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.
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.