慢性肾功能受损对心房颤动患者心脑血管死亡的影响

Effects of chronic renal damage on cardiovascular death in patients with atrial fibrillation

目的探讨慢性肾功能受损对心房颤动（简称房颤）患者心脑血管死亡的影响。方法2006～2007年开滦（集团）有限责任公司职工进行体检和问卷调查。经12导联心电图及体检筛选非瓣膜房颤患者。根据估算肾小球滤过率（eGFR），分为≥90、60～89和〈60组，随访71．5个月计算各组心脑血管死亡率，采用Cox比例模型对eGFR及其他影响房颤患者心脑血管死亡因素进行分析。结果①389例房颤患者心脑血管死亡80例，累积死亡率为20．6％。≥90、60-89、〈60组累积心脑血管死亡率分别为9．6％、21．2％、26．9％（P=0．024）；②以心脑血管死亡为因变量，以eGFR为自变量，校正可能影响房颤患者心脑血管死亡的所有因素建立Cox比例模型，以≥90组为参照，〈60组心脑血管死亡风险比为2．589（95CI：1．047～6．400），心力衰竭、血尿酸是影响房颤患者心脑血管死亡的独立危险因素，风险比为2．241（95CI：1．244～4．037）、1．003（95CI：1．001～1．005），体重指数（BMI）为保护性因素，风险比为0．912（95CI：0．857～0．971）。结论①随eGFR下降，房颤患者心脑血管死亡风险增加。②心力衰竭、血尿酸是房颤患者心脑血管死亡的独立危险因素，BMI是保护性因素。

Objective To observe effects of chronic renal damage on cardiovascular death in patients with atrial fibrillation（AF）. Methods From 2006 to 2007,101 510 staff members of kailuan （group） co. LTD participated in physical examination and completed unified questionnaires. By 12-lead electrocardiogram and physical examination to observe patients with nonvalvular AF. According to the estimated glomerular filtration rate （eGFR）,all patients with AF were divided into ≥ 90, 60-89 and 〈 60 group. After an average follow-up of 71.5 months, patients of each group were calculated cardiovascular mortality. By using the Cox proportional hazards model , eGFR and other factors affecting cardiovascular death in patients with AF were analyzed. Results O80 cases of cardiovascular death in 389 patients with AF, cumulative mortality was 20. 6%. Cumulative cardiovascular mortality rates of 90, 60-89 and 60 groups were 9.6%, 21.2% and 26.9% respectively（P=0. 024）;（2）To make cardiovascular death as the dependent variable, eGFR grouped as independent variables, and after correction of all influence factors of cardiovascular death of AF ,Cox proportional hazards model was set up. eGFR ≥ 90 ml/（min. 1.73 m^2） as reference, risk of cardiovascular death ratio in eGFR 〈 60 ml/（min. 1.73 m^2） group was 2. 589 （95 CI： 1. 047-6. 400）. Heart failure, blood uric acid were independent risk factors of cardiovascular death in patients with AF and the risk ratio was 2. 241 （95 CI： 1. 244-4. 037）, 1. 003 （95 CI： 1. 001-1. 005）, and BMI was protective factors, risk ratio was 0. 912 （95 CI： 0. 857-0. 971）. Conclusions OWith eGFR decreased, risk of cardiovascular death in patients with AF is increased. （2）Heart failure, blood uric acid were independent risk factors of cardiovascular death in patients with AF, BMI is the protective factors of cardiovascular death. [ Chinese Journal of Cardiac Pacing and Electrophysiology, 2016,30 （3） ： 242 -- 245]