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P波指数与阵发性心房颤动合并缺血性脑卒中的相关性研究

Correlation between P-wave indices and paroxysmal atrial fibrillation with ischemic stroke

摘要:

目的:探讨P波指数与阵发性心房颤动(房颤)合并缺血性脑卒中的相关性。方法:收集2017年1月至2019年10月临床资料完整的阵发性房颤患者141例,根据是否合并缺血性脑卒中分为对照组(无脑梗死)55例、合并腔隙性脑梗死(腔梗)组37例、合并急性脑梗死组49例,急性脑梗死组中有41例患者在急性脑梗死前有心电图记录。比较阵发性房颤患者发生急性脑梗死前后P波时限、V 1导联P波终末电势(PTFV 1)及P波电轴差异及3组间P波时限、PTFV 1及P波电轴差异。 结果:阵发性房颤患者发生急性脑梗死后P波时限较急性脑梗死前显著延长[(122.80±12.40) ms对(109.53±12.32) ms, P<0.001]。P波时限延长为阵发性房颤合并腔梗的独立危险因素( OR=1.090,95% CI 1.039~1.142, P<0.001);P波时限延长为阵发性房颤合并急性脑梗死的独立危险因素( OR=1.129,95% CI 1.066~1.196, P<0.001);PTFV 1为阵发性房颤合并急性脑梗死的独立危险因素( OR=1.090,95% CI 1.042~1.140, P<0.001)。P波时限以112.0 ms为截断点预测阵发性房颤合并腔梗的曲线下面积(AUC)为0.722,敏感性为80.8%,特异性为57.9%;P波时限以118.5 ms为截断点预测阵发性房颤合并急性脑梗死的AUC为0.852,敏感性为81.6%,特异性为81.8%;PTFV 1以40.55 mm·ms为截断点预测阵发性房颤合并急性脑梗死的AUC为0.833,敏感性为81.6%,特异性为71.5%。 结论:窦性心律P波增宽提示阵发性房颤患者可能容易并发腔梗和急性脑梗死,PTFV 1值增大提示阵发性房颤患者可能容易并发急性脑梗死。

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abstracts:

Objective:To investigate the correlation between P wave indices and paroxysmal atrial fibrillation (PAF) with ischemic stroke.Methods:One hundred and forty-one PAF patients with complete clinical data were enrolled from January 2017 to October 2019. They were divided into control group (without cerebral infarction, n=55) , PAF with lacuna infarction group ( n=37) and PAF with acute cerebral infarction group ( n=49) . In the acute cerebral infarction group, electrocardiogram was recorded in 41 cases before acute cerebral infarction. The P-wave duration, PTFV 1, P-wave axis were compared before and after acute cerebral infarction in PAF patients. The P-wave duration, PTFV 1 and P-wave axis were compared among the three groups. Results:In patients with PAF, the P wave duration after acute cerebral infarction was significantly longer than that before acute cerebral infarction[ (122.80±12.40) ms vs. (109.53±12.32) ms, P<0.001]. P-wave duration was an independent risk factor for PAF with lacuna infarction ( OR=1.090, 95% CI 1.039-1.142, P<0.001, ) ; P-wave duration was an independent risk factor for PAF with acute cerebral infarction ( OR=1.129, 95% CI 1.066-1.196, P<0.001) . PTFV 1 was an independent risk factor for PAF with acute cerebral infarction ( OR=1.090, 95% CI 1.042-1.140, P<0.001) . The area under curve (AUC) of P-wave duration in predicting PAF with lacuna infarction and PAF with acute cerebral infarction was 0.722 and 0.852. The sensitivity was 80.8% and 81.6%. The specificity was 57.9% and 81.8%, and the cut-off points were 112.0 ms and 118.5 ms, respectively. PTFV 1 predicted AUC of PAF with acute cerebral infarction was 0.833, cut-off point was 40.55 mm·ms, sensitivity was 81.6%, and specificity was 71.5%. Conclusion:Sinus rhythm P-wave duration prolongation and suggests that patients with PAF may be prone to complicated with lacuna infarction and acute cerebral infarction. Increased PTFV 1 suggests that patients with PAF may be prone to acute cerebral infarction.

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作者: 陶依娆 [1] 李芳 [1] 杨岩 [1] 张钧博 [1] 杜婕 [1] 许振 [1] 赵云飞 [1] 杨东辉 [1]
栏目名称: 临床研究
DOI: 10.3760/cma.j.cn.113859-20191212-00250
发布时间: 2024-03-19
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