老年体检人群心电图异常与脑血管血流动力学的关系研究

Relationship between Electrocardiogram Abnormalities and Cerebrovascular Hemodynamics in Elderly Physical Examination Population

目的分析老年体检人群心电图(ECG)异常与脑血管血流动力学的关系。方法选取2020年6—8月在上海市奉贤区金汇镇泰日社区卫生服务中心参加健康体检的6613例老年人作为研究对象,查阅老年人的体检资料,记录其人口学特征(性别和年龄)、ECG异常情况、脑血管功能积分及脑血流动力学指标。根据ECG检查情况将老年人分为ECG异常组(n=1327)和ECG正常组(n=5286)。根据脑血管功能积分将老年人分为高危组(<75分,n=2674)和非高危组(≥75分,n=3939)。老年体检人群脑血管功能积分的影响因素分析采用多因素Logistic回归分析。结果ECG异常组脑血管功能积分及左侧和右侧平均流量、脉压差低于ECG正常组,左侧和右侧平均流速、最大流速、最小流速慢于ECG正常组,左侧和右侧脉搏波速快于ECG正常组,左侧和右侧特性阻抗、外周阻力、动态阻力、临界压高于ECG正常组(P<0.05)。高危组和非高危组性别、年龄及左心室肥厚、心房颤动、陈旧性心肌梗死、ST段压低、T波低平或倒置、心肌缺血检出率比较,差异有统计学意义(P<0.05)。多因素Logistic回归分析结果显示,性别〔OR=1.56,95%CI(1.40,1.74)〕、年龄〔65~69岁:OR=1.70,95%CI(1.49,1.94);70~74岁:OR=2.36,95%CI(2.04,2.74);75~79岁:OR=4.21,95%CI(3.52,5.04);≥80岁:OR=9.40,95%CI(6.89,12.81)〕、左心室肥厚〔OR=5.07,95%CI(2.17,11.86)〕、心房颤动〔OR=1.68,95%CI(1.10,2.58)〕、陈旧性心肌梗死〔OR=2.05,95%CI(1.18,3.55)〕、ST段压低〔OR=1.27,95%CI(1.04,1.54)〕、T波低平或倒置〔OR=1.59,95%CI(1.36,1.86)〕是老年体检人群脑血管功能积分的独立影响因素(P<0.05)。结论ECG异常的老年体检人群脑血管功能积分降低,卒中发生风险升高,其脑血管血流动力学变化特征是运动学指标普遍降低、动力学指标普遍升高;左心室肥厚、心房颤动、陈旧性心肌梗死、ST段压低、T波低平或倒置是老年体检人群脑血管功能积分的独立影响因素。

Objective To analyze the relationship between electrocardiogram(ECG)abnormalities and cerebrovascular hemodynamics in elderly physical examination population.Methods A total of 6613 elderly people who participated in physical examination in Tairi Community Health Service Center,Jinhui Town,Fengxian District from June to August in 2020 were selected as the research objects.The physical examination data of the elderly people were reviewed,and their demographic characteristics(gender and age),ECG abnormalities,cerebrovascular function scores and cerebral hemodynamics were recorded.According to the ECG examination results,the elderly people were divided into abnormal ECG group(n=1327)and normal ECG group(n=5286).According to the cerebrovascular function score,the elderly people were divided into highrisk group(<75 points,n=2674)and non-high-risk group(≥75 points,n=3939).Multivariate Logistic regression analysis was used to analyze the influencing factors of cerebrovascular function score in elderly physical examination population.Results The cerebrovascular function score,average flow and pulse pressure difference of the left and right sides in the abnormal ECG group were lower than those in the normal ECG group,the average flow velocity,maximum flow velocity and minimum flow velocity of left and right sides in the abnormal ECG group were slower than those in the normal ECG group,the pulse wave velocity of left and right sides in the abnormal ECG group was faster than that in the normal ECG group,the characteristic impedance,peripheral resistance,dynamic resistance and critical pressure of left and right sides in the abnormal ECG group were higher than those in the normal ECG group(P<0.05).There were statistically significant differences in gender,age and detection rates of left ventricular hypertrophy,atrial fibrillation,old myocardial infarction,ST-segment depression,low or inverted T wave and myocardial ischemia between high-risk group and non-high-risk group(P<0.05).Multivariate Logistic regression analysis showed that gender[OR=1.56,95%CI(1.40,1.74)],age[65-69 years old:OR=1.70,95%CI(1.49,1.94);70-74 years old:OR=2.36,95%CI(2.04,2.74);75-79 years old:OR=4.21,95%CI(3.52,5.04);≥80 years old:OR=9.40,95%CI(6.89,12.81)],left ventricular hypertrophy[OR=5.07,95%CI(2.17,11.86)],atrial fibrillation[OR=1.68,95%CI(1.10,2.58)],old myocardial infarction[OR=2.05,95%CI(1.18,3.55)],ST segment depression[OR=1.27,95%CI(1.04,1.54)],low or inverted T wave[OR=1.59,95%CI(1.36,1.86)]and myocardial ischemia[OR=1.59,95%CI(1.36,1.86)]were the independent influencing factors of cerebrovascular function score in elderly physical examination population(P<0.05).Conclusion The cerebrovascular function score of the elderly physical examination population with ECG abnormalities is reduced,and the risk of stroke is increased.The characteristics of cerebrovascular hemodynamic changes are generally reduced kinematic indicators and generally increased kinetic indicators;left ventricular hypertrophy,atrial fibrillation,old myocardial infarction,ST segment depression,low or inverted T wave are independent influencing factors of cerebrovascular function score in elderly physical examination populatin.