关键词: 心房颤动, 心血管疾病, 肺疾病, 脑梗死, 疾病特征, 危险因素

Abstract: Background　Atrial fibrillation is an independent risk factor for cerebral infarction.With the introduction of new anticoagulants in recent years，the anticoagulation ratio in patients with cardiovascular disease and atrial fibrillation has gradually increased，and the incidence of cerebral infarction shows the downward trend.However，relatively few reports on the incidence of cerebral infarction and current status of anticoagulant therapy in chronic pulmonary patients with atrial fibrillation are available.Objective　To explore the clinical characteristics of patients with cardiovascular disease and chronic pulmonary disease complicated with atrial fibrillation in the same period of admission and the incidence of long-term cerebral infarction among them，and to evaluate the incidence of cerebral infarction and anticoagulation status in patients with chronic pulmonary disease and atrial fibrillation，in order to provide the early intervention and improve the prognosis.Methods　287 Patients with persistent or permanent atrial fibrillation admitted to the Second Affiliated Hospital of Soochow University were selected prospectively and continuously as the study subjects from June 2012 to May 2013.According to the main complications，the subjects were divided into the cardiovascular disease group（combined with cardiovascular diseases，n=162） and the lung disease group（combined with chronic pulmonary diseases，n=125）.The general data of patients，blood examination results in the early morning of the day after admission，echocardiographic data and CHA2DS2-VASc scores were recorded.The patients were followed up for a period of five years，and the use of anticoagulants and the incidence of cerebral infarction were recorded.Results　The age，proportion of male，resting heart rate，heart failure proportion，right atrial long axis diameter，right atrial short axis diameter，right ventricular diameter（RVD） of basal segment，pulmonary artery pressure，prothrombin time（PT），D-dimer，international normalized ratio（INR），NT-proBNP，CHA2DS2-VASc scores and proportion of CHA2DS2-VASc scores≥4 in the lung disease group were higher than those in the cardiovascular disease group，while the level of thrombin Ⅲ was lower（P<0.05）.There was no significant difference in the use of anticoagulants between the two groups（P=0.208）.The proportion of clopidogrel，ACEI/ARB and amiodarone in the cardiovascular disease group was higher than that in the lung disease group（P<0.05）.During five consecutive years of follow-up，16（9.9%） patients in the cardiovascular disease group and 29（23.2%） patients in the lung disease group suffered from cerebral infarction.The difference between the two groups was statistically significant（χ2=9.477，P=0.002）.Multivariate Logistic regression analysis showed that age，CHA2DS2-VASc scores，right atrial short axis diameter and pulmonary artery pressure were the risk factors of cerebral infarction in patients with atrial fibrillation（P<0.05）.Conclusion　The incidence of long-term cerebral infarction in patients with chronic pulmonary disease and atrial fibrillation is high during the same period of admission，and these patients have high CHA2DS2-VASc scores，right atrial diameter（RAD），RVD and pulmonary artery pressure.For patients with chronic pulmonary disease and atrial fibrillation，anticoagulation indications should be evaluated in time，and corresponding treatment schemes should be strengthened，and the treatment of comorbidities such as heart failure and pneumonia should be emphasized.

Key words: Atrial fibrillation, Cardiovascular diseases, Lung diseases, Cerebral infarction, Disease attributes, Risk factors