心房颤动对中国老年二尖瓣反流治疗决策及预后的影响  

Effect of AF on treatment strategy and outcome of elderly Chinese mitral regurgitation patients

作　　者：叶蕴青[1] 周政 李喆[1] 王墨扬[1] 张而立[1] 刘庆荣[1] 齐喜玲 许海燕[1] 吴永健[1] Ye Yunqing;Zhou Zheng;Li Zhe;Wang Moyang;Zhang Erli;Liu Qingrong;Qi Xiling;Xu Haiyan;Wu Yongjian(Center for Coronary Heart Disease,Peking Union Medical College,Fuwai Hospital,National Center for Cardiovascular Diseases,Chinese Academy of Medical Sciences,Beijing 100037,China)

机构地区：[1]北京协和医学院中国医学科学院阜外医院冠心病中心国家心血管病中心,北京100037

出　　处：《中华老年心脑血管病杂志》2021年第6期585-588,共4页Chinese Journal of Geriatric Heart,Brain and Vessel Diseases

基　　金：国家科技支撑计划课题(2015BAI12B02);中国医学科学院医学与健康科技工程(2017-12M-3-002)。

摘　　要：目的了解中国老年二尖瓣反流(MR)合并心房颤动(房颤)的发生率、治疗现状,分析房颤是否与MR治疗决策及预后相关。方法选择中度以上老年MR患者2248例,分为房颤组(537例)和非房颤组(1711例),比较2组基线特点、治疗方式及预后差异。结果老年MR合并房颤发生率为23.89%。与非房颤组比较,房颤组年龄更大(P<0.01),吸烟、合并心肌病、缺血性脑卒中、心功能不全、NYHAⅢ级和Ⅳ级比例更高(72.25%vs 67.97%,14.71%vs 10.29%,12.66%vs 7.95%,73.00%vs 67.62%,40.04%vs 32.14%,17.13%vs 13.85%,P<0.05,P<0.01)。房颤组风湿性及功能性MR比例、接受二尖瓣修复比例明显高于非房颤组(P<0.01),接受干预治疗比例、住院天数、监护病房天数、院内不良事件及死亡率与非房颤组比较,无统计学差异(P>0.05)。房颤组随访12个月累积生存率、因心力衰竭再住院率与非房颤组比较,无统计学差异(P>0.05)。结论老年MR合并房颤比例较高。但房颤并未明显影响MR治疗的决策和近中期预后。Objective To investigate the incidence and treatment of AF in elderly patients with mitral regurgitation(MR)in China,and to analyze whether AF is related to MR treatment strategy and prognosis.Methods A total of 2248≥60 years old Chinese MR patients were divided into AF group(n=537)and AF-free group(n=1711).Their baseline clinical characteristics,treatment methods and outcome were compared.Results The incidence of MR with AF was 23.89%.The age was significantly older(P<0.01),the rate of smoking was significantly higher,the incidence of cardiomypathy,ischemic cerebral stroke,cardiac insufficiency,NYHAⅢandⅣwas significantly higher in AF group than in AF-free group(72.25%vs 67.97%,14.71%vs 10.29%,12.66%vs 7.95%,73.00%vs 67.62%,40.04%vs 32.14%,17.13%vs 13.85%,P<0.05,P<0.01).The rate of rheumatic MR,functional MR and mitral repair was significantly higher in AF group than in AF-free group(P<0.01).No significant difference was detected in intervention rate,hospital stay time,ICU stay time,in-hopital adverse events,mortality and in 12-month cumulative survival rate and readmission rate due to heart failure between the two groups during the follow-up period(P>0.05).Conclusion The incidence of MR with AF is relatively high in elderly Chinese patients.The presence of AF does not affect the treatment strategy for MR and its short-and mid-term outcome in elderly Chinese MR patients.

关 键 词：心房颤动 二尖瓣闭锁不全 二尖瓣成形术 预后 

分 类 号：R542.51[医药卫生—心血管疾病] R541.75[医药卫生—内科学]