A Retrospective Study Of Related Factors In Ischemic Stroke Patients With Non-valvular Atrial Fibrillation

Objective: By comparing the clinical data between ischemic stroke patients complicated with non-valvular atrial fibrillation and ischemic stroke patients,to explore the difference of risk factors between the two groups,in order to provide a reference basis for clinical diagnosis and treatment.Methods: From January 2012 to November 2016,311 non-valvular atrial fibrillation patients complicated with acute ischemic stroke were enrolled retrospectively as case group in the The Second Hospital of Tianjin Medical University,2610 acute ischemic stroke patients without atrial fibrillationin in the Department of Neurology of our hospital at the same time were served as control group.Single factor analysis was used to compare the clinical data of the two groups,including general clinical data（sex,age,history of hypertension,history of diabetes mellitus,history of ischemic coronary heart disease,history of smoking）,relevant laboratory index（red blood cell distribution width,high density lipoprotein,total cholesterol,triglyceride,low density lipoprotein,uric acid,fibrinogen,high sensitive C-reactive protein,homocysteine,platelet distribution width）,and NIHSS score in difference.Multivariate logistic regression analysis was used to screen out the risk factors of non-valvular atrial fibrillation associated with ischemic stroke.According to the severity of the disease,The case group were divided into mild（NIHSS score < 8）and moderate to severe（NIHSS score ≥ 8 points）subgroups,According to the CHADS₂ standard,patients will be divided into lower risk（CHADS₂ score < 2）and high risk（CHADS₂ score ≥ 2points）subgroups.Statistical analysis was used to compare the differences between the subgroups.Result:（1）The average age of the patients in the case group was higher than that of the control group [（75.32±9.67）vs（67.82±10.82）],and the proportion of female patients in the case group was higher than that in the control group（45.34% to35.86%）,the difference was statistically significant（P < 0.05）.（2）According to age group,the patients in the case group with 75 to 84 years of age accounted for the largest proportion of patients,accounting for 44.05%,and the number of male patients in all age groups were higher than that of female patients,but the difference was not statistically significant（P > 0.05）.（3）Prevalence rates in hypertension（71.70% vs 64.56%）,diabetes（33.12% vs25.94%）,ischemic heart disease（56.59% vs 34.64%）and smoking history（47.91%vs 41.07%）of case patients were higher than control group,and the difference was statistically significant（P < 0.05）.（4）Analysis of Analysis of the relevant test indicators showed:in the case group,the red blood cell distribution width,uric acid,homocysteine,high sensitivity C-reactive protein,fibrinogen,platelet distribution width were higher than those in the control group.However,the levels of total cholesterol,triglyceride,high density lipoprotein and low density lipoprotein were lower than those in the control group,and the difference was statistically significant（P < 0.05）.（5）Multivariate logistic regression analysis showed that age（OR:1.068,95%CI:1.053¹.084）,female（OR:1.360,95%CI:1.030¹.796）,diabetes mellitus（OR:1.773,95%CI:1.326².371）,ischemic heart disease（OR:1.644,95%CI:1.248².167）,smoking（OR:2.060,95%CI:1.565².710）,red cell distribution width（OR:1.404,95%CI:1.255¹.570）,platelet distribution width（OR:1.193,95%CI:1.112¹.279）,uric acid（OR:1.003,95%CI:1.002¹.004）,high sensitive C reactive protein（OR:1.006,95%CI:1.003¹.010）,total the cholesterol（OR:0.788,95%CI:0.706⁰.881）,triglyceride（OR:0.760,95%CI:0.657⁰.878）,high density lipoprotein（OR:0.225,95%CI:0.136⁰.372）,low density lipoprotein（OR:0.323,95%CI:0.238⁰.438）were statistically significant.（6）The NIHSS score of the patients in the case group was higher than that in the control group[（6.65±5.74）vs（4.38±4.20）],and the difference was statistically significant（P < 0.05）.The RDW and Fbg levels in patients with moderate to severe subgroups were significantly higher than those in mild subgroup,and the difference was statistically significant（P < 0.05）,Pearson correlation analysis showed that RDW or Fbg and NIHSS score were statistically significant（P < 0.05）,but there was no significant difference in platelet distribution width,uric acid,homocysteine,high sensitive C-reactive protein,total cholesterol,triglyceride,high density lipoprotein,low density lipoprotein（P > 0.05）.（7）The average score of CHADS₂ score of patients in the case group was 2.31 ±1.26.CHADS₂ score = 0（low-risk group）accounted for 4.82%,CHADS₂ score = 1（medium risk group）accounted for 23.79%,CHADS₂ = 2（High-risk group）accounted for 71.38%,the proportion of patients with CHADS₂ = 2 was the largest among them,accounting for 30.87%.According to the score of CHADS₂,RDW and Fbg level in the high risk group was higher than that in the low risk group,Pearson correlation analysis showed that RDW or Fbg and CHADS₂ score were statistically significant（P < 0.05）.However,there was no significant difference in platelet distribution width,uric acid,homocysteine,high sensitivity C-reactive protein,total cholesterol,triglyceride,high density lipoprotein,low density lipoprotein.Conclusion:（1）Compared with acute ischemic stroke patients without atrial fibrillation,the proportion of elderly and female acute ischemic stroke patients associated with nonvalvular atrial fibrillation is higher.（2）Compared with acute ischemic stroke patients without atrial fibrillation,the proportion of hypertension,diabetes mellitus,ischemic heart disease and smoking increased in acute ischemic stroke patients complicated with non-valvular atrial fibrillation.（3）Old age,female,diabetes,ischemic heart disease,smoking,red cell distribution width,PDW,uric acid,high-sensitivity C reactive protein are independent risk factors of ischemic stroke complicated with non-valvular atrial fibrillation.（4）Ischemic stroke patients with nonvalvular atrial fibrillation may occur more severe neurological damage,and increased RDW or fibrinogen level may be related to the severity of ischemic stroke complicated with non-valvular atrial fibrillation.（5）In risk stratifications according to CHADS₂ score,RDW and Fbg levels were higher in the high-risk group,it may be related to the risk of ischemic stroke with nonvalvular atrial fibrillation.