糖尿病与非糖尿病患者发生心律失常类型和危险因素分析

Analyses of types and risk factors of cardiac arrhythmias in hospitalized patients with and without diabetes mellitus

目的分析糖尿病与非糖尿病住院患者的心律失常类型和危险因素。方法回顾性分析北京大学人民医院1998年10月至2008年9月期间住院的3 489例心律失常患者。其中,糖尿病组501例,非糖尿病组2 988例。比较两组心律失常类型和危险因素的构成比。结果单变量分析表明,糖尿病与心房颤动(P=0.01)、房室传导阻滞(P<0.01)有关。多变量分析表明,心律失常与下列因素呈独立相关:冠心病[相对危险度比值比(OR):1.46;95%的可信区间(CI):1.08～1.98;P=0.01]、高血压(OR:2.50;95%CI:1.96～3.20;P<0.01)、甲状腺功能减低症(OR:3.06;95%CI:1.56～6.02;P<0.01)、胃炎(或消化性溃疡)(OR:0.60;95%CI:0.37～0.97;P=0.04)、自身免疫性疾病(OR:2.99;95%CI:1.32～6.77;P<0.01)、年龄≥65(OR:1.56;95%CI:0.22～2.00;P<0.01)及血糖升高(OR:2.18;95%CI:2.01～2.37;P<0.01)。结论糖尿病与心房颤动、房室传导阻滞有关。非糖尿病组发生心律失常主要与高龄及冠心病、高血压、甲状腺功能减低症、胃炎(或消化性溃疡)、自身免疫性疾病等合并症有关;而糖尿病组年龄较轻,其心律失常主要与血糖升高等代谢因素相关。

Objective To investigate the types and risk factors of cardiac arrhythmias in hospitalized patients with and without diabetes mellitus. Methods The inpatient medical records of patients with cardiac arrhythmias in the People＇s Hospital of Peking University from October 1998 to September 2008 were retrospectively analyzed in our present study. All patients were divided into diabetes group（n =501 ） and non-diabetes group（n = 2988 ）. Their clinical characteristics were compared and the risk factors were also investigated. Results Univariate analysis demonstrated that diabetes mellitus was associated with atrial fibrillation（AF） and atrioventricular block（P 〈 0. 01 ）. Multivariate analysis demonstrated that cardiac arrhythmias were independently associated with coronary heart disease（CHD） [ odds ratio （OR） ： 1.46; 95% confidence interval （CI） ： 1.08 -1.98; P=0.01], hypertension （OR： 2.50; 95% CI： 1.96 -3.20; P〈0.01）, hypothyroidism （ OR ： 3.06 ; 95 % CI ： 1.56 - 6.02 ; P 〈 0.01 ）, gastritis/alimentary ulcer （ OR ：0.60 ; 95 % CI：0.37 - 0.97 ; P = 0.04）, immune system disease （OR：2.99; 95% CI：1.32 -6.77; P〈0.01）, age（~〉65） （OR：1.56; 95% CI：0.22 - 2.00; P〈0.01）, and hyperglycemia （OR：2.18; 95% CI：2.01 -2.37; P〈0.01）. Conclusions Diabetes mellitus is associated with AF and atrioventricular block. The risk factors in non-diabetes group includ CHD, hypertension, hypothyroidism, gastritis/alimentary ulcer, immune system disease,older age. The patients with diabetes mellitus are younger compared with non-diabetes ones, and hyperglycemia and other metabolic disturbance are responsible for their cardiac arrhythmias.