Relationships between Large Artery Atherosclerotic Stroke and Cardiac Function
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摘要:
目的 分析主动脉弓粥样硬化性脑卒中与颅内外动脉粥样硬化性脑卒中心脏功能的区别，探讨心脏功能对大动脉粥样硬化性脑卒中预后的影响。 方法 选取2014年1月至2017年10月在解放军联勤保障部队第920医院住院的首次急性缺血性脑卒中患者共846例，其中符合中国缺血性卒中亚型分型的大动脉粥样硬化患者552例，分为颅内外动脉粥样硬化组507例，主动脉弓粥样硬化组45例。分析主动脉弓粥样硬化性脑卒中与颅内外动脉粥样硬化性脑卒中心脏功能的区别，采用多因素回归分析心脏功能对卒中30 d预后的影响。 结果 （1）主动脉弓粥样硬化组患者左室射血分数[（55.14±9.41） vs （62.99±10.44），P < 0.001]、左室缩短率（中位数 28.00 vs 35.00，P < 0.001）低于颅内外动脉粥样硬化组；主动脉弓粥样硬化组患者收缩末期容量大于颅内外动脉粥样硬化组（中位数 45.00 vs 36.00，P = 0.001）；（2）大动脉粥样硬化性脑卒中患者，每搏输出量降低（OR = 0.968，95%CI：0.951～0.985）、冠心病（OR = 2.063，95%CI：1.050～4.055）增加30 d残疾风险；心输出量增加（HR = 1.582，95%CI：1.170～2.139）、高尿酸血症（HR = 5.411，95%CI：1.265～23.153）、年龄（HR = 1.104，95%CI：1.023～1.192）增加30 d死亡风险。 结论 主动脉弓粥样硬化性脑卒中患者心脏收缩功能比颅内外动脉粥样硬化性脑卒中患者差。大动脉粥样硬化性脑卒中患者，冠心病、每搏输出量降低与30 d残疾独立相关；心输出量增加、年龄、高尿酸血症与30d死亡独立相关。 -
关键词:
- 大动脉粥样硬化性脑卒中 /
- 心脏功能 /
- 残疾 /
- 死亡
Abstract:Objective To analyze the difference in cardiac function between intracranial and extracranial atherosclerotic stroke and aortic arch atherosclerotic stroke, so as to investigate the effect of cardiac function on the prognosis of large artery atherosclerotic stroke. Methods A total of 846 patients with first-ever acute ischemic stroke from January 2014 to October 2017 in 920th Hospital of People’s Liberation Army, Logistics Support Force were selected. A total of 552 large artery atherosclerotic stroke patients who met the Chinese Ischemic Stroke Subclassification. Among these 507 were diagnosed with intracranial and extracranial atherosclerotic stroke and 45 were diagnosed with aortic arch atherosclerotic stroke. To analyze the difference in cardiac function between intracranial and extracranial atherosclerotic stroke and aortic arch atherosclerotic stroke. The multivariate regression analysis was used to analyze the effect of cardiac function on the 30-day prognosis of stroke. Results The LVEF and LVFS in the aortic arch atherosclerosis group were lower than those in the intracranial and extracranial atherosclerosis group. The ESV in patients with aortic arch atherosclerosis was greater than that in the intracranial and extracranial atherosclerosis groups. In patients with large artery atherosclerotic stroke, decreased SV and coronary atherosclerotic heart disease increased the risk of 30-day disability; increased CO, hyperuricemia and age increased the risk of 30-day death. Conclusions The cardiac systolic function of patients with aortic arch atherosclerotic stroke is worse than that of patients with intracranial and extracranial atherosclerotic stroke. In patients with large artery atherosclerotic stroke, the decrease of SV and coronary atherosclerotic heart disease is independently associated with the 30-day disability, the increase of CO, age and hyperuricemia are independently associated with the 30-day death. -
Key words:
- Large artery atherosclerotic stroke /
- Cardiac function /
- Disability /
- Death
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表 1 2组一般资料比较[（
$ \bar x \pm s $ ）/M（P25，P75）/n（%）]Table 1. Comparison of general data between two groups of patients [（
$ \bar x \pm s $ ）/M（P25，P75）/n（%）]项目 主动脉弓组（n = 45） 颅内外动脉组（n = 507） χ2/t/Z P 性别 0.092 0.762 男 31（68.90） 338（66.70） 女 14（31.10） 169（33.30） 年龄（岁） 65.56 ± 11.925 65.67 ± 12.927 0.056 0.956 冠心病 9（20.00） 101（19.90） 0.000 0.990 高血压 39（86.70） 385（75.90） 2.672 0.102 糖尿病 13（28.90） 144（28.40） 0.005 0.945 高脂血症 23（51.10） 211（41.60） 1.525 0.217 高尿酸血症 19（42.20） 132（26.00） 5.449 0.020* 高同型半胱氨酸血症 18（40.00） 226（44.60） 0.351 0.554 吸烟 14（31.10） 128（25.20） 0.744 0.388 饮酒 8（17.80） 76（15.00） 0.249 0.618 入院时NIHSS评分 3.00（2.00，5.00） 4.00（3.00，7.00） -1.937 0.053 出院时NIHSS评分 2.00（1.00，4.00） 3.00（2.00，5.00） -1.363 0.173 *P < 0.05。 
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表 2 2组心脏功能比较[（
$ \bar x \pm s $ ）/M（P25，P75）]Table 2. Comparison of cardiac function beween two groups of patients [（
$ \bar x \pm s $ ）/M（P25，P75）]项目 主动脉弓组（n = 45） 颅内外动脉组（n = 507） t/Z P 左室射血分数 55.14 ± 9.41 62.99 ± 10.44 4.864 < 0.001* 舒张末期容量 108.00（88.80，129.00） 103.00（81.00，127.00） −1.285 0.199 收缩末期容量 45.00（38.75，56.50） 36.00（25.00，53.00） −3.351 0.001* 每搏输出量 63.60（49.50，71.00） 64.00（52.00，78.00） −1.048 0.295 左室缩短率 28.00（25.00，30.75） 35.00（29.00，41.00） −4.926 < 0.001* 心输出量 4.42（3.07，5.26） 4.31（3.40，5.70） −0.327 0.744 心指数 3.00（2.14，3.65） 2.80（2.20，3.87） −0.486 0.627 E/A 0.70（0.63，0.80） 0.70（0.59，0.80） −0.396 0.692 注：E/A：二尖瓣舒张早期血流峰值速度/二尖瓣舒张晚期血流峰值速度。*P < 0.05。
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表 3 大动脉粥样硬化性脑卒中30 d残疾影响因素
Table 3. Influencing factors of the 30-day disability in patients with large artery atherosclerotic stroke
项目 B P OR（95%CI） SV −0.032 < 0.001* 0.968（0.951-0.985） 冠心病 0.724 0.036* 2.063（1.050-4.055） SV：每搏输出量。*P < 0.05。
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表 4 大动脉粥样硬化性脑卒中30 d死亡影响因素
Table 4. Influencing factors of the 30-day death in patients with large artery atherosclerotic stroke
项目 B P HR（95%CI） CO 0.459 0.003* 1.582（1.170-2.139） 年龄 0.099 0.011* 1.104（1.023-1.192） 高尿酸血症 1.688 0.023* 5.411（1.265-23.153） CO：心输出量。*P < 0.05。
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[1] Wu Q,Cui J,Xie Y,et al. Outcomes of ischemic stroke and associated factors among elderly patients with large-artery atherosclerosis:A hospital-based follow-up study in China[J]. Front Neurol,2021,12:642426. doi: 10.3389/fneur.2021.642426 [2] Gao S,Wang Y J,Xu A D,et al. Chinese ischemic stroke subclassification[J]. Front Neurol,2011,2(6):1-5. [3] Orgah J O,Yu J,Zhao T,et al. Danhong injection reversed cardiac abnormality in brain-heart syndrome via local and remote β-adrenergic receptor signaling[J]. Front Pharmacol,2018,9:692. doi: 10.3389/fphar.2018.00692 [4] Hatano S. Experience from a multicentre stroke register:A preliminary report[J]. Bull World Health Organ,1976,54(5):541-553. [5] Brott T,Adams H P Jr,Olinger C P,et al. Measurements of acute cerebral infarction:A clinical examination scale[J]. Stroke,1989,20(7):864-870. doi: 10.1161/01.STR.20.7.864 [6] Swieten J C,Koudstaal P J,Visser M C,et al. Interobserver agreement for the assessment of handicap in stroke patients[J]. Stroke,1988,19(5):604-607. doi: 10.1161/01.STR.19.5.604 [7] Yanai H,Adachi H,Hakoshima M,et al. Molecular biological and clinical understanding of the pathophysiology and treatments of hyperuricemia and its association with metabolic syndrome,cardiovascular diseases and chronic kidney disease[J]. Int J Mol Sci,2021,22(17):9221. doi: 10.3390/ijms22179221 [8] Erdogan D,Gullu H,Caliskan M,et al. Relationship of serum uric acid to measures of endothelial function and atherosclerosis in healthy adults[J]. Int J Clin Pract,2005,59(11):1276-1282. doi: 10.1111/j.1742-1241.2005.00621.x [9] Kaess B M,Rong J,Larson M G,et al. Aortic stiffness,blood pressure progression,and incident hypertension[J]. JAMA,2012,308(9):875-881. doi: 10.1001/2012.jama.10503 [10] 陈贺中. 动脉血液双层面流动假说[J]. 医学理论与实践,2005,18(11):6-7. doi: 10.19381/j.issn.1001-7585.2005.11.001 [11] Bhatia R,Sharma G,Patel C,et al. Coronary artery disease in patients with ischemic stroke and TIA[J]. J Stroke Cerebrovasc Dis,2019,28(12):104400. doi: 10.1016/j.jstrokecerebrovasdis.2019.104400 [12] Pagliaro B R,Cannata F,Stefanini G G,et al. Myocardial ischemia and coronary disease in heart failure[J]. Heart Fail Rev,2020,25(1):53-65. doi: 10.1007/s10741-019-09831-z [13] Zheng J,Heidenreich P A,Kohsaka S,et al. Variability in coronary artery disease testing for patients with new-onset heart failure[J]. J Am Coll Cardiol,2022,79(9):849-860. [14] 王红梅,张婷,陈静炯,等. 低T3水平与大动脉粥样硬化型脑梗死患者短期预后的关系[J]. 临床荟萃,2020,35(6):517-520. doi: 10.3969/j.issn.1004-583X.2020.06.007 [15] 刘奕娴,王绮婧,刘星辰,等. 侧支循环对再灌注治疗后出血转化及短期预后的影响[J]. 中华神经医学杂志,2021,20(11):1108-1116. doi: 10.3760/cma.j.cn115354-20210805-00489 [16] Falsetti L,Viticchi G,Tarquinio N,et al. Charlson comorbidity index as a predictor of in-hospital death in acute ischemic stroke among very old patients:a single-cohort perspective study[J]. Neurol Sci,2016,37(9):1443-1448. doi: 10.1007/s10072-016-2602-1 [17] Padda J,Khalid K,Padda S,et al. Hyperuricemia and its association with ischemic stroke[J]. Cureus,2021,13(9):e18172. [18] Falsetti L,Capeci W,Tarquinio N,et al. Serum uric acid,kidney function and acute ischemic stroke outcomes in elderly patients:A single-cohort,perspective study[J]. Neurol Int,2017,9(1):6920. -
