大于等于75岁非瓣膜性心房颤动患者发生体循环栓塞相关因素分析  

Analysis of factors related to systemic embolism in patients≥75 years old with non-valvular atrial fibrillation

作　　者：于雅平 冯玉薇 张小雪 魏猛 祖克拉·吐尔洪 芦颜美[1,2] 邢强 张疆华[1,2] 李耀东 汤宝鹏[1,2] 周贤惠 Yaping Yu;Yuwei Feng;Xiaoxue Zhang;Meng Wei;Zukela·Tuerhong;Yanmei Lu;Qiang Xing;Jianghua Zhang;Yaodong Li;Baopeng Tang;Xianhui Zhou(Department of Cardiac Pacing and Electrophysiology,the First Affiliated Hospital of Xinjiang Medical University,Urumqi 830054,China;Xinjiang Key Laboratory of Cardiac Electrophysiology and Remodeling,the First Affiliated Hospital of Xinjiang Medical University,Urumqi 830054,China)

机构地区：[1]新疆医科大学第一附属医院心脏中心起搏电生理科,乌鲁木齐830054 [2]新疆心电生理与心脏重塑重点实验室,乌鲁木齐830054

出　　处：《中华内科杂志》2023年第2期156-162,共7页Chinese Journal of Internal Medicine

基　　金：省部共建中亚高发病成因与防治国家重点实验室基金(SKL-HIDCA-2021-10)。

摘　　要：目的探讨≥75岁非瓣膜性心房颤动(NVAF)患者体循环栓塞(SE)的相关危险因素,为临床中降低NVAF患者SE风险提供依据。方法病例对照研究。收集2018年10月至2020年10月于新疆医科大学第一附属医院住院的≥75岁NVAF患者,根据NVAF后发生SE情况分为无SE组(1127例)和SE组(433例)。应用多因素logistic回归对NVAF患者SE相关因素及未抗凝患者相关危险因素进行分析。结果多因素回归分析表明房颤病史≥5年的OR值为2.75(95%CI 1.98~3.82,P<0.01),脂蛋白(a)>300 g/L的SE风险高于脂蛋白(a)≤300 g/L(OR=2.07,95%CI 1.50~2.84,P<0.01),载脂蛋白B>1.2 g/L的OR值为1.91(95%CI 1.25~2.93,P=0.003),左心室射血分数(LVEF)30%~49%的SE风险较高(OR=2.45,95%CI 1.63~3.69,P<0.01),左心房内径>40 mm的OR值为1.54(95%CI 1.16~2.07,P=0.003),CHA2DS2-VASc≥3分的OR值为15.14(95%CI 2.05~112.13,P=0.01)。载脂蛋白AI>1.6 g/L是SE的保护性因素(OR=0.28,95%CI 0.15~0.51,P<0.01)。结论房颤病史≥5年、脂蛋白(a)>300 g/L、载脂蛋白B升高、左心房内径>40 mm、LVEF 30%~49%、CHA2DS2-VASc评分、HAS-BLED评分是NVAF患者SE的独立相关危险因素。其中载脂蛋白AI>1.6 g/L与NVAF患者SE风险呈负相关。Objective To explore the related risk factors for systemic embolism(SE)in patients aged>75 years with non-valvular atrial fibrillation(NVAF).Methods A case-control study.NVAF patients aged>75 years who were hospitalized at the First Affiliated Hospital of Xinjiang Medical University from October 2018 to October 2020 were divided into no SE(n=1127)and SE(n=433)groups according totheoccurrence of SE after NVAF.Multivariate logistic regression was used to analyze SE-related factors in patients with NVAF without anticoagulation treatment.Results In the multivariate model,the following factors were associated with an increased risk of SE in patients with NVAF:history of AF>5 years[odds ratio(OR)=2.75,95% confidence interval(CI)1.98-3.82,P<0.01],lipoprotein(a)>300 g/L(OR=2.07,95%CI 1.50-2.84,P<0.01),apolipoprotein(Apo)B>1.2 g/L(OR=1.91,95%CI 1.25-2.93,P=0.003),left ventricular ejection fraction(LVEF)of 30%-49%(0R=2.45,95%CI 1.63-3.69,P<0.01),left atrial diameter>40 mm(0R=1.54,95%CI 1.16-2.07,P=0.003),and CHA,DS,-VASc score≥3(OR=15.14,95%CI 2.05-112.13,P=0.01).ApoAI>1.6 g/L was negatively correlated with the occurrence of SE(OR=0.28,95%CI 0.15-0.51,P<0.01).Conclusions History of AF>5 years,lipoprotein(a)>300 g/L,elevated ApoB,left atrial diameter>40 mm,LVEF of 30%-49%,and CHA,DS,-VASC score>3 are independent risk factors for SE whereas ApoAI>1.6 g/L is a protective factor against SE in patients with NVAF.

关 键 词：老年人 心房颤动 栓塞 

分 类 号：R541.75[医药卫生—心血管疾病]