收缩压联合体重指数对新发心房颤动的影响  

Impact of combined systolic blood pressure and body mass index on the risk of new-onset atrial fibrillation

作　　者：施继红[1] 季春鹏[1] 邢爱君[1] 朱辰蕊[1] 杜鑫[1] 林黎明[1] 魏晓明[1] 吴寿岭[1] 

机构地区：[1]华北理工大学附属开滦总医院心内科,唐山063000

出　　处：《中华心血管病杂志》2016年第3期231-237,共7页Chinese Journal of Cardiology

摘　　要：目的 观察收缩压和（或）体重指数对新发心房颤动的影响.方法 选择参加2006年7月至2007年10月（第1次体检）开滦集团公司职工健康体检且无心房颤动病史的研究对象作为观察队列.分别于2008年7月至2009年10月、2010年7至2011年10月以及2012年7月至2013年10月对上述人群进行第2、3、4次健康体检.将研究对象按基线体重指数和收缩压水平分别进行分组,即体重指数≤24 kg/m2、24 ～ 28 kg/m2和≥28 kg/m2组,以及收缩压≤120 mmHg（1 mmHg =0.133kPa）、120～140 mmHg和≥140 mmHg组,并将体重指数各组和收缩压各组进行任意组合,形成9组.采用多因素Cox回归分析各组合人群心房颤动的发病风险.结果 共入选职工99 206例作为观察队列,排除新发瓣膜性心房颤动者以及参数缺失者后,最终纳入统计分析的有效数据为88 715例.平均随访5.6年后,共有265例职工发生心房颤动,发病率为0.54/千人年,并且随体重指数和收缩压水平升高,新发心房颤动发病率呈递增趋势,其中体质指数≥28 kg/m2且收缩压≥140 mmHg组心房颤动发病率最高,达1.15/千人年,而体重指数≤24 kg/m2且收缩压≤120 mmHg组心房颤动发病率仅为0.25/千人年.多因素Cox回归分析结果显示,在校正基线年龄、性别等混杂因素后,基线收缩压≥140 mmHg组和体质指数≥28 kg/m2组发生心房颤动的风险分别是收缩压≤120 mmHg组和体质指数≤24 kg/m2组的1.59倍（95％CI1.07～2.35）和1.52倍（95％CI1.07～2.15）.体重指数≥28 kg/m2且收缩压≥140 mmHg组发生心房颤动的风险是体重指数≤24 kg/m2且收缩压≤120 mmHg组的2.08（95％CI1.18 ～3.67）倍.结论 收缩压≥140 mmHg和体重指数≥28 kg/m2协同增加心房颤动发病风险.临床试验注册中国临床试验注册中心,ChiCTR-TNRC-11001489.Objective To observe the impact of combined systolic blood pressure and body mass index （BMI） on the risk of new-onset atrial fibrillation.Methods The participants who participated the health examination between July 2006 and October 2007 at Kailuan medical group and had no history of atrial fibrillation were selected as the observation cohort.The second,the third and the fourth health examination were conducted between July 2008 and October 2009,July 2010 and October 2011,July 2012 and October 2013,respectively.The participants were stratified by 3 systolic blood pressure levels （≤ 120,120-140,≥140 mmHg （1 mmHg =0.133 kPa）） ＆#215;3 BMI levels （≤24,24-28,≥28 kg/m2） at baseline.The combined effect of systolic blood pressure and BMI on the risk of new-onset atrial fibrillation was analyzed by multiple Cox regression analysis.Results A total of 99 206 participants were recruited and 88 715 participants were included in the final analysis after excluding participants who had new-onset valvular atrial fibrillation or lost to follow-up.A total of 265 participants developed atrial fibrillation during the 5.6 years follow-up.The incidence of atrial fibrillation increased with the BMI and systolic blood pressure,the incidence of new onset of atrial fibrillation was significantly higher in the group with systolic blood pressure ≥ 140 mmHg and BMI ≥ 28 kg/m2 than the group with systolic blood pressure ≤ 120 mmHg and BMI ≤ 24 kg/m2（1.15/1 000 person-year vs.0.25/1 000 person-year）.Multiple Cox regression analysis showed that participants in the group with systolic blood pressure ≥ 140 mmHg and BMI ≥ 28 kg/m2 carried 2.08 （95%CI 1.18-3.67） times higher risk for atrial fibrillation than the group with systolic blood pressure≤ 120 mmHg and BMI ≤ 24 kg/m2 after adjustment for age,gender and other confounders at baseline.Conclusion Participants with systolic blood pressure ≥ 140 mmHg and BMI ≥ 28 kg/m2 are at high risk for new onset of atrial fibrillation.Clinical Trail Regist

关 键 词：心房颤动 血压 体重 

分 类 号：R541.75[医药卫生—心血管疾病]