摘要
目的分析左心室局部室壁异常与脑梗死复发的相关性。方法选择2017年1—10月收治的脑梗死215例,入院后均予相应治疗,随访18个月,根据脑梗死有无复发,分为脑梗死复发组(复发组,n=50)与脑梗死未复发组(未复发组,n=165)。所有患者均于确诊脑梗死24 h内行超声心动图检查,并检测脑利钠肽(brain natriuretic peptide,BNP)、血压及血生化相关指标水平,分析影响脑梗死复发的相关因素。结果与未复发组比较,复发组收缩压、舒张压、甘油三酯、低密度脂蛋白胆固醇水平显著升高,BNP、左心室心肌重量指数水平上升,左心室后壁厚度、室间隔厚度及主动脉根部内径增大,每搏输出量、心输出量、左心室射血分数及二尖瓣口舒张早期血流峰值速度与二尖瓣口舒张晚期血流峰值速度的比值降低,且BNP水平上升、左心室后壁增厚、室间隔增厚的发生率升高,差异有统计学意义(P<0.05或P<0.01)。多因素logistic回归分析显示,BNP水平上升、左心室后壁增厚、室间隔增厚是脑梗死复发的独立危险因素(P<0.01)。受试者工作特征曲线分析显示,室间隔厚度预测脑梗死复发的曲线下面积最大、敏感度最高,左心室后壁厚度预测脑梗死复发的特异度最高。结论左心室局部室壁异常与脑梗死复发关系密切,可将左心室后壁厚度、室间隔厚度作为脑梗死复发的预测指标。
Objective To analyze the correlation between left ventricular regional wall motion abnormality(RWMA)and recurrence of cerebral infarction(CI).Methods A total of 215 patients with CI treated between January and October 2017 were selected.All of them were given corresponding treatment after admission and followed up for 18 months.According to presence or absence of recurrence of CI,the subjects were divided into CI recurrence group(recurrence group,n=50)and CI non-recurrence group(non-recurrence group,n=165).Echocardiography was performed within 24h after confirmed diagnosis of CI.Brain natriuretic peptide(BNP),blood pressure and blood biochemical indicators were recorded,and related factors affecting the recurrence of CI were analyzed.Results Compared with the non-recurrence group,the systolic blood pressure,diastolic blood pressure,levels of triglyceride and low density lipoprotein cholesterol in recurrence group were significantly higher.BNP and left ventricular myocardial mass index were increased,and thickness of left ventricular posterior wall(LVPW),ventricular septal thickness and aortic root diameter in recurrence group were significantly larger.The stroke volume,cardiac output,left ventricular ejection fraction and ratio of early diastolic transmitral velocity to early mitral anulus diastolic velocity in recurrence group were significantly lower.The incidence rates of increased BNP level,thickened LVPW and thickened ventricular septal thickness in recurrence group were significantly lower(P<0.05 or P<0.01).Multivariate logistic regression analysis showed that increased BNP level,thickened LVPW and increased ventricular septal thickness were independent risk factors of recurrent CI(P<0.01).ROC curve analysis showed that the area under the curve and sensitivity of ventricular septal thickness in predicting recurrent CI were the largest or the highest,and the specificity of LVPW was the highest.Conclusion The left ventricular RWMA is closely related to the recurrence of CI.The thickness of LVPW,ventricular septal thickness can be used as predictors of recurrence of CI.
作者
李宝芸
马成龙
王鹏
李少辉
LI Bao-yun;MA Cheng-long;WANG Peng;LI Shao-hui(Department of Function,Baoji Central Hospital,Baoji,Shaanxi 721008,China;Intensive Care Unit,Hanzhong People's Hospital,Hanzhong,Shaanxi 723000,China)
出处
《临床误诊误治》
2020年第3期107-111,共5页
Clinical Misdiagnosis & Mistherapy
基金
陕西省社会发展科技攻关项目(2015SF056)。
关键词
脑梗死
疾病复发
左心室心肌重量指数
每搏输出量
利钠肽
脑
室间隔
Cerebral infarction
Recurrence
Left ventricular myocardial mass index
Stroke volume
Natriuretic peptide
brain
Ventricular septum
