不同性别老年非瓣膜性心房颤动患者的临床特点

Clinical characteristics of different gender elderly nonvalvular AF patients

目的分析老年女性非瓣膜性心房颤动(房颤)住院患者的临床特点。方法收集2019年1月~2020年6月天津中医药大学第一附属医院心血管科首次就诊且通过24 h动态心电图或多导心电图确诊的老年非瓣膜性房颤患者203例,其中老年男性组96例,老年女性组107例。比较2组一般临床资料、实验室检查指标、心脏彩色多普勒超声、用药特点等相关指标。结果与老年男性组比较,老年女性组年龄、心率、持续性房颤、心力衰竭、高血压、脑卒中、TC、HDL-C、LDL-C和D-二聚体水平明显升高,吸烟、饮酒、阵发性房颤、肌酐和糖化血红蛋白水平明显降低(P<0.05,P<0.01)。与老年男性组比较,老年女性组平均肺动脉压、HAS-BLED评分和CHA2DS2-VASc评分明显升高,左心室舒张末期内径明显降低,差异有统计学意义(P<0.05,P<0.01)。与老年男性组比较,老年女性组使用β受体阻滞剂、抗血小板药物、洋地黄类比例明显升高(87.9%vs 74.0%,32.7%vs 18.8%,27.1%vs 15.6%,P<0.05),抗凝药物比例明显降低(82.2%vs 92.7%,P<0.05)。结论老年女性非瓣膜性房颤住院患者年龄偏大、心率较快,血栓栓塞及出血风险更高,更易合并心力衰竭、高血压、脑卒中等疾病。

Objective To analyze the clinical characteristics of hospitalized elderly female nonvalvular AF patients.Methods Two hundred and three elderly nonvalvular AF patients with their diagnosis established by 24 h echocardiography in our hospital from January 2019 to June 2020 were divided into female nonvalvular AF group(n=107) and male nonvalvular AF group(n=96).Their general clinical data, laboratory testing and color-Doppler echocardiography parameters, medication characteristics were compared.Results The age was significantly older, the heart rate, incidence of persistent AF,HF,hypertension, cerebral stroke and serum levels of TC,HDL-C,LDL-C,D-dimer were significantly higher while the history of smoking and alcohol consumption was significantly shorter, the incidence of paroxysmal AF and serum levels of creatinine and HbA1 c were significantly lower in female nonvalvular AF group than in male nonvalvular AF group(P<0.05,P<0.01).The mean pulmonary arterial pressure, HAB-BLED score and CHA2DS2-VASC score were significantly higher while the end-diastolic left ventricular diameter was significantly shorter in female nonvalvular AF group than in male nonvalvular AF group(P<0.05,P<0.01).The ratio of using β-blockers, antiplatelet drugs and digitalis was significantly higher while that of using anticoagulant drugs was significantly lower in female nonvalvular AF group than in male nonvalvular AF group(87.9% vs 74.0%,32.7% vs 18.8%,27.1% vs 15.6%,P<0.05;82.2% vs 92.7%,P<0.05).Conclusion The hospitalized elderly female nonvalvular AF patients are older with a faster heart rate, a higher risk of thromboembolism and bleeding, and are more likely complicated with HF,hypertension, and cerebral stroke.