非瓣膜性心房颤动合并2型糖尿病患者的临床特征与生存状况研究

Analysis of clinical characteristics and survival status of patients with non-vaIvular atrial fibrillation complicated with type 2 diabetes mellitus

目的探讨非瓣膜性心房颤动(NVAF)并发2型糖尿病(T2DM)患者的临床特点,以及T2DM对NVAF患者生存状况的影响。方法选取2014年1月至2015年9月天津市胸科医院收治的646例NVAF患者,根据患者是否合并T2DM将其分为T2DM组(n=110)与非T2DM组(n=536)。比较两组的临床资料及随访1年脑梗死、心血管死亡的发生率,采用多因素Cox比例风险模型筛选影响患者1年内脑梗死、心血管死亡发生的因素。结果 T2DM组患者的年龄、体质量指数,高血压、冠心病、短暂性脑缺血发作(TIA)或脑卒中、高脂血症的发生率,以及阿司匹林、他汀类降脂药的应用率均明显高于非T2DM组,差异均有统计学意义(P<0.05)。随访1年,T2DM组患者心血管死亡的发生率为14.5%,明显高于非T2DM组的5.1%(P<0.05)。T2DM组、非T2DM组患者脑梗死的发生率分别为12.7%、6.4%,组间比较差异无统计学意义(P>0.05)。多因素Cox回归分析结果表明,年龄、TIA或脑卒中、T2DM是脑梗死发生的独立危险因素(P<0.05)。年龄、心力衰竭、T2DM是心血管死亡发生的独立危险因素,而血管紧张素转换酶抑制剂/血管紧张素Ⅱ受体阻滞剂是其独立保护因素(P<0.05)。结论合并T2DM可增加NVAF患者脑梗死与心血管死亡的风险。

Objective To investigate the clinical characteristics of patients with non-vaIvular atrial fibrillation （NVAF） combined with type 2 diabetes mellitus （T2DM）, and explore the effect of T2DM on survival status of patients with NVAF. Methods A total of 646 patients with NVAF in Tianjin Chest Hospital from January 2014 to September 2015 were enrolled in the study, and were divided into T2DM group （n： 110） and non-T2DM group （n= 536） according to whether these patients were complicated with T2DM. The clinical data, incidence rates of cerebral infarction and cardiovascular death after 1-year follow-up were compared between the two groups. Multivariate Cox regression analysis was performed to determine independent factors for cerebral infarction and cardiovascular death within 1 year. Results The age, body mass index,incidence rates of hypertension,coronary heart disease,transient ischemic attack （TIA） or stroke,and hyperlipidemia, and application rates of aspirin, statins in the T2DM group were higher than those in the non-T2DM group,there were statistically significant differences （P〈0.05）. After 1-year follow-up, the incidence rate of cardiovascular death in the T2DM group was 14.5% which was significantly higher than 5.1% in the non- T2DM group （P〈0.05）. The incidence rate of cerebral infarction within 1 year in the T2DM group and non-T2DM group were 12.7 % and 6.4 %, respectively. There was no significant difference in the incidence rate between the two groups （P〉0.05）. Multivariate Cox regression analysis showed that age,TIA or stroke history and T2DM were the independent risk factors for cerebral infarction （P〈0.05）. Age,heart failure and T2DM were the independent risk factors for cardiovascular death, and ACEI/ARB was an independent protective factor （P〈0.05）. Conclusion T2DM could increase the risk for cerebral infarction and cardiovascular death in patients with NVAF.