老年人509例病理资料分析心房颤动与冠心病的关系

Investigate the relation between atrial fibrillation and coronary heart disease in the elderly:an analysis of pathological data of 509 cases

目的根据老年人尸体解剖资料探讨心房颤动(房颤)与冠心病的关系。方法查阅院内56年1012例老年连续尸体解剖病例的临床及病理资料,入选有生前心电图记录者540例,其中31例缺少心脏解剖资料。结果 (1)房颤发生率随年龄的增长而显著增加(Coehran-Armitage 趋势检验,P<0.01)。(2)房颤患者冠心病发病率显著增加(P=0.0028);房颤组心肌梗死发病率明显高于窦性心律组(P=0.014.4);房颤组冠状动脉病变程度较窦性心律组明显严重(P=0.0121)。(3)经多元 Logistic 回归分析,发现年龄(OR=1.34,95%CI 为1.11～1.60)、男性(OR=5.71,95%CI 1.87～17.39)、慢性心功能不全(OR=1.87,95% CI1.27～2.76)可能是房颤的独立危险因素,冠心病(OR=1.47,95% CI 0.91～2.39)并非房颤的独立危险因素。结论老年人房颤发病率随着年龄增加而显著增加,老年房颤患者冠心病发病率明显增加,但冠心病并非房颤的独立危险因素。

Objective To investigate the relation between atrial fibrillation（AF） and coronary heart disease according to the pathological data. Method Total 540 out of 1012 anatomic older cases were admitted to our study, according to the clinical and pathological data in our hospital. Results （ 1 ） The incidence of AF increased significantly with aging （Cochran： Armitage trend test, P 〈0.01 ）. （2） The AF patients were more likely to accompany coronary heart disease （ P = 0. 0028 ） based on the anatomical documentation; the incidence of myocardial infarction in the AF group was statistifically significant higher than that in the sinus rhythm group（P = 0. 0144）. The level of coronary arterie lesion in AF group was statistifically significant severe than that in the sinus rhythm group. （3）Age（ OR = 1.34, 95% CI 1.11 - 1.60） ,male （ OR = 5.71, 95% CI 1.87 - 17.39） and chronic heart failure（ OR = 1.87, 95% CI 1.27 - 2. 76） were independent risk factors of AF based on muhivariant logistic analysis , while coronary heart disease （ OR = 1.47, 95% CI 0.91 - 2. 39 ） was not an independent risk factor. Conclusions The incidence of AF increases significantly with aging in the elderly. The AF patients seem more likely to accompany coronary heart disease hut coronary heart disease may be not the independent risk factor of AF in the elderly.