开滦集团社区心房颤动人群全因死亡及其相关因素的观察

Observation on all-cause death and related factors of atrial fibrillation in Kailuan Group Community

目的 探讨社区非瓣膜性心房颤动(简称房颤)患者全因、心脑血管死亡率及危险因素。方法 2006~2007年度对开滦(集团)有限责任公司在职和离退职工101 510例进行健康体检,对经12导联心电图检出的房颤患者作为观察对象。课题组专人每半年进行一次电话随访,每2年进行一次面对面随访。住院期间死亡者由经过培训的医务人员调取住院病历,根据ICD~10疾病编码确定死因。非住院死亡者与所在工作单位工会和(或)户口所在地的派出所核实。至2013年12月31日完成末次随访。采用Cox比例风险模型分析影响房颤患者全因、心脑血管死亡的危险因素。结果 (1)438例房颤患者,排除器质性心脏病和瓣膜性房颤48例,对390例房颤患者平均随访71.5个月,1例因服毒自杀。389例房颤患者累积全因、心脑血管死亡率为35.0%(年37.5‰)、20.6%(年18.7‰)。CHADS2评分分层分析,低、中、高危房颤患者累积全因死亡率分别为22.9%、30.2%、47.2%,心脑血管死亡率为4.8%、15.4%、35.4%,经Log-rank检验差异均达到统计学意义(P<0.01或P<0.05);(2)多因素Cox比例风险模型分析,年龄(HR:1.063,95%CI:1.042~1.085)、血尿酸(HR:1.003,95%CI:1.001~1.005)、心室率<80次/分(HR:1.784,95%CI:1.253~2.538)为房颤患者全因死亡的独立危险因素。年龄(HR:1.093,95%CI:1.062~1.126)、血尿酸(HR:1.004,95%CI:1.002~1.006)、心力衰竭(HR:2.031,95%CI:1.137~3.628)为房颤患者心脑血管死亡的独立危险因素;(3)以CHADS2评分分层建立Cox比例风险模型,以低危为参照,高危患者全因、心血管死亡风险比分别为2.495(95%CI:1.461~4.262)、7.661(95%CI:2.710~21.656)。结论 (1)年龄、血尿酸、心室率<80次/分是房颤患者全因死亡的独立危险因素。年龄、血尿酸及心力衰竭是房颤患者心脑血管死亡的独立危险因素;(2)CHADS2评分分层能预测房颤患者全因、心脑血管死亡。

Objective To investigate the all-cause, cardiovascular and cerebrovascular mortality and risk factors of patients with non-valvular atrial fibrillation including atrial flutter in community. Methods From 2006 to 2007, 101510 in-service and retired employees of Kailuan(Group) Co., Ltd. underwent physical examination. Patients with atrial fibrillation detected by 12 lead ECG were observed. The special personnel of the research group conduct telephone follow-up every six months and face-to-face follow-up every two years. For those who died during hospitalization, the trained medical personnel shall obtain the inpatient medical records and determine the cause of death according to the ICD-10 disease code. The non hospitalized death shall be verified with the labor union of the work unit and/or the local police station where the registered permanent residence was located. The last follow-up was completed on December 31, 2013. Cox proportional hazards model was used to analyze the risk factors of all-cause and cardiovascular and cerebrovascular death in patients with atrial fibrillation. Results(1) Among 438patients with atrial fibrillation,48patients with organic heart disease and valvular atrial fibrillation were excluded.390patients with atrial fibrillation were followed up for an average of 71.5months,and 1patient committed suicide due to taking poison. The cumulative all-cause,cardio cerebrovascular mortality of 389patients with atrial fibrillation was 35.0%(37.5‰ person years)and 20.6%(18.7‰ person years).According to the stratified analysis of CHADS2score,the cumulative all-cause mortality of low,medium and high-risk patients with atrial fibrillation were 22.9%,30.2%and 47.2%respectively,and the cardiovascular and cerebrovascular mortality were 4.8%,15.4%and 35.4%respectively.The difference was statistically significant by log rank test(P<0.01or P< 0.05);(2) Multivariate Cox proportional hazards model analysis showed that age(HR:1.063,95%CI:1.042-1.085),blood uric acid(HR:1.003,95%CI:1.001-1.005)and ventricular rate< 80beats/minute(HR:1.784,95%CI:1.253-2.538)were independent risk factors for all-cause death in patients with atrial fibrillation.Age(HR:1.093,95%CI:1.062-1.126),blood uric acid(HR:1.004,95%CI:1.002-1.006),heart failure(HR:2.031,95%CI:1.137-3.628)were independent risk factors for cardiovascular and cerebrovascular death in patients with atrial fibrillation;(3) The Cox proportional hazards model was established according to the CHADS2score.Taking the low risk as the reference,the risk ratios of all-cause and cardiovascular death in high-risk patients were 2.495(95%CI:1.461-4.262)and 7.661(95%CI:2.710-21.656)respectively. Conclusion(1) age,serum uric acid and ventricular rate< 80beats/min are independent risk factors for all-cause death in patients with atrial fibrillation.Age,serum uric acid and heart failure were independent risk factors for cardiovascular and cerebrovascular death in patients with atrial fibrillation;(2) CHADS2score stratification can predict all-cause,cardiovascular and cerebrovascular death in patients with atrial fibrillation.