吸烟的非瓣膜性房颤患者的临床特性分析

Analysis of the clinical characteristics of smoking patients with non-valvular atrial fibrillation

目的:探讨吸烟的非瓣膜性心房颤动(房颤)患者的临床特性及吸烟对房颤的影响。方法:入选2010年1月至2016年12月于新疆医科大学第一附属医院住院治疗的非瓣膜性房颤患者1 297例,根据是否有主动吸烟史将患者分为吸烟组(n=452)与不吸烟组(n=845),分析两组房颤患者的一般临床资料,比较不同吸烟指数下、不同房颤类型下患者的临床特点。采用logistic回归分析吸烟是否为非阵发性房颤的独立危险因素。结果:吸烟组患者平均年龄明显小于不吸烟组,男性比例、合并心肌病比例、体质量指数、血肌酐、室间隔厚度、左房内径均高于不吸烟组(P均<0.05)。根据吸烟指数将吸烟组患者分为轻度组(n=269)、中度组(n=118)和重度组(n=65),3组的阵发性房颤占比的差异有统计学意义(52.4%对47.5%对35.4%,P<0.05),在两两比较中,轻度组与重度组阵发性房颤占比的差异有统计学意义(P<0.05);3组LAD的差异有统计学意义[(39.07±6.26)mm对(41.21±7.09)mm对(44.60±6.04)mm,P<0.05],组间两两比较均有统计学差异(P均<0.05)。根据房颤类型不同将吸烟组患者分为阵发性房颤组(n=220)、持续性房颤组(n=200)和永久性房颤组(n=32),持续性房颤组吸烟指数明显高于阵发性房颤组(P<0.05)。二分类logistic回归分析中,调整年龄、冠状动脉粥样硬化性心脏病、糖尿病、高血压、慢性肾衰竭、慢性阻塞性肺疾病等房颤的常见危险因素后,吸烟是非阵发性房颤的独立危险因素(OR=1.407,95%CI:1.109~1.786,P=0.005)。结论:吸烟的房颤患者趋于年轻化,左房内径较大;吸烟是非阵发性房颤发生的独立危险因素。

Objective：To investigate the clinical characteristics of smoking patients with nonvalvular atrial fibrillation（AF）and the effect of smoking on atrial fibrillation. Methods：A total of1 297 patients with non-valvular AF who were admitted to First Affiliated Hospital of Xinjiang Medical University from January 2010 to December 2016 were enrolled.According to the active smoking history,AF patients were divided into smoking group（n=452）and non-smoking group（n=845）.The general clinical data of two groups were analyzed,and the clinical characteristics were compared in patients with different type of AF and different smoking index.Logistic regression analysis was used to analyze whether smoking is an independent risk factor for non-paroxysmal AF. Results：The average age of the smoking group was significantly lower than that of non-smoking group,while the proportion of men,cardiomyopathy,body mass index,serum creatinine,IVST and LAD were higher than those in non-smoking group（all P〈0.05）.According to smoking index,the smoking patients were divided into mild group（n=269）,moderate group（n=118）and severe group（n=65）.The difference between the3 groups in proportion of paroxysmal AF was statistically significant（52.4% vs.47.5% vs.35.4%,P〈0.05）.In the post hoc multiple comparison,there was significant difference between the mild group and severe group（P〈0.05）.The difference of LAD between the 3 groups was statistically significant[（39.07±6.26）mm vs.（41.21±7.09）mm vs.（44.60±6.04）mm,P〈0.05],and there were statistically significant differences between each two groups（all P〈 0.05）.According to the different types of AF,the patients of smoking group were divided into paroxysmal AF group（n=220）,persistent AF group（n=200）and permanent AF group（n=32）.The smoking index of persistent AF group was significantly higher than that of paroxysmal AF group（P〈0.05）.In the logistic regression analysis,smoking is an independent risk factor for non-paroxysmal AF after adjusting the common risk factors such as age,coronary heart disease,diabetes,hypertension,chronic renal failure and chronic obstructive pulmonary disease（OR=1.407,95%CI：1.109~1.786,P=0.005）. Conclusions：Smoking patients with AF tend to be younger and have larger LAD.Smoking is an independent risk factor for occurrence of non-paroxysmal atrial fibrillation.