中国急诊心房颤动患者死亡危险因素分析  

Analysis of risk factors for all cause-mortality in Chinese emergency atrial fibrillation patients

作　　者：王娟[1] 杨艳敏[1] 朱俊[1] 张晗[1] 邵兴慧[1] 黄毕[1] 田力[1] 

机构地区：[1]中国医学科学院北京协和医学院阜外心血管病医院心内科急重症中心,北京100037

出　　处：《中华医学杂志》2013年第36期2871-2875,共5页National Medical Journal of China

摘　　要：目的探讨我国急诊心房颤动（简称房颤）患者1年随访的全因死亡率及其危险因素。方法2008年11月至2011年10月在全国20家医院连续入选任何原因急诊就诊中有房颤诊断的患者。记录患者的基线资料、治疗情况，并进行1年随访，记录全因死亡事件，根据是否生存将患者分为死亡组和生存组。用单因素和多因素Cox回归模型分析影响房颤患者1年死亡的独立危险因素。结果共人选2016例房颤患者，其中死亡组279例，生存组1737例，1年全因死亡率为13．8％。死亡组年龄显著高于生存组[（76．1±11．6）比（67．2±13．1）岁，P〈0．01]，而体质指数显著低于生存组[（23．7±3．6）比（22．3±3．4）kg／m2，P〈0．01]；永久性房颤在死亡组所占的比例高（62．1％比44．6％，P〈0．01），房颤血栓危险度（CHADS：）评分2分以上者在死亡组所占比例更高（71．8％比47．5％，P〈0．01）；既往心力衰竭病、脑血管意外、左室收缩功能不全、糖尿病、痴呆、慢性阻塞性肺疾病（COPD）史在死亡组所占比例更高（51．2％比35．1％、26．3％比17．6％、26．7％比17．9％、21．0％比14．6％、6．0％比1．6％、21．4％比10．1％，均P〈0．01）。死亡组患者利尿剂、地高辛、其他抗凝药（肝素等）的应用比例高于生存组（50．9％比42．2％、41．3％比34．7％、10．0％比5．9％，均P〈0．01）。Kaplan—Meier生存曲线显示随着CHADS：评分的增高，患者死亡率亦随之增高。多因素Cox回归模型分析显示年龄（HR=1．053，95％CI：1．040～1．066）、永久性房颤（HR=1．374，95％CI：1．003～1．883）、心力衰竭史（HR：1．385，95％CI：1．009—1．901）、脑血管意外史（HR=1．345，95％CI：1．009～1．795）、既往COPD史（HR=1．379，95％CI：1．030—1．848）、未用血管紧张素Ⅱ受体阻滞剂（ARB）治疗（HR=1．955，95％CI：1Objective To explore the independent risk factors associated with one-year mortality in patients with atrial fibrillation （AF）. Methods This study consecutively enrolled AF patients presenting to an emergency department at 20 Chinese hospitals from November 2008 to October 2011. Their baseline data and therapies were recorded. They were followed up for one year. Their major cardiovascular outcomes were recorded. And the predictors of one-year mortality were identified by uni- and muhi-variate Cox regression analysis with baseline, therapy variables and follow-up therapy variables. Results The one-year all-cause mortality was 13.8% among a total of 2016 AF patients. They were divided into mortality group （A, n = 279） and survival group （B, n = 1737）. The baseline data of two groups were analyzed. The group A patients were older （ （76. 1 ± 11.6） vs （67. 2± 13. 1 ） years, P 〈0. 01 ） and had smaller body mass index compared with group B （ （ 23.7 ± 3.6） vs （ 22. 3± 3.4 ） kg/m2, P 〈 0. 01 ） ; the proportion of permanent AF and CHADS2 score 〉t2 points was higher in the group A （71.8% vs 47.5% , P 〈0. 01 ）. History of heart failure, previous stroke, left ventricular systolic dysfunction, diabetes, dementia and chronic obstructive pulmonary disease （COPD） were in a higher proportion of group A （51.2% vs 35.1% , 26. 3%vs 17.6% , 26.7% vs 17.9% , 21.0% vs 14.6% , 6.0% vs 1.6% , 21.4% vs 10. 1% , all P 〈0.01）. With regards to drug treatment, usage of diuretics, digoxin and other anticoagulants （ heparin, etc）, the values were greater in group A （50. 9% vs 42.2% , 41.3% vs 34. 7% , 10. 0% vs 5.9% , all P 〈0. 01 ）. The Kaplan-Meier survival curves showed that the mortality rate increased along with rising CHADS2 score. Multi-variate Cox regression analysis showed that age （HR = 1. 053, 95% CI： 1. 040 - 1. 066） , permanent AF （HR=1.374, 95%CI： 1.003 -1.883）, history of heart failure （HR =1.385, 95%CI： 1.009 - 1.901）, previous stroke （HR

关 键 词：心房颤动 死亡率 危险因素 急诊室 医院 

分 类 号：R541.75[医药卫生—心血管疾病]