心电图非特异性ST-T异常与急性缺血性脑卒中复发的相关性

doi:10.3969/j.issn.1004-583X.2023.10.003

摘要/Abstract

摘要： 目的心电图非特异性ST-T异常NSSTTAs常见于无症状人群,为缺血性脑卒中的危险因素。本研究旨在探索心电图非特异性ST-T异常对于急性缺血性脑卒中患者复发的相关性。方法本研究纳入北京清华长庚医院2016年12月-2017年8月急诊入院及2019年8月-2020年4月收入病房的急性缺血性脑卒中患者,对入组患者进行电话/门诊随访;以1年内缺血性脑卒中复发为终点指标;根据复发情况分为复发组和非复发组,分别对两组患者进行单因素及多因素分析明确NSSTTAs对于急性缺血性脑卒中复发的相关性。结果本研究共纳入197例患者,平均年龄(66.4±11.4)岁,女性54例(27.4%);根据是否在1年内复发,分为复发组及非复发组;其中, 22例(11.2%)患者复发;78例(39.5%)存在NSSTTAs,复发组具有吸烟史的比例大于非复发组(72.7% vs 50.3%, P=0.047); 复发组具有NSSTTAs的比例大于非复发组(63.6% vs 36.6%, P=0.014);矫正吸烟、高同型半胱氨酸血症、高脂血症后,NSSTTAS(OR=2.847,95%CI:1.110~7.305,P=0.030)为缺血性脑卒中患者复发的独立危险因素。结论 NSSTTAs在急性缺血性脑卒中常见,可能是急性缺血性脑卒中复发的预测因子。

关键词: 缺血性脑卒中, 心电图, ST-T段, 复发

Abstract: Objective Non-specific ST-T abnormalities (NSSTTAs) in electrocardiogram are common in asymptomatic people, which are risk factors for ischemic stroke. This study aims to investigate the correlation between NSSTTAs in electrocardiogram and recurrence of acute ischemic stroke. Methods Patients with acute ischemic stroke admitted to Department of Emergency, Beijing Tsinghua Changgung Hospital from December 2016 to August 2017 and hospitalized from August 2019 to April 2020 were included in this study, and the telephone / outpatient follow-up was performed. Recurrence of ischemic stroke within one year was the endpoint. According to the recurrence, patients were divided into recurrent group and non-recurrent group. Univariate and multivariate analyses were performed on the two groups to determine the correlation between NSSTTAs and recurrence of acute ischemic stroke. Results A total of 197 patients were included in this study, with the mean age of (66.4±11.4) years. Among them, 27.4% (54/197) were female. They were divided into recurrent group and non-recurrent group according to the 1-year recurrence, involving 11.2%(22/197) relapsed patients and 39.5% (78/197) with NSSTTAs. The proportion of patients with a history of smoking in the recurrent group was significantly higher than that of the non-recurrent group (72.7% vs 50.3%, P=0.047) and that with NSSTTAs in the recurrent group was significantly higher than the non-recurrent group (63.6% vs 36.6%, P=0.014). NSSTTAs (OR=2.847, 95%CI: 1.110-7.305, P=0.030) were the independent risk factor for recurrent ischemic stroke patients after adjustmnet for smoking, hyperhomocysteinemia and hyperlipemia. Conclusion NSSTTAs are common in patients with acute ischemic stroke. Patients with acute ischemic stroke and NSSTTAs may have a higher risk of recurrence.

Key words: ischemic stroke, electrocardiographic, non-specific ST-T abnormalities, recurrence

中图分类号:

R743.3

徐文灯, 沈懿, 张小峰. 心电图非特异性ST-T异常与急性缺血性脑卒中复发的相关性[J]. 临床荟萃, 2023, 38(10): 883-886.

Xu Wendeng, Shen Yi, Zhang Xiaofeng. Correlation between nonspecific ST-T abnormalities in electrocardiogram and recurrence of acute ischemic stroke[J]. Clinical Focus, 2023, 38(10): 883-886.

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链接本文: https://huicui.hebmu.edu.cn/CN/10.3969/j.issn.1004-583X.2023.10.003

https://huicui.hebmu.edu.cn/CN/Y2023/V38/I10/883

图/表 3

表1 两组基线资料比较

Tab. 1 Comparison of baseline data between groups

项目	总数 (n=197)	复发组 (n=22)	非复发组 (n=175)	统计值	P值
年龄(岁,$bar{x}$±s)	66.4±11.4	66.0±11.7	69.2±8.4	t=-1.23	0.220
女性[例(%)]	54(27.4)	4(18.2)	50(28.6)		0.447^*
高血压[例(%)]	146(74.1)	18(81.8)	128(73.1)	χ²=0.76	0.381
糖尿病[例(%)]	65(33.0)	10(45.5)	55(31.4)	χ²=1.74	0.187
高脂血症[例(%)]	107(54.3)	14(63.6)	93(53.1)	χ²=0.86	0.352
肾功能不全[例(%)]	21(10.7)	2(9.1)	19(10.9)		1.000^*
脑血管病家族史[例(%)]	38(19.3)	4(18.2)	34(19.4)		1.000^*
高同型半胱氨酸血症[例(%)]	94(47.7)	14(63.6)	80(45.7)	χ²=2.51	0.113
房颤[例(%)]	15(7.6)	3(13.6)	12(6.9)		0.258^*
吸烟史[例(%)]	104(52.8)	16(72.7)	88(50.3)	χ²=3.94	0.047
饮酒史[例(%)]	58(29.4)	6(27.3)	52(29.7)	χ²=0.56	0.813
NSSTTAs[例(%)]	78(39.5)	14(63.6)	64(36.6)	χ²=5.98	0.014

表2 缺血性脑卒中患者复发的多变量逻辑回归分析

Tab. 2 Multivariate logistic regression analysis of recurrence in patients with ischemic stroke

项目	回归系数	标准误	Wald χ²值	OR值	95%CI	P值
糖尿病	0.714	0.477	2.239	2.042	0.802~5.202	0.135
高同型半胱氨酸血症	0.636	0.484	1.728	1.889	0.732~4.876	0.189
吸烟	0.904	0.515	3.079	2.470	0.900~6.782	2.470
NSSTTAs	1.046	0.481	4.737	2.847	1.110~7.305	0.030

表3 NSSTTAs的相关性因素分析

Tab. 3 Analysis of correlation factors of NSSTTAs

项目	NSSTTAs组 ( $n$ =78)	非NSSTTAs组 ( $n$ =119)	统计值	P值
年龄(岁,$bar{x}$±s)	66.1±11.4	66.7±11.7	$t$ =0.350	0.723
女性[例(%)]	20(25.6)	34(28.6)	χ²=20.200	0.652
高血压[例(%)]	59(75.6)	87(73.1)	χ²=0.760	0.381
糖尿病[例(%)]	25(33.6)	40(32.1)	χ²=0.050	0.820
高脂血症[例(%)]	43(55.1)	64(53.8)	χ²=0.030	0.853
肾功能不全[例(%)]	10(12.8)	11(9.2)	χ²=0.630	0.426
脑血管病家族史[例(%)]	13(16.7)	25(21.0)	χ²=0.570	0.450
高同型半胱氨酸血症[例(%)]	41(52.6)	53(44.5)	χ²=1.210	0.270
房颤[例(%)]	6(7.7)	9(7.6)	χ²=0.000	0.973
吸烟史[例(%)]	45(57.7)	59(49.6)	χ²=1.240	0.265
饮酒史[例(%)]	26(33.3)	32(26.9)	χ²=0.940	0.332

表3 NSSTTAs的相关性因素分析

Tab. 3 Analysis of correlation factors of NSSTTAs

项目	NSSTTAs组 ( $n$ =78)	非NSSTTAs组 ( $n$ =119)	统计值	P值
年龄(岁,$bar{x}$±s)	66.1±11.4	66.7±11.7	$t$ =0.350	0.723
女性[例(%)]	20(25.6)	34(28.6)	χ²=20.200	0.652
高血压[例(%)]	59(75.6)	87(73.1)	χ²=0.760	0.381
糖尿病[例(%)]	25(33.6)	40(32.1)	χ²=0.050	0.820
高脂血症[例(%)]	43(55.1)	64(53.8)	χ²=0.030	0.853
肾功能不全[例(%)]	10(12.8)	11(9.2)	χ²=0.630	0.426
脑血管病家族史[例(%)]	13(16.7)	25(21.0)	χ²=0.570	0.450
高同型半胱氨酸血症[例(%)]	41(52.6)	53(44.5)	χ²=1.210	0.270
房颤[例(%)]	6(7.7)	9(7.6)	χ²=0.000	0.973
吸烟史[例(%)]	45(57.7)	59(49.6)	χ²=1.240	0.265
饮酒史[例(%)]	26(33.3)	32(26.9)	χ²=0.940	0.332

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