湖北地区慢性收缩性心力衰竭患者房性心律失常分布调查

The prevalence and correlated risk factors of atrial arrhythmia in patients with chronic systolic heart failure in Hubei province

目的了解慢性收缩性心力衰竭（CSHF）住院患者房性心律失常的分布及相关影响因素。方法回顾性调查和分析湖北地区武汉、黄石、孝感、襄樊、十堰、宜昌、荆州、咸宁8市12家三级甲等医院2000年至2010年CSHF住院患者资料，多因素logistic回归分析房性早搏（房早）、房性心动过速（房速）和心房颤动（房颤）相关危险因素。结果CSHF住院患者房早、房速和房颤发生率分别为35．39％、23．57％和40．81％。多因素logistic回归分析发现：（1）房速和房颤的发生风险（HR）随年龄增加而增加（与≤40岁组相比，41～50岁、51～60岁、61～70岁、71～80岁和≥81岁组房速HR分别为1．210、1．597、1．635、2．117和2．216；房颤HR分别为1．670、2．315、3．103、3．805和5．018）；（2）房速和房颤HR随左心室射血分数（LVEF）降低而显著增加（与LVEF0．41～0．50组相比，LVEF0．31～0．40、0．21～0．30和≤0．20组房速HR分别为1．238、1．541和2．169；房颤HR分别为1．565、1．640和2．104）；（3）与冠心病组相比，扩张性心肌病、高血压性心脏病和风湿性心脏病组房颤HR分别为1．876、1．297和12．111。结论CSHF住院患者房性心律失常常见。房速和房颤HR随年龄增加和LVEF减低而增加，房颤HR在不同病因引起的CSHF患者中存在差异。

Objective To investigate the prevalence of atrial arrhythmia including premature atrial contract （PAC） , atrial taehyeardia （AT） and atrial fibrillation （AF） and to analyze the correlation between atrial arrhythmia and age, NYHA heart function classification, left ventrieular ejection fraction （LVEF） and etiology, respectively in patients with chronic systolic heart failure（CSHF） in Hubei province. Methods Data of in-hos- pital patients with CSHF were investigated between 2000 and 2010 from 12 hospitals in Hubei Prov- ince. Univariate and multivariate logistic proportional hazard analysis were performed to determinate the relation- ships between atrial arrhythmia and age, NYHA heart function classification, LVEF, etiology, respective- ly. Results （ 1 ） PAC,AT and AF were common in patients with CSHF which account for 35.39% ,23.57% and 40. 81%, respectively. （2） Compared with patients in ~〈40 years group, the HRs （ 95% CI） of AT and AF for patients in 41-50,51-60,61-70,71-80 and ~〉80 age were 1. 210（ 1. 049-1. 351 ,P=O. 04）, 1. 597（ 1. 296- 1. 872,P〈0. 01 ） ,1. 635（ 1. 336-1. 950, P〈0. 01 ） ,2. 117（ 1. 901-2. 329,P〈0. 01 ） ,2. 216（ 1. 983-2. 471 ,P〈 0. O1 ） ,respectively, and 1. 670 （ 1. 237-2. 253, P〈O. 01 ）, 2. 315 （ 1. 759-3. 047, P〈O. 01 ）, 3. 103 （ 2. 368- 4. 067, P〈0. 01 ）, 3. 805 （2. 911-4. 972, P〈0. 01 ） , 5.018 （3.771- 6. 676, P〈0. 01 ）, respectively. （3）The HRs （95 % CI）of AT and AF for patients in LVEF 0. 31 -0. 40,0. 21 -0. 30 and ~〈 0.20 group were 1. 238 （1.112- 1. 369 ,P= 0. 01 ）, 1. 541 （ 1. 290-1. 761, P〈0. 01 ）, 2. 169 （ 1. 774-2. 537, P〈0. O1 ）, respectively, and 1. 565 （ 1. 446 - 1.717, P〈 0. 01 ）, 1. 640 （ 1. 225-1. 923, P 〈 0.01 ）, 2. 104 （ 1. 925-2. 223, P 〈 0.01 ）, respectively, com- pared with patients in LVEF 0. 41 ~ 0. 50 group. （4） The HRs（95% CI） of AF for patients with dilated car-diomyopathy,hypertension heart disease or valvular heart disease were 1. 876（ 1. 608-2. 188 ,P〈0. 01 ）, 1. 297 （ 1. 132-1. 486,P〈0. 01 ） and 12. 111 （9. 820-14. 937,P〈0. 01 ）, respectively, compared with patients in coro- nary heart disease group. Conclusion Atrial arrhythmia is common in patients with CSHF. The risk of AT and AF morbidity increases as age inereases or LVEF decreases.decreases. The prevalence of AF varies in patients with different etiology.