| ?Objective?To investigate the difference in the clinical characteristics and risk factors of cerebral infarction in senile patients with non-valvular atrial fibrillation(NVAF)and non atrial fibrillation(the control group)through the retrospective analysis.Furthermore,to analyze the recurrence risk factors of NVAF senile cerebral infarction in order to guide the clinical pathogeny analysis of senile cerebral infarction with NVAF and provide the reference opinion of the treatment in the primary and secondary prevention.?Methods?In this retrospective analysis,we investigated 244 confirmed cases ofsenile cerebral infarction from the First Affiliated Hospital of Fujian Medical University(112/244 cases are with NVAF,and 132/244 without AF).We made a comparison of the clinical characteristics and related risk factorsin in both groups,including general information,past medical history,personal history,related laboratory tests,and the index from color Doppler echocardiography and carotid artery ultrasonography examination.Furthermore,the elder NVAF cerebral infarction patients were divided into 2 groups(the first onset and recurrent groups).The factors mentioned above of the two groups were retrospectively compared to analyze the risk factors of recurrent cerebral infarction.?Results? 1)In the aspect of clinical characteristics:first of all,this study came to a conclusion that neurological function damage in the NVAF group was more serious than it in the control group.The NIHSS of the first group was higher(P<0.001).The significant difference was found in the NVAF group in the aspect of signs such as disturbance of consciousness,aphasia,gaze,cognitive disorder between the two groups(P<0.05).It is certified that posterior circulation infarction was more likely to occur in the control group(P<0.05).In the aspect of risk factors,there was no significant difference in the aspect of age,sex,hypertension,coronary heart disease,history of stroke,hypercholesteremia(high TC),low HDL – C,high LDL – C,high Hcy levels,hyperuricaemia,hyperfibrinogenemia and carotid intima thickness,plaque echo properties between the two groups(P > 0.05).And significant difference was found in the aspect of the history of cardiac insufficiency,BNP,EF,LAD,D-Dimer,smoking time and cigarette amounts per day,diabetes,hypertriglyceridemia(high TG),high levels of glycated hemoglobin between the two groups(P<0.05).In addition,the carotid artery local stenosis rate and the number of carotid plaques in non atrial fibrillation senile cerebral infarction group were significantly higher than in NVAF group(P < 0.05);2)This study found that the risk factor of recurrence for the senile cerebral infarction with NVAF include high levels of glycated hemoglobin,the duration of atrial fibrillation and the ventricular rate are in the univariate analysis.However,in the Logistic regression analysis,only the years of AF history(OR= 4.617,95% CI 4.617 ~ 11.839)and the ventricular rate of AF(OR = 2.809,95% CI 1.010 to 7.814)are the independent risk factors for recurrent stroke.?Conclusion? 1)The similarities and differences of the risk factors mentioned above may indicate that the pathogenesis for the elderly NVAF patients who suffer from cerebral infarction involves not only the usual accepted mechanism that cerebral embolism caused by cardiac embolic loss,but also several other mechanisms includes hemodynamic abnormalities,changes of hemorheology and atherosclerotic plaque formations or scales off based on the intracranial and extracranial artery atherosclerosis.2)In the primary and secondary prevention treatment to senile cerebral infarction with NVAF we must be comprehensively to control the risk factors of atherosclerosis,to make an anticoagulant therapy to improve the blood rheology,to control of heart failure and ventricular rhythm to improve hemodynamics. |
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