收缩压纵向轨迹与心房颤动的关系  

Relationship Between Longitudinal Trajectory of Systolic Blood Pressure and Atrial Fibrillation Occurrence in Kailuan Group Population

作　　者：杜鑫[1] 张芮英 张莹 施继红[1] 黄喆[1] 朱辰蕊[1] 李慧英[1] 魏晓明[1] 林黎明[1] 熊海亮[1] 刘妍[1] 季春鹏[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二科,河北省唐山市063000 [2]华北理工大学研究生院 [3]华北理工大学附属医院超声科

出　　处：《中国循环杂志》2017年第6期584-588,共5页Chinese Circulation Journal

摘　　要：目的:探讨收缩压(SBP)纵向轨迹与心房颤动(房颤)的关系。方法:以开滦研究中满足标准的对象组成研究队列。通过SAS Proc Traj程序确定观察对象2006~2007、2008~2009、2010~2011年健康体检的SBP纵向轨迹,生成5个不同的SBP轨迹组:低-稳定轨迹组、中-稳定轨迹组、中-高轨迹组、高-中轨迹组和高-稳定轨迹组。采用Log-Rank检验比较不同SBP轨迹组于2012~2013、2014~2015年2次健康体检时的房颤发病率的差异,采用多因素COX回归模型分析不同SBP轨迹组与房颤的关系。结果:(1)40 727例纳入研究,平均年龄(51.81±11.54)岁,其中,男性30 693例(75.4%)。低-稳定轨迹组10 950例,中-稳定轨迹组19 158例,中-高轨迹组3 736例,高-中轨迹组4 702例,高-稳定轨迹组2 181例。(2)低-稳定轨迹组、中-稳定轨迹组、中-高轨迹组、高-中轨迹组和高-稳定轨迹组房颤发病率分别为:0.1%、0.2%、0.5%、0.5%、0.6%(P均<0.05)。(3)在多因素COX回归分析中,校正其他混杂因素后,与低-稳定轨迹相比,中-高轨迹、高-中轨迹、高-稳定轨迹均是新发房颤的危险因素,对应的HR(95%CI)分别为7.58(2.08~27.73)、5.30(1.88~14.95)、8.52(1.96~37.09)(P均<0.05)。排除有心肌梗死病史、脑卒中病史者后,进行敏感性分析,结果与以上主要研究结果趋势一致。结论:SBP纵向轨迹水平升高是新发房颤的危险因素。Objective： To explore the relationship between longitudinal trajectory of systolic blood pressure （SPB） and atrial fibrillation （AF） in Kailuan group population. Methods： Our study cohort consisted of 40727 participants with the specific criteria in Kailuan group, Tangshan. SAS Proc Traj procedure was used to identify longitudinal trajectories of SPB throughout 2006-2007, 2008-2009 and 2010-2011. There were 5 longitudinal trajectories generated： Low-stable group,n=10950, Moderate-stable group, n=19158, Moderate-high stable group,n=3713, High-moderate stable group,n=4702 and High stable group,n=2181. Log-rank test was performed to compare AF incidence throughout 2012-2013 and 2014-2015 by physical examination among different groups; Multi Cox regression analysis was conducted to study the relationship among different SBP longitudinal trajectories and AF occurrence. Results：①The mean age of participants was （51.81±11.54） years including 30693 （75.4%） male.②AF occurrence rates in Low-stable, Moderate-stable, Moderate-high stable, High-moderate stable and High stable groups were 0.1%, 0.2%, 0.5%, 0.5% and 0.6% respectively, allP〈0.05.③Multi Cox regression analysis presented that with adjusted confounding＆nbsp;factors, compared with the patients in Low-stable group, Moderate-high stable, High-moderate stable and High stable SBP longitudinal trajectories were the risk factors for new AF occurrence （HR=7.58, 95% CI 2.08-27.73）, （HR=5.30, 95% CI 1.88-14.95） and （HR=8.52, 95% CI 1.96-37.09） respectively, allP〈0.05. With excluded history of myocardial infarction/stroke, the sensitivity study showed the similar result with the major research trend. Conclusion： Elevated long trajectory of SPB was the risk factor for new AF occurrence in Kailuan group population.

关 键 词：收缩压纵向轨迹 心房颤动 

分 类 号：R54[医药卫生—心血管疾病]