非瓣膜性房颤的危险因素分析

A multi-factor clinical study on nonvalvular atrial fibrillation

目的 探讨非瓣膜性房颤的危险因素并建立初步预警评分系统.方法 入选 2014年1月至2016年1月本院心内科的住院患者,其中房颤患者236例,选取同时期窦性心律患者作为对照组（291例）,收集其一般信息、心脏彩超资料、实验室资料,以单因素分析筛选出具有统计学意义的危险因素,再通过多元逐步Logistic回归分析确定非瓣膜性房颤患者的独立危险因素,进而根据各危险因素的比值比（OR值）,初步建议预警评分系统,应用受试者工作特征（ROC）曲线下面积（AUC）评价其分辨能力,采用Hosmer-Lemeshow拟合优度检验评价其校准能力.结果 单因素分析显示,年龄、卒中、心衰、糖尿病、高血压、左房直径（LAD）、左室射血分数（LVEF）、短缩率（FS）、左室舒张末内径（LVEDD）、左室收缩末内径（LVESD）、血山型半胱氨酸（HCY）、三酰甘油（TG）、总胆固醇（TC）、高密度脂蛋白（HDL）、低密度脂蛋白（LDL）、铜蓝蛋白（CER）是房颤的危险因素.经多元Logistic回归分析显示矫正性别、年龄、常见并发症等混杂因素后,LAD、HCY是房颤的独立危险因素,TG、TC、HDL、LDL在一定程度上是房颤的保护因素.进而初步建立房颤的预警评分系统,总分为各独立危险因素评分之和,总分为3.5分,结合Youden指数,预测房颤的最佳界值为1.25分.从而得知风险评分标准：评分〈1.25分为低危风险,评分≥1.25分为高危风险.此评分系统分辨能力较高（AUC=0.841,P〈0.000）,具有较好的校准能力（Hosmer-Lemeshow拟合优度检验P=0.235）.结论 矫正性别、年龄、常见合并症等混杂因素后,LAD、HCY是非瓣膜性房颤的独立危险因素,TG、TC、HDL、LDL是保护因素,初步建立房颤预警评分系统有助于早期预测房颤发生风险,做到早期预防.

Objective To investigate the risk factors for nonalvular atrial fibrillation and to establish a prediction score system for it.Methods Totally 236 hospitalized patients with nonvalvular atrial fibrillation and 291 patients with the sinus rhythm rate who were selected as control group,who were admitted to cardiovascular internal medicine,were enrolled during January 2014 to January 2016.Collected the dates include Demographic,color sonography,laboratory examinations for all patients.Nonvalvular atrial fibrillation risk factors and it OR values were determined after statistically analyzed date by One-Way ANOVA,multivariate logistics regression analysis.Prediction score system for nonvalvular atrial fibrillation was further established by area under the ROC curve and Hosmer-Lemeshow goodness of fit test.Results One-Way ANOVA showed that age,stroke,heart failure,Diabetes,Hypertension,Left atrial diameter,Left ventricular ejection fraction,left ventricular fractional shortening,Left ventricular end-diastolic diameter,left ventricular end-systolic dimension,homocysteine,Triglycerides,Totl cholesterol,high-density lipoprotein,Low density lipoprotein and ceruloplasmin were risk fators for nonvalvular atrial fibrillation.Logistic analysis showed that left atrial diameter and homocysteine were independent factors associated with nonvalvular atrial fibrillation,and Triglycerides,Totl cholesterol,high-density lipoprotein and Low density lipoprotein were the protective factors to a certain extent,after correct the confounding factors such as age,gender and common complication.Prediction score system was established which the highest score was 3.5.A risk score of 1.25 points was determined by Youden′s index,as the optimal cut-off for predict nonvalvular atrial fibrillation.Patients with 〈1.25 points were considered by low risk,and ≥1.25 points were considered at high risk for nonvalvular atrial fibrillation.The prediction score system of nonvalvular atrial fibrillation showed adequate discrimination（area under ROC curve was 0.841） and calibration（Hosmer-Lemeshow statistic test,P=0.235）.Conclusion Logistic analysis showed that left atrial diameter and homocysteine were independent factors associated with nonvalvular atrial fibrillation,and Triglycerides,Totl cholesterol,high-density lipoprotein and Low density lipoprotein were the protective factors,after correct the confounding factors such as age,gender and common complication.The clinical prediction score system may help clinicians to make pre-intervention for patients with high nonvalvular atrial fibrillation risk.