急性缺血性脑卒中患者心肌损伤标志物及心电图异常对预后的影响研究

CHEN Xuan; LIU Shi-yang; ZHOU Qin-zhi

doi:10.3969/j.issn.1009-8933.2025.04.004

摘要：Background Patients with acute ischemic stroke(AIS)frequently present with subclinical cardiac injury.Cur-rent clinical assessments predominantly focus on neurological deficits,while the systematic identification and risk stratification of early cardiac complications remain inadequate.Myocardial injury markers and electrocardiograph-ic abnormalities reflect biochemical myocardial damage and electrophysiological disturbances,respectively.Their combined use may provide a more comprehensive evaluation of cardiac involvement following AIS,thereby com-pensating for the limitations of neurological assessment alone.However,their synergistic value in predicting the prognosis of AIS patients requires further clarification.Methods A retrospective analysis was conducted on the medical records of 204 AIS patients admitted to our hospital from July 2023 to July 2025.Based on cardiac troponin I(cTnI)and creatine kinase-MB(CK-MB)levels,as well as electrocardiographic findings within 72 hours of onset,patients were categorized into a myocardial injury group(n=87)and a non-myocardial injury group(n=117).Both groups received standardized treatment.The modified Rankin Scale(mRS)scores at 90 days post-onset and the in-cidence of in-hospital major adverse cardiovascular events(MACE)were compared between the groups.Indepen-dent prognostic factors were analyzed,and the predictive performance of these factors was evaluated.Results Among the 204 patients,myocardial injury markers were elevated in 42.65%(87/204)of them.The incidence of electrocardiographic abnormalities,such as ST T changes(38.24%,78/204)and arrhythmias(24.02%,49/204),was significantly higher in the injury group than in the non injury group(all P<0.05).Elevated cTnI level(OR=1.052),prolonged QTc interval(OR=1.049),and a high National Institutes of Health Stroke Scale(NIHSS)score(OR=1.458)were identified as independent risk factors for poor prognosis at 90 days(all P<0.05),whereas CK-MB level was not an independent risk factor(P>0.05).The combination of NIHSS score,cTnI,and QTc interval demonstrat-ed an area under the curve(AUC)of 0.920,with a specificity of 96.80%and a sensitivity of 70.89%,in predicting poor prognosis.Conclusions Patients with AIS frequently exhibit concomitant myocardial injury and electrocar-diographic abnormalities.Elevated cTnI levels and prolonged QTc intervals are independently associated with poor 90-day prognosis,serving as significant predictive biomarkers.Early monitoring of these indicators contributes to risk stratification and personalized management.[S Chin J Cardiol 2025;26(4):239-248]