Study On The Related Factors Of Ischemic Stroke In Patients With Non-valvular Atrial Fibrillation

Objective: To study the relationship between clinical indicators of patients with nonvalvular atrial fibrillation(NVAF)and the incidence of ischemic stroke.To preliminarily discuss the value of the indicators in predicting the incidence of ischemic stroke in patients with NVAF combined with the CHA2DS2-VASC stroke risk score.Methods: A total of 325 hospitalized patients with NVAF diagnosed in the first people's hospital of changde city from January 2018 to March 2019 were selected,including 123 patients with acute ischemic stroke in the case group and 202 patients with pure NVAF in the control group.General clinical data of the two groups were collected and risk factors of patients with NVAF complicated with ischemic stroke were analyzed by multivariate logistic regression.Then the ROC curve was used to analyze the clinical value of the prediction of ischemic stroke in patients with NVAF,and further combined with the CHA2DS2-VASc scoring system to try to construct a new prediction model.Result:(1)Case group compared with control group,two groups of age,history of hypertension,history of ischemic stroke,CHA2DS2-VASc score,leukocyte count,neutrophil count,lymphocyte count,neutrophil count/lymphocyte count ratio(NLR),homocysteine,D dimer,troponin I,NT-proBNP and left atrium diameter and left ventricular ejection fraction of the difference was statistically significant(P < 0.05);(2)After adjusting for confounders,logistic multivariate regressionanalysis showed that NLR(OR=1.48,95CI% : 1.18 ~ 1.84,P < 0.001),homocysteine(OR=1.09,95CI% : 1.02 ~ 1.17,P=0.01),D dimer(OR=1.88,95CI% : 1.28 ~ 2.77,P < 0.001),and troponin I(OR=2.05,95CI% : 1.18 ~1.84,P < 0.001)1.02 ~ 4.12,P=0.0445),NT-proBNP(OR=1.04,95CI% : 1.00~ 1.09,P=0.0487),and left atrial diameter(OR=1.10,95CI% : 1.04 ~ 1.16,P=0.0017)were independent risk factors for ischemic stroke in patients with NVAF.(3)The area under the ROC curve(AUC)of NLR,homocysteine,d-dimer,nt-probnp,left atrial diameter and cha2ds2-vasc score were 0.725,0.7651,0.725,0.638,0.709 and 0.719,respectively.For the prediction of ischemic stroke in patients with NVAF,the optimal prediction thresholds were 3.62,15.05umol/L,1.11mg/L,2141.50pg/ml and 40.50 mm,respectively;(4)NLR,homocysteine,d-dimer,troponin I,NT-proBNP,and left atrial diameter are combined with CHA2DS2-VASc score,and the above seven indexes are combined for ROC curve analysis and the AUC increased by0.042,0.051,0.046,0.012,0.023,0.034 and 0.114,respectively.The AUC of 7indexes is the largest.Conclusion: NLR,Hyperhomocysteinemia,D-dimer,troponin I,NT-proBNP,and left atrium inner diameter are possible independent risk factors for ischemic stroke in patients with NVAF.If combined with CHA2DS2-VASc score,it can improve the predictive value of ischemic stroke in patients with NVAF.