性别与原发性高血压病程在非瓣膜病心房颤动相关的首次栓塞中的交互作用

Sex interacts with duration of hypertension on non-valvular atrial fibrillation related initial thromboembolism

目的:探讨原发性高血压(essential hypertension,EH)病程在不同性别中对非瓣膜病心房颤动(nonvalvular atrial fibrillation,NVAF)相关的首次血栓栓塞风险的影响。方法:连续纳入2010年1月1日至2018年12月31期间住院且年龄≥16岁的心房颤动患者进行回顾性分析。以370例首次血栓栓塞的NVAF患者为病例组,2002例无血栓栓塞的NVAF患者为对照组。将所有研究对象按照无EH,EH病程≤10年、EH病程>10年及性别分为参照组(无EH的女性),无EH的男性组(无EH的男性),EH病程≤10年的女性组,EH病程>10年的女性组,EH病程≤10年男性组及EH病程>10年的男性组。采用logistic回归分析各组间的首次血栓栓塞风险,同时采用相加模型和相乘模型评价EH病程与性别在首次血栓栓塞中的交互作用。校正的因素有近期心力衰竭、年龄、2型糖尿病、血管疾病(心肌梗死、动脉狭窄)、血清肌酐、PT国际标准化比值(international normalized ratio,INR)、服用新型口服抗凝剂。结果:经多因素校正后与参照组相比,无EH男性组OR为1.40(95%CI:1.00~1.96,P=0.0048),EH病程≤10年的女性组OR为2.49(95%CI:1.74~3.55,P<0.001),EH病程>10年的女性组OR为1.93(95%CI:1.00~3.72,P=0.048);EH病程≤10年的男性组OR为2.56(95%CI:1.75-3.76,P<0.001),EH病程>10年的男性组OR为4.42(95%CI:2.54~7.70,P<0.001)。当EH病程>10年,超额相对危险度为2.35(95%CI:0.01~4.68)。EH病程与性别在logistic回归中的乘积项P始终>0.05。结论:EH病程与性别在NVAF相关的首次栓塞中存在相加交互作用。在NVAF患者中,合并EH病程>10年的男性发生栓塞风险最高,约为无EH女性的4倍。

Objective:To evaluate the risk of non-valvular atrial fibrillation(NVAF)related initial thromboembolism for different duration of essential hypertension(EH)among different sex.Methods:A total of 370 cases and 2002 controls were retrospectively analyzed with Logistic regression.According to different sex and duration of EH,the patients were divided into a reference group(non-EH women),a non-EH men group,a women with duration of EH≤10 years group,a women with duration of EH>10 years group,a men with duration of EH≤10 years group,and a men with duration of EH>10 years group.We evaluated the interactions with the measures of effect modification on both additive(relative excess risk due to interaction,RERI)and multiplicative scales.Results:Compared with the reference group,the multivariable-adjusted OR(95%CI)was 1.40(1.00–1.96)in the non-EH men group,2.49(1.74–3.55)in the women with duration of EH≤10 years group,1.93(1.00–3.72)in the women with duration of EH>10 years group,2.56(1.75–3.76)in the men with duration of EH≤10 years group and 4.42(2.54–7.70)in the men with duration of EH>10 years group.RERI(95%CI)is 2.35(0.01–4.68)in the men with duration of EH>10 years group,with significant difference.But there is no interaction between duration of EH and sex on multiplicative scale.Conclusion:Duration of EH interacts with sex in initial thromboembolism on an additive scale.The risk of initial thromboembolism for NVAF men with duration of EH>10 years is almost 4 times of that for non-EH women.NVAF men with duration of EH>10 years may further benefit from more aggressive strategy of anticoagulation.