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北京大学学报（医学版） ›› 2026, Vol. 58 ›› Issue (3): 536-542. doi: 10.19723/j.issn.1671-167X.2026.03.013

• 论著 • 上一篇    下一篇

老年人心源性卒中抗凝治疗的预后

孟庆伟1,*, 范梦2,*, 郭煌达3, 章涵宇3, 王梦莹4,5, 王斯悦3, 彭和香6, 王雪珩3, 侯天姣3, 秦雪英3,4, 陈大方3,4, 李劲3,4, 武轶群3,4, 吴涛3,4,*(), 陈洪波1,*(), 胡永华3,4   

  1. 1. 北京市房山区良乡医院神经内科，北京 102400
    2. 航天中心医院人力资源处，北京 100049
    3. 北京大学公共卫生学院流行病与卫生统计学系，北京 100191
    4. 重大疾病流行病学教育部重点实验室，北京 100191
    5. 北京大学公共卫生学院营养与食品卫生学系，北京 100191
    6. 中南大学湘雅公共卫生学院流行病与卫生统计学系，长沙 410013
  • 收稿日期:2025-11-12 出版日期:2026-06-18 发布日期:2026-04-24
  • 通讯作者: 吴涛, 陈洪波
  • 作者简介:

    *These authors contributed equally to this work

  • 基金资助:
    国家重点研发计划(2024YFC3606700); 国家自然科学基金(82473716); 国家自然科学基金(81230066)

Prognostic analysis of anticoagulation therapy in elderly patients with cardioembolic stroke

Qingwei MENG1, Meng FAN2, Huangda GUO3, Hanyu ZHANG3, Mengying WANG4,5, Siyue WANG3, Hexiang PENG6, Xueheng WANG3, Tianjiao HOU3, Xueying QIN3,4, Dafang CHEN3,4, Jing LI3,4, Yiqun WU3,4, Tao WU3,4,*(), Hongbo CHEN1,*(), Yonghua HU3,4   

  1. 1. Department of Neurology, Liangxiang Hospital, Fangshan District, Beijing 102400, China
    2. Human Resources Center, Aerospace Center Hospital, Beijing 100049, China
    3. Department of Epidemiology and Biostatistics, Peking University School of Public Health, Beijing 100191, China
    4. Key Laboratory of Epidemiology of Major Diseases, Ministry of Education, Beijing 100191, China
    5. Department of Nutrition and Food Hygiene, Peking University School of Public Health, Beijing 100191, China
    6. Department of Epidemiology and Biostatistics, Xiangya School of Public Health, Central South University, Changsha 410013, China
  • Received:2025-11-12 Online:2026-06-18 Published:2026-04-24
  • Contact: Tao WU, Hongbo CHEN
  • Supported by:
    the National Key Research and Development Program of China(2024YFC3606700); the National Natural Science Foundation of China(82473716); the National Natural Science Foundation of China(81230066)

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摘要：

目的: 系统评估抗凝治疗与老年心源性卒中患者远期预后(全因死亡、卒中复发及出血事件)的关联，为老年人群的临床决策提供参考。方法: 采用回顾性队列研究设计，对北京市房山区良乡医院的567例老年心源性卒中患者进行4年随访，主要结局指标包括全因死亡、脑卒中复发以及出血事件(包括颅内出血、消化道出血、泌尿系统出血、牙龈出血和皮肤黏膜出血)。采用多因素Logistic回归分析抗凝治疗与各结局指标的关联，使用R 4.2.2软件进行统计分析。结果: 共纳入567例老年心源性卒中患者，平均年龄(73.92±9.70)岁，男性占比49.74%，567例患者中142(25.04%)例患者接受了抗凝治疗。随访期内有266例死亡(粗死亡率46.91%)，107例脑卒中复发(累积复发率18.87%)，28例出血(累积出血率4.94%)。多因素Logistic回归显示，接受抗凝治疗患者的死亡风险更低(OR=0.22, 95%CI：0.12, 0.41, P < 0.001)；未发现抗凝治疗与患者脑卒中复发和出血风险的关联(P>0.05)。结论: 抗凝治疗有利于降低老年心源性卒中患者的全因死亡风险，同时未发现抗凝治疗与卒中复发或出血风险增加相关；本研究支持在老年心源性卒中患者中考虑抗凝治疗以改善远期生存，但仍需更大样本量的前瞻性研究进一步验证结果。

关键词: 心源性卒中, 抗凝治疗, 全因死亡, 脑卒中复发, 出血

Abstract:

Objective: To systematically evaluate the association between anticoagulant therapy and long-term outcomes (all-cause mortality, stroke recurrence, and hemorrhage events) in elderly patients with cardiogenic stroke, thereby providing evidence for clinical decision-making. Methods: A retrospective cohort study design was adopted. A total of 567 elderly patients with cardiogenic stroke from Liang-xiang Hospital in Fangshan District, Beijing, were followed up for 4 years. The primary outcomes included all-cause mortality, stroke recurrence, and hemorrhage events (including intracranial hemorrhage, gastrointestinal bleeding, urinary system bleeding, gingival bleeding, and skin and mucosal hemorrhage). Multivariable Logistic regression was used to analyze the association between anticoagulant therapy and each outcome. All statistical analyses were performed using R software (version 4.2.2). Results: A total of 567 elderly patients were included in this study, with a mean age of (73.92±9.70) years and 49.74% being male. Among them, 142 patients (25.04%) received anticoagulant therapy. During the follow-up period, 266 deaths occurred (crude mortality rate: 46.91%), 107 patients had stroke recurrence (cumulative recurrence incidence: 18.87%), and 28 patients experienced bleeding events (cumulative hemorrhage incidence: 4.94%). Multivariable Logistic regression showed that elderly patients with cardiogenic stroke who received anticoagulant therapy had a significantly lower risk of death (OR=0.22, 95%CI: 0.12, 0.41, P < 0.001). No significant association was found between anticoagulant therapy and the risk of stroke recurrence or hemorrhage (P>0.05). Conclusion: Anticoagulant therapy is beneficial in reducing the risk of all-cause mortality in elderly patients with cardiogenic stroke, and no evidence was found that anticoagulant therapy increases the risk of stroke recurrence or hemorrhage. The study supports considering anticoagulant therapy to improve long-term survival in elderly patients with cardiogenic stroke, and larger prospective studies are still needed to further validate the findings.

Key words: Cardiogenic stroke, Anticoagulant therapy, All-cause mortality, Recurrent stroke, Hemorrhage

中图分类号: 

  • R181.3

表1

心源性卒中患者的基线信息"

Characteristics Anticoagulated (n=142) Not anticoagulated (n=425) P value
Age/years, $\bar x \pm s$ 69.99±9.46 75.24±9.43 < 0.001
Gender, n (%) 0.827
  Female 212 (49.88) 73 (51.41)
  Male 213 (50.12) 69 (48.59)
Smoking, n (%) 58 (41.13) 180 (42.45) 0.860
Drinking, n (%) 28 (20.29) 74 (18.41) 0.718
Hypertension, n (%) 104 (74.82) 349 (82.12) 0.079
Diabetes, n (%) 38 (27.34) 141 (33.25) 0.232
Antiplatelet drugs, n (%) 12 (8.96) 294 (70.33) < 0.001
CHA2DS2-VASc, M (P25, P75) 4 (3, 5) 5 (4, 6) < 0.001
HAS-BLED, M (P25, P75) 3 (2, 3) 3 (3, 3) < 0.001
INR, M (P25, P75) 1.10 (1.04, 1.35) 1.07 (1.02, 1.15) < 0.001
TC/mmol/L, $\bar x \pm s$ 4.06±0.84 4.29±0.97 0.033
TG/mmol/L, $\bar x \pm s$ 1.23±0.82 1.15±0.64 0.379
HDL-C/mmol/L, $\bar x \pm s$ 1.31±0.39 1.36±0.37 0.030
LDL-C/mmol/L, $\bar x \pm s$ 2.14±0.71 2.29±0.76 0.026

表2

心源性卒中患者抗凝治疗和死亡风险的关联"

Model OR (95%CI) P value
Model 1 0.48 (0.31, 0.73) < 0.001
Model 2 0.22 (0.12, 0.38) < 0.001
Model 3 0.22 (0.12, 0.42) < 0.001
Model 3 (IPTW method) 0.21 (0.09, 0.50) < 0.001

表3

不同亚组中心源性卒中患者抗凝治疗和死亡风险的关联"

Variable OR (95%CI) P value P for interaction
Gender 0.465
  Male 0.19 (0.06, 0.51) 0.002
  Female 0.23 (0.10, 0.54) < 0.001
Smoking 0.921
  Yes 0.21 (0.07, 0.63) 0.006
  No 0.21 (0.09, 0.47) < 0.001
Drinking 0.243
  Yes 0.41 (0.03, 5.41) 0.507
  No 0.20 (0.10, 0.39) < 0.001
Hypertension 0.976
  Yes 0.24 (0.11, 0.49) < 0.001
  No 0.16 (0.04, 0.61) 0.010
Diabetes 0.822
  Yes 0.17 (0.05, 0.52) 0.003
  No 0.25 (0.11, 0.56) < 0.001

表4

心源性卒中患者抗凝治疗和卒中复发风险的关联"

Model OR (95%CI) P value
Model 1 2.71 (1.71, 4.29) < 0.001
Model 2 2.27 (1.22, 4.24) 0.010
Model 3 1.87 (0.94, 3.75) 0.077
Model 3 (IPTW method) 2.34 (0.99, 5.56) 0.053
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ISSN 1671-167X
CN 11-4691/R
主管单位：中华人民共和国教育部
主办单位：北京大学
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