高血压病患者发生心房颤动的预测因素  

The Predictive Factors for the Onset of Atrial Fibrillation in Patients with Essential Hypertension

作　　者：赵瑞革[1] 赵月[1] 王荣军[1] 

机构地区：[1]阜新市中心医院心内科,辽宁阜新123000

出　　处：《高血压杂志》2006年第7期523-526,共4页Chinese Journal of Hypertension

摘　　要：目的评价高血压病患者发生心房颤动(AF)的影响因素。方法回顾性分析97例高血压病患者,通过观察临床症状、24h动态血压(AMBP)、12导联心电图、超声心动图。结果随访(25±3)月,19例(19·5%)发生AF,3例(15·8%)发生脑栓塞,AF组患者年龄明显增加,AMBP平均日间收缩压(SBP)、平均夜间SBP明显增加,最大P波间期(Pmax)和P波离散度(Pdis)明显延长,左心室质量(LVM)和左心房内径(LAD)明显增加,舒张期二尖瓣A波流速(VA)明显减少。多因素分析提示:年龄(OR3·28,P<0·001)、平均日间SBP(OR1·35,P<0·01)、平均夜间SBP(OR1·16,P<0·01)、Pmax(OR2·09,P<0·01)、Pdis(OR2·52,P<0·001)、LVM(OR1·43,P<0·01)、LAD(OR2·81,P<0·001)、和VA(OR2·24,P<0·01)为房颤发生的独立预测因素。结论年龄、24hAMBP日间SBP、夜间SBP、LAD和LVM的增加、Pmax和Pdis延长、A波流速的减少是预测AF因素。Objective To evaluate the predictive factors for the onset of atrial fibrillation （AF） in hypertensive patients. Methods Clinical data, the noninvasive ambulatory 24 hours measurement of blood pressure （AMBP）, standard 12-lead electrocardiogram, and Doppler echocardiogram were analysed in 97 patients with hypertension. Results After a follow-up of 25±3 months, 19（19.5%} patients had AF, 3（15.8%） of whom complicated with cerebrovascular accident. The patients with AF were older; higher mean systolic diurnal and nocturnal blood pressures. Maximum duration of the P wave （Pmax } and its dispersion （Pdis ） were prolonged. Left ventricular mass （LVM） and left atrial dimension （LAD} were greater, and the A-wave velocity （VA） of diastolic mitral flow reduced. Multivariate analysis revealed age （odds ratio 3.28, P〈0. 001 ）, diurnal systolic blood pressure （odds ratio 1.35, P〈0.01 ） and nocturnal systolic blood pressure （odds ratio 1.16, P〈0. 01 }, the Pmax （odds ratio 2.09, P〈0.01）, Pdis （odds ratio 2.52, P〈0. 001）, LVM （odd ratio 1.43, P〈0.01）, LAD （odd ratio 2. 81, P〈0. 001）, and VA （odd ratio 2.24, P〈0.01） were independent predictors for the onset of AF. Conclusion In patients with hypertension, age and the level of diurnal and nocturnal systolic blood pressures measured by 24-hour AMBP are important independent predictors for the onset of AF. Increases in LAD and LVM, prolongation of the Pmax and Pdis and reduced VA were predictors for the onset of AF as well.

关 键 词：高血压 心房颤动 24 h动态血压 心电图 多普勒超声心动图 

分 类 号：R544.1[医药卫生—心血管疾病] R541.75[医药卫生—内科学]