完全性右束支传导阻滞对住院患者全因死亡的预测价值

Predictive value of complete right bundle branch block in all-cause mortality in hospitalized patients

目的观察合并完全性左束支传导阻滞(CLBBB)或完全性右束支传导阻滞(CRBBB)住院患者的临床结局差异,探讨CRBBB在院内全因死亡中的预测价值。方法选择2007年1月至2017年1月于郑州市第九人民医院住院的合并CLBBB或CRBBB的1556例患者为研究对象。根据合并束支传导阻滞类型分为CLBBB组和CRBBB组,比较2组患者性别、年龄及合并疾病等临床资料。根据是否发生院内死亡分为死亡组和非死亡组,比较2组患者临床疾病、束支传导阻滞类型、性别及年龄等临床指标的差异。应用logistic回归分析院内全因死亡的预测因素。结果CLBBB组合并冠状动脉粥样硬化性心脏病(CHD)、急性心肌梗死(AMI)、扩张型心肌病(DCM)、其他心律失常患病率显著高于CRBBB组(P<0.05);CLBBB组男性占比、合并高血压病、糖尿病(DM)患病率及病死率显著低于CRBBB组(P<0.05);2组患者年龄、合并肿瘤和高脂血症患病率比较差异均无统计学意义(P>0.05)。院内死亡患者44例(2.8%),死亡组患者年龄大于非死亡组,合并AMI、CRBBB及肿瘤患病率均高于非死亡组(P<0.05);2组合并CHD、DCM、高血压病、DM、高脂血症患病率比较差异均无统计学意义(P>0.05)。校正年龄、AMI和肿瘤后,CRBBB是住院患者全因死亡的独立预测因素[比值比=3.682,95%置信区间(CI):1.249~10.865,P=0.018]。该模型用于预测院内全因死亡的受试者工作特征曲线下面积为0.833(95%CI:77.6%~88.9%,P<0.001)。结论合并CRBBB可增加住院患者的全因死亡率,CRBBB是与AMI和年龄等传统全因死亡危险因素同等重要的心电指标,CRBBB可作为院内全因死亡的独立危险因素。

Objective To observe the differential clinical outcomes of inpatients with complete left bundle branch block(CLBBB)or complete right bundle branch block(CRBBB),and investigate the predictive value of CRBBB in all-cause death in hospitalized patients.Methods A total of 1556 inpatients with CLBBB or CRBBB hospitalized at the Ninth People′s Hospital of Zhengzhou from January 2007 to January 2017 were selected as research subjects.According to the bundle branch block chamber,the patients were divided into the CLBBB group and the CRBBB group.The clinical data of the patients were compared between the two groups,including gender,age and complicated diseases.And the patients were divided into the death group and the non-death group based on whether or not the death was occurred.The differences in clinical indicators of the patients between the two groups were compared,including clinical disease,type of bundle branch block,gender,age,etc.Multivariate logistic regression analysis was used to analyze the predictor of in-hospital all-cause.Results The prevalence rate of combined coronary atherosclerotic heart disease(CHD),acute myocardial infarction(AMI),dilated cardiomyopathy(DCM)and other arrhythmia in the CLBBB group were significantly higher than those in the CRBBB group(P<0.05).The constituent ratio of male,the prevalence rate of combined hypertension and diabetes mellitus(DM)and mortality in the CLBBB group were significantly lower than those in the CRBBB group(P<0.05).There was no significant difference in the age,prevalence rate of combined cancer and hyperlipidemia of the patients between the two groups(P>0.05).Forty-four patients(2.8%)died in the hospital.The age of the patients,prevalence rate of combined AMI,CRBBB and tumer in the death group were significantly higher than those in the non-death group(P<0.05).There was no significant difference in the prevalence rate of combined CHD,DCM,hypertension,DM,and hyperlipidemia between the two groups(P>0.05).CRBBB was an independent predictor of in-hospital all-cause death after adjusting for age,AMI and tumor[odds ratio=3.682,95%confidence interval(CI):1.249-10.865,P=0.018].Area under the receiver operating characteristic curve of the model used to predict in-hospital all-cause mortality was 0.833(95%CI:77.6%-88.9%,P<0.001).Conclusion Combining CRBBB can increase the all-cause death of hospitalized patients.CRBBB is an indicator in ECG which is as important as traditional risk factors for all-cause death such as AMI and age.CRBBB can be used as an indepen-dent risk factor for all-cause death in the hospital.