| 吴小妹,汪群芳,周扬.心电图评估左心室肥厚与血瘀型脑卒中后认知障碍和临床预后的相关研究[J].浙江中西医结合杂志,2023,33(12): |
| 心电图评估左心室肥厚与血瘀型脑卒中后认知障碍和临床预后的相关研究 |
| Correlation between left ventricular hypertrophy assessed by electrocardiogram and cognitive impairment, prognosis after stroke |
| 投稿时间：2023-07-12 修订日期：2023-10-30 |
| DOI： |
| 中文关键词: 心电图 左心室肥厚 脑卒中 认知功能障碍 预后 Cornell 乘积 Sokolow-Lyon电压 |
| 英文关键词:Electrocardiogram Left ventricular hypertrophy Stroke Cognitive impairment Prognosis Cornell product Sokolow-Lyon voltage |
| 基金项目:浙江省医学会临床科研(编号:2021ZYC-A200)； |
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| 中文摘要: |
| 目的：探讨入院心电图Cornell 乘积（简称CP）和Sokolow-Lyon电压（简称SL）评估左心室肥厚（LVH）与卒中后认知障碍和临床预后的相关性。方法：回顾性总结2021年6月至2022年12月我院确诊血瘀型脑卒中患者96例为研究对象，治疗后90d根据MMSE评分＜27分为认知功能障碍，根据mRS评分≥2为预后不良。入院完成常规12导联心电图，CP判断LVH标准为（RaVL+SV3）×QRS 间期时间>2440 mV·ms（男） 或（RaVL+SV3+8）×QRS 间期时间>2440 mV·ms（女），SL判断LVH标准为SV1+RV5或 RV6> 38 mV。结果：96例患者诊断认知功能障碍34例（35.4%，34/96），预后不良22例（22.9%，22/96）。单因素比较发现，认知障碍组年龄增大，入院NIHSS评分、收缩压和低密度脂蛋白（LDL）、CP和SL值增加，LVH（CP和SL标准）百分比增多（P＜0.05）。预后不良组年龄较预后良好组增大，入院NIHSS评分、CP和SL值增加，LVH（CP和SL标准）百分比增多（P＜0.05）。多因素Logistic回归显示，年龄≥65岁（OR=1.564，95%CI=1.234~1.896，P=0.001）、入院NIHSS评分≥5（OR=1.998，95%CI=1.456~2.526，P＜0.001）、LVH（CP标准）（OR=1.754，95%CI=1.302~2.012，P＜0.001）和LVH（SL标准）（OR=1.359，95%CI=1.112~1.785，P=0.003）是卒中后认知功能障碍的独立预测因子。年龄≥65岁（OR=1.326，95%CI=1.102~1.759，P=0.004）、入院NIHSS评分≥5（OR=1.845，95%CI=1.521~2.232，P＜0.001）和LVH（CP标准）（OR=1.554，95%CI=1.265~1.921，P=0.001）是卒中后预后不良的独立预测因子。受试者工作曲线（ROC）显示，LVH（CP标准）预测卒中后认知功能障碍和预后不良的AUC分别为0.852和0.813，LVH（SL标准）预测卒中后认知功能障碍和预后不良的AUC分别为0.809和0.745。结论：心电图是临床较易获得的无创检查工具，CP和SL标准判断LVH在血瘀型脑卒中患者治疗90d后认知障碍和临床预后诊断中有较好的应用价值，其中CP标准似乎诊断性能优于SL。 |
| 英文摘要: |
| Objective: To investigate the correlation between Cornell product (CP) and Sokolow-Lyon voltage(SL) of electrocardiogram on admission to assess left ventricular hypertrophy (LVH) and cognitive impairment,clinical prognosis after stroke. Methods: 96 patients with stroke of blood stasis type diagnosis into our hospital from June 2021 to December 2022 were studied retrospectively. 90 days after treatment, cognitive impairment was MMSE score <27, and poor prognosis was mRS score≥2. The routine 12-lead ECG was completed upon admission, and LVH standard judged by CP was (RaVL+SV3)×QRS interval time>2440 mV·ms (male) or (RaVL+SV3+8)×QRS interval time>2440 mV·ms (female), the criteria for SL to judge LVH was SV1+RV5 or RV6>38 mV. Results: Among 96 patients, 34 (35.4%, 34/96) were cognitive impairment, and 22 (22.9%, 22/96) had poor prognosis. Univariate comparison showed that the age of patients with cognitive impairment was older than that of patients without cognitive impairment, admission NIHSS score, systolic blood pressure, low density lipoprotein (LDL), CP and SL values, LVH (CP and SL standards) percentages were higher,too(P<0.05). The age of the poor prognosis group was larger, admission NIHSS score, CP and SL values,and LVH (CP and SL standards)percentages were higher,too(P<0.05). Multivariate Logistic regression showed that age≥65 years (OR=1.564, 95% CI=1.234~1.896, P=0.001), admission NIHSS score≥5 (OR=1.998, 95% CI=1.456~2.526, P<0.001), LVH (CP standard) (OR=1.754, 95% CI=1.302~2.012, P<0.001) and LVH (SL standard) (OR=1.359, 95% CI=1.112~1.785, P=0.003) were the independent predictors of cognitive impairment after stroke. Age≥65 years (OR=1.326, 95%CI=1.102~1.759, P=0.004), admission NIHSS score≥5 (OR=1.845, 95% CI=1.521~2.232, P<0.001) and LVH (CP standard) (OR=1.554, 95% CI=1.265~1.921, P=0.001) were independent predictors of poor prognosis after stroke. The receiver operating curve (ROC) showed that area under curve (AUC) of LVH (CP standard) for predicting cognitive impairment and poor prognosis were 0.852 and 0.813 respectively, and the AUC of LVH (SL standard) were 0.809 and 0.745 respectively. Conclusion: ECG is a noninvasive examination tool that is easy to obtain in clinic. CP and SL standards have good value in the diagnosis of cognitive impairment and clinical prognosis in patients with blood stasis stroke after 90 days of treatment,especially CP standard seems to have better diagnostic performance than SL. |
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