非瓣膜性心房颤动合并糖尿病的临床特征和随访一年卒中及死亡分析  

Analysis of clinical characteristics and risk of stroke and death within 1 year of patients with nonvalvular atrial fibrillation combined with diabetes mellitus

作　　者：吴双[1] 杨艳敏[1] 朱俊[1] 黄毕[1] 王娟[1] 万槐斌[1] 张晗[1] 邵兴慧[1] 

机构地区：[1]北京协和医学院中国医学科学院国家心血管病中心阜外医院心内科急重症中心,100037

出　　处：《中华医学杂志》2016年第26期2044-2048,共5页National Medical Journal of China

摘　　要：目的探讨非瓣膜性心房颤动（简称房颤）合并糖尿病患者的临床特征和随访1年的卒中及死亡的发生率及危险因素。方法分析自2008年11月至2011年10月中国急诊房颤注册研究（20家医院）的非瓣膜性房颤患者资料，根据是否合并糖尿病分为糖尿病组和非糖尿病组。采用单因素和多因素Cox回归模型分析影响非瓣膜性房颤患者1年终点事件的危险因素。结果 共入选1 644例非瓣膜性房颤患者，其中糖尿病患者有227例（16.8%）。与非糖尿病组相比，糖尿病组基线临床特征显示：年龄和体质量显著增高，且陈旧性心肌梗死、冠心病、高血压和卒中的比例也显著升高，血栓栓塞风险评分更高。两组接受抗凝治疗的比例均很低（11.2%比12.8，P＝0.488）。糖尿病组1年的全因死亡率、心血管死亡、复合终点事件的发生率显著高于非糖尿病组（19.5%比12.7%，10.8%比7.0%，26.4%比20.4%，均P〈0.05），但卒中的发生率相当（10.1%比7.4%，P＝0.141）。多因素Cox回归模型分析显示，糖尿病是全因死亡（HR＝1.558，95% CI 1.126～2.156）、心血管死亡（HR＝1.615，95% CI 1.052～2.479）和复合终点事件（HR＝1.523，95% CI 1.098～2.112）的独立危险因素，而并非卒中发生的危险因素（HR＝1.119，95% CI 0.724～1.728）。结论糖尿病是非瓣膜性房颤患者全因死亡、心血管死亡和复合终点事件的独立危险因素，而非卒中发生的危险因素。Objective To explore the clinical characteristics and impact of diabetes mellitus （DM） on prognosis in patients with nonvalvular atrial fibrillation （AF）. Methods Data of nonvalvular AF patients in the Chinese Emergency Atrial Fibrillation Registry Study were retrospectively analyzed. The eligible patients were divided into the DM group and the non-DM group. Uni- and multi-variate Cox regression analysis were used to explore risk factors of 1-year outcomes. Results A total of 1 644 patients were enrolled in the study with 227 patients combined with DM （ 16. 8% ） . Compared with non-DM group, patients with DM were older and had higher body weight, had higher prevalence of myocardial infarction, coronary heart disease, hypertension and stroke, and were at higher risk of thromboembolism. The proportion of anticoagulant treatment was low in both groups （10. 1% vs 7.4% , P = 0. 141 ）. Compared with patients without DM, patients with DM had higher all-cause mortality （19.5% vs 12.7%, P= 0.004）, cardiovascular death （ 10. 8% vs 7.02% ,P = 0. 047） and combined end events （CEE, 26. 4% vs 2.4% , P =0. 023）, while with comparable incidence of stroke （ 10. 1% vs 7.4% , P =0. 141 ）. Multi-variate Cox regression analysis showed that DM was an independent risk factor for 1-year all-cause mortality （HR = 1. 558,95% CI 1. 126 - 2. 156） , cardiovascular death （HR = l. 615,95% CI 1. 052 - 2. 479） and CEE （HR=1.523,95% CI 1.098-2.112）, while not for stroke （fIR=l.523,95% CI 1.098-2.112）. Conclusion DM is the independent risk factor for all-cause mortality, cardiovascular death and combined end events in patients with nonvalvular AF, while not a predictor for the occurrence of stroke.

关 键 词：心房颤动 糖尿病 卒中 死亡 

分 类 号：R541.75[医药卫生—心血管疾病]