2017. The patient with only CHD were chosen into group A(n=46) and those with CHD and concomitant ischemic stroke were chosen into group B(n=51). The clinical baseline data were compared in 2 groups. The relevant factors influencing CHD complicated by ischemic stroke were analyzed by using Logistic regression analysis. The predictive value of different influencing factors was compared through drawing receiver operating characteristic(ROC) curve.Results The comparisons in gender, smoking history, medication status, concomitant hyperlipidemia history and concomitant diabetes history had no significant differences between the two groups(all P>0.05). The age, carotid plaque incidence and concomitant hypertension history were significantly higher in group B than those in group A(all P<0.05). The comparison in left ventricular diameter(LVD) showed no significant difference between 2 groups(P>0.05). The left atrial diameter(LAD) and left atrial diameter index(LADi) increased significantly(all P<0.05),and left ventricular ejection fraction(LVEF) decreased significantly(P<0.05) in group B compared with group A.The results of Logistic regression analysis showed that carotid plaque, concomitant hypertension history, LAD and LADi were influencing factors of CHD with concomitant ischemia stroke(all P<0.05), and the area under ROC curve was 0.68, 0.59, 0.86 and 0.89 respectively. Conclusion Carotid plaque, concomitant hypertension history, LAD and LADi are influence factors of CHD with concomitant ischemic stroke, and LAD and LADi with higher predictive value. So the left ventricular size can be considered to be included in review indexes of CHD with concomitant ischemic stroke in clinical practice.
引文
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[13]许翔,王娟,高玮,等.上海地区老年人群缺血性心血管病的危险度与血脂、血糖相关性[J].中国老年学杂志,2013,33(7):1639-40.
[14]杜永东.冠心病住院患者生活质量及其影响因素研究[J].中国卫生统计,2017,34(2):307-8,311.
[15]Muntner P,Colantonio LD,Cushman M,et al.Validation of the atherosclerotic cardiovascular disease Pooled Cohort risk equations[J].JAMA,2014,311(14):1406-15.
[2]饶杰,邱伟文,程伟进,等.缺血性脑卒中急性期纤维蛋白原水平与1年死亡风险的相关性[J].心脑血管病防治,2016,16(3):212-4,220.
[3]张巨荣.早发冠心病的影响因素研究[J].现代预防医学,2014,41(14):2521-2,2543.
[4]Mozaffarian D,Benjamin EJ,Go AS,et al.Executive summary:heart disease and stroke statistics-2016 update:a report from the American Heart Association[J].Circulation,2016,133(4):447-54.
[5]赵阳,郑辑英.进展性缺血性脑卒中危险因素的临床研究[J].中西医结合心脑血管病杂志,2016,14(8):820-4.
[6]Dichgans M,Malik R,K?nig IR,et al.Shared genetic susceptibility to ischemic stroke and coronary artery disease[J].Stroke,2014,45(1):24-36.
[7]孙勇,李辉明,王立强,等.CTA下颈动脉斑块负荷与前循环缺血性脑卒中远期复发事件的相关性研究[J].心脑血管病防治,2016,16(3):184-6.
[8]张小曼,石红丽,胡惠惠,等.中青年冠心病患者自我管理状况及其影响因素研究[J].中国实用护理杂志,2013,29(12):45-7.
[9]刘湘华,张瑶,唐铭翔,等.老年冠心病的影响因素研究[J].实用心脑肺血管病杂志,2016,24(10):27-9.
[10]Kivim?ki M,Jokela M,Nyberg ST,et al.Long working hours and risk of coronary heart disease and stroke:a systematic review and meta-analysis of published and unpublished data for 603 838individuals[J].Lancet,2015,386(10005):1739-46.
[11]Nichols M,Townsend N,Scarborough P,et al.Cardiovascular disease in Europe 2014:epidemiological update[J].Eur Heart J,2014,35(42):2950-9.
[12]郭素箴,田云鹏,菅练,等.70岁以上伴缺血性脑卒中的急性冠状动脉综合征患者介入治疗的临床研究[J].中华老年心脑血管病杂志,2014,16(3):315-6.
[13]许翔,王娟,高玮,等.上海地区老年人群缺血性心血管病的危险度与血脂、血糖相关性[J].中国老年学杂志,2013,33(7):1639-40.
[14]杜永东.冠心病住院患者生活质量及其影响因素研究[J].中国卫生统计,2017,34(2):307-8,311.
[15]Muntner P,Colantonio LD,Cushman M,et al.Validation of the atherosclerotic cardiovascular disease Pooled Cohort risk equations[J].JAMA,2014,311(14):1406-15.