血液透析患者心房颤动患病率的横断面调查研究

A cross-sectional study on the prevalence of atrial fibrillation in hemodialysis patients

目的心房颤动作为血液透析患者一种常见的心律失常,其患病率高于一般人群。国外既往大量的横断面和队列研究报道血液透析患者心房颤动的患病率在2.8%～27%之间,我国尚缺少此类研究的报道,了解心房颤动在透析患者中的情况,可为患者预防和治疗措施的制定提供一定的依据。本研究的目的是调查北京大学第一医院2个血液透析中心患者心房颤动的患病率、相关危险因素及治疗情况。方法以在北京大学第一医院2个血液透析中心的305例长期透析患者为研究对象,进行心电图检查及病史的收集,记录患者基础资料、主要临床诊断及合并疾病、吸烟史、饮酒史等资料。心房颤动由心电图或既往确切病史判定。计算总体及每个血液透析中心心房颤动的患病率,比较心房颤动与非心房颤动2组间各个因素的差异,利用Logistic回归分析与心房颤动发生的关联因素,对心房颤动患者进行CHA2DS2-VASc评分,调查患者的治疗情况。结果 2中心整体的心房颤动患病率是9.8%,其中阵发性心房颤动占73.3%,持续性心房颤动占26.7%。其中急诊血液透析中心的心房颤动患病率是9.0%,第三住院部血液透析中心的心房颤动患病率是11.7%。心房颤动与非心房颤动患者在年龄、合并冠心病、心肌梗塞和血管疾病存在差异。有心房颤动的透析患者中小于55岁的占6.7%,55～64岁的占23.3%,65～74岁的占26.7%,大于75岁的占43.3%,其患病率随年龄增加而增加。Logistic回归分析显示年龄和血管疾病与心房颤动发生显著相关(OR=1.042,95%CI:1.006～1.078,P=0.020;OR=3.854,95%CI:1.358～10.942,P=0.011),性别、吸烟、饮酒、高血压、糖尿病、恶性肿瘤等与心房颤动无显著相关性。心房颤动患者中有13人进行了抗凝抗血小板治疗,治疗率为43.3%。结论心房颤动的患病率高与年龄和血管疾病显著相关,标准抗凝治疗率低。

Objective Atrial fibrillation （AF） is a common arrhythmia in hemodialysis patients and its prevalence is higher in hemodialysis patients than in general population. Cross-sectional and cohort studies reported that the prevalence of AF in hemodialysis patients was between 2.8% and 27%. The purpose of this study was to investigate the prevalence of AF, its related risk factors and treatment in patients in the two hemo- dialysis centers of our hospital. Methods A total of 305 patients with long-term hemodialysis were recruited in the two hemodialysis centers of our hospital. They accepted electrocardiogram （ECG） examination. We col- lected their medical information including demographic data, clinical diagnosis, comorbidity, smoking and drinking history. Atrial fibrillation was determined by ECG or previous diagnostic history. We then calculated the prevalence of AF and compared the differences between the groups with AF and without AF. The factors associated with AF were analyzed by logistic regression. CHA2DS2-VASc score was used for patients with AF. Results The overall prevalence of AF was 9.8%, in which 73.3% were paroxysmal AF and 26.7% were persistent AF. The prevalence of AF was 9.0% in the hemodialysis center in emergency department and 11.7% in the Third Inpatient Department of our hospital. There axe differences in age, coronary heart disease, myocar- dial infarction and vascular disease between patients with AF and without AF. The prevalence of AF increased with age. In AF patients, 6.7% patients were younger than 55 years old, 23.3% were between 55-64 yearsold, 26.7% aged between 65-74 years old, and 43.3% aged ≥75 years old. Multivariate analyses showed that AF was independently associated with age （odds ratio： 1.042 per year increase, 95% CI： 1.006-1.078, P= 0.020） and vascular diseases （OR=3.854, 95% CI 1.358-10.942, P=0.011）. Thirteen AF patients accepted an- ticoagulant and antiplatelet therapy and the treatment rate was 43.3%. Conclusions The prevalence of AF was associated with older age and vascular diseases. The rate of standard anticoagulant therapy was lower in this cohort of patients.