长期透析患者新发房颤的风险分析  

Analysis of risk factors of new onset atrial fibrillation in long-term dialysis patients

作　　者：史玉生[1] 张彩侠[1] 包红英[1] 

机构地区：[1]句容市人民医院内科,江苏句容212400

出　　处：《临床和实验医学杂志》2011年第3期165-166,169,共3页Journal of Clinical and Experimental Medicine

摘　　要：目的评价长期透析患者发生房颤的临床特点和超声心动图特征。方法入选本中心106例长期透析患者,男性64例,女性42例,平均年龄为(51±19)岁,透析时间为6个月至10年。根据患者发生房颤与否分为房颤组和非房颤组,详细记录患者的病史、实验室检查指标,并于透析间期行超声心动图检查。结果本组患者中有16例出现房颤,房颤组患者表现为高龄(63.1±9.7,P<0.001),透析年限更长(53.8±47.9,P<0.05),冠心病发病率更高(43.8%,P<0.05)。超声心动图结果显示,房颤组患者室间隔厚度(13.1±1.4,P<0.001)、左心室后壁厚度(12.3±0.9,P<0.001)、左心房内径(41.8±4.1,P<0.001)、左室重量指数(178.9±41.1,P<0.05)和肺动脉压(39.7±8.1,P<0.001)均显著高于非房颤组,且房颤组患者左室射血分数显著低于非房颤组患者(56.8±13.7,P<0.05)。多变量lo-gistic回归分析证实,年龄、左心室后壁厚度是透析患者发生房颤的独立风险因子。结论年龄、左心室后壁厚度是透析患者发生房颤的独立风险因子。心肌结构的变化可能是透析患者发生房颤的病因。Objective The aim of this study was to identify clinical and echocardiographic risk factors of atrial fibrillation in long-term hemodialysis patients.Methods The study included 106 patients（64 males,42 females;mean age 51±19 years） who had been on long-term hemodialysis（mean 51.6±37.4 months）.Atrial fibrillation was determined electrocardiographically and the patients were divided into two groups depending on the presence or absence of atrial fibrillation.Conventional Doppler echocardiographic examinations were performed on interdialytic days.Clinical,laboratory,and echocardiographic parameters were compared.Results Sixteen patients had atrial fibrillation.Patients with atrial fibrillation significantly differed in terms of higher age（63.1±9.7 vs.47.2±15.3 years;P0.001） and higher frequency of coronary artery disease（43.8% vs.13.3%;P=0.003）.Echocardiographic examination showed significantly increased left atrial diameter（P0.001）,increased interventricular septal thickness（IVSd）,increased systolic pulmonary artery pressure（39.7±8.1 vs.27.5±5.7 mmHg,P0.001） and left ventricular posterior wall thickness（LVPWd）（12.3±0.9 vs.9.3±1.1,P0.001） in patients with atrial fibrillation.In multivariate logistic regression analysis,age（OR 1.08;95% CI 1.00-1.19;P=0.021） and LVPWd（OR 1.10;95% CI 0.99-1.27;P=0.013） were independent risk factors for the development of atrial fibrillation.Conclusion Our findings highlight age and LVPWd as independent predictors of atrial fibrillation in hemodialysis patients.

关 键 词：长期透析 房颤 风险 

分 类 号：R541.75[医药卫生—心血管疾病]