上海市浦东新区某社区60岁及以上人群心房颤动危险因素调查  

Risk factors of atrial fibrillation in people aged 60 years and above:a community-based study in Shanghai Pudong New Area

作　　者：孙欢 李小荣 杨春英 林颖 杨兵 SUN Huan;LI Xiaorong;YANG Chunying;LIN Ying;YANG Bing(Deparment of General Practice,Beicai Community Health Service Center of Pudong New Area,Shanghai 200125,China)

机构地区：[1]上海市浦东新区北蔡社区卫生服务中心全科,上海200125 [2]同济大学附属东方医院心内科

出　　处：《上海医学》2024年第12期719-723,共5页Shanghai Medical Journal

基　　金：上海市浦东新区科技发展基金(PKJ2021-Y70);上海市浦东新区卫生健康委员会卫生科技项目(PW2023A-17);上海市浦东新区卫生健康委员会卫生系统学科建设项目(PWZzk2022-03)。

摘　　要：目的探讨上海市浦东新区某社区60岁及以上人群心房颤动(简称房颤)发生的危险因素。方法2021年9—12月间采用随机整群抽样的方式抽取上海市浦东新区某社区(9个居委、2个村委)≥60岁行健康体格检查(简称体检)、12导联心电图检查和接受问卷调查的人群。将根据问卷调查和心电图检查确诊为房颤的患者纳入房颤组,在抽样人群中按年龄(±3岁)、性别比一致性进行1∶4频数匹配窦性心律人群作为对照组。比较两组患者人口学资料(性别、年龄、BMI、吸烟史、饮酒史)、合并疾病[高血压、糖尿病、冠心病、脑卒中、代谢综合征(MS)、高尿酸血症(UHA)]、实验室检查指标[红细胞分布宽度标准差(RDW-SD)、TC、TG、HDL-C、LDL-C、FBG、血肌酐、血尿酸]水平。将两组间差异有统计学意义(P<0.1)的因素纳入二元logistic回归模型,分析房颤发生的危险因素。根据危险因素构建风险回归预测模型,绘制ROC曲线。结果共调查8739人,确诊为房颤的患者(房颤组)178例(2.04%),匹配窦性心律人群(对照组)712人。房颤组合并高血压、糖尿病、冠心病、脑卒中、UHA患者比例,以及BMI、RDW-SD均显著高于对照组(P值均<0.05),TC、TG、LDL-C水平均显著低于对照组(P值均<0.05)。两组间年龄和男性、吸烟、饮酒、MS患者比例,以及HDL-C、FBG、血肌酐、血尿酸水平的差异均无统计学意义(P值均>0.05)。将单因素分析中P<0.1的指标高血压、糖尿病、冠心病、脑卒中、UHA、BMI、RDW-SD、TG、LDL-C纳入二元logistic回归模型的分析结果显示,高血压、糖尿病、冠心病、脑卒中和RDW-SD、BMI增高是房颤发生的独立危险因素(P值均<0.05),而TG和LDL-C水平升高与房颤的发生呈负相关(P值均<0.05)。以房颤发生的独立危险因素构建风险回归预测模型,绘制ROC曲线,AUC为0.736(95%CI为0.695~0.778,P<0.001),灵敏度为0.640,特异度为0.721,最佳截断值为0.361。HosmerObjective To explore the risk factors of atrial fibrillation(AF)in people aged≥60 years in a community in Shanghai Pudong New Area.Methods People aged≥60 years who underwent health check-up,electrocardiograms,and questionnaires survey in a community(9 neighborhood committees and 2 village committees)in Shanghai Pudong New Area between September and December 2021 were selected by random cluster sampling.Patients diagnosed with AF based on the questionnaire and ECG were included in the AF group.The sampled people with sinus rhythm based on 1∶4 frequency matching and age(±3 years)and sex ratio consistency were assigned to the control group.The demographic data(gender,age,BMI,history of smoking,and history of alcohol drinking),co-morbidities(hypertension,diabetes mellitus,coronary artery disease,stroke,metabolic syndrome,and hyperuricemia),and laboratory test indices(red cell distribution width-standard deviation[RDW-SD],total cholesterol[TC],triglyceride[TG],high-density lipoprotein cholesterol[HDL-C],low-density lipoprotein cholesterol[LDL-C],fasting blood glucose(FBG),blood creatinine,and blood uric acid)were compared between the two groups.The factors with statistically significant differences were included in a binary logistic regression model to analyze the risk factors for the occurrence of AF.A risk regression prediction model was constructed based on the risk factors and ROC curves were drawn.Results A total of 8739 people were investigated,and 178 patients(2.04%)were diagnosed with AF and 712 people with sinus rhythm were taken as control.The proportion of patients with hypertension,diabetes mellitus,coronary heart disease,stroke and hyperuricemia,as well as BMI and RDW-SD in the AF group were significantly higher than those in the control group(all P<0.05).The levels of TC,TG and LDL-C in the AF group were significantly lower than those in the control group(all P<0.05).There were no significant differences in the age,gender composition,proportion of patients with a history of smoking,alcohol drinkin

关 键 词：心房颤动 社区 老年人 危险因素 

分 类 号：R541.75[医药卫生—心血管疾病]