中国部分地区心房颤动住院病例回顾性调查

Retrospective investigation of hospitalized patients with atrial fibrillation in major parts of China

目的 了解中国心房颤动 (房颤 )患者年龄分布、病因 (或相关因素 )、房颤类型、脑卒中等流行病学特征及不同类型房颤的治疗现状。方法 对 1999～ 2 0 0 1年中国内地 4 1家医院诊断的心房颤动患者的住院病历进行回顾性分析和统计。结果 (1)共入选 92 97例 ,平均年龄 6 5 5岁 ,男女比为 13∶12。三年内房颤占同期心血管住院病人比例呈逐年上升趋势 ,平均 7 9%。随年龄增高病例数进行性递增。 (2 )房颤病因及相关因素统计 (单项 % ) ,老年 5 8 1% ,高血压 4 0 3% ,冠心病34 8% ,心衰 33 1% ,风湿性瓣膜病 2 3 9% ,特发性房颤 7 4 % ,心肌病 5 4 %和糖尿病 4 1%等。其中以高龄与高血压的组合最常见。本组患者中 2 / 3有心房增大 ,1/ 3有射血分数降低。 (3)房颤类型中阵发性占 33 7% ,持续性 16 7% ,持久性 4 9 5 %。 (4)阵发性房颤 5 6 4 %采用节律控制治疗 ,18 2 %用心室率控制方法 ,应用药物以胺碘酮、洋地黄制剂最多 ,其次为 β受体阻滞剂、普鲁帕酮等。(5 )慢性房颤 82 8%接受心室率控制治疗 ,常用药物为地高辛、β受体阻滞剂及钙拮抗剂。在持续性房颤患者中 ,试行复律者不足 1/ 2 ,其中 31 1%复律后可维持稳定窦性心律 ,应用药物以胺碘酮最多 ,其次为普鲁帕酮、奎尼丁、索他洛尔等。 (6 )

Objective Atrial fibrillation (AF) is a common arrhythmia associated with increased cardiovascular morbididy and mortality. This study was undertaken to analyze the epidemiological factors and evaluate the current status of treatment in patients with AF in China. Methods Retrospective analysis of hospital records were taken from patients with primary diagnosis of AF, discharged from Jan. 1999 to Dec. 2001. Results (1) A total of 9 297 cases with AF were enrolled from 41 hospitals in major parts of China. Mean age was 65.5 years old. The percentage of hospital admission with AF were gradually increased comparing to those of total cardiovascular admission during three years, with the average of 7.9%. The cases distribution progressively rose with age. (2) The causes and associated conditions of AF: advanced age 58.1%, hypertension 40.3%, coronary heart disease 34.8%, heart failure 33.1%, rheumatic valvular disease 23.9%, idiopathic AF 7.4%, cardiomyopathy 5.4%, diabetes 4.1%. The most common coexistence among these variables was advanced age with hypertension. (3) Types of AF: Permanent AF almost accounted for half of our cases (49.5%), paroxysmal and persistent AF were 33.7% and 16.7% respectively . Paroxysmal AF was mainly treated with rhythm control ( 56.4% ). However 82.8% patients with chronic AF had therapeutical strategy of rate control. In patients with persistent AF, the cardioversion had been attempted in cases less than 50%, with only 31.1% of these patients who could maintain stabilized sinus rhythm. (4) The prevalence of stroke in this group was 17.5%. In nonvalvular AF patients the risk factors that significantly associated with stroke included advanced age, history of hypertension, coronary heart disease and type of AF. 64.5% of our patients received antithrombotic therapy with dominated use of antiplatelet agents. The long term prevention with anticoagulants only accounted for 6.6%. In this investigation patients with antiplatelets as well as patients with anticoagulants showed significant lower stroke rate in comparison with those managed neither. However the difference between antiplatelets and anticoagulants in terms of stroke rate was not significant. Conclusion Most epidemiologic factors of AF from this group showed highly in accordance with those from the reports from other countries, such as age distribution, causes and associated conditions, type of AF, risk factors of stroke and so on. Paroxysmal AF was mainly managed with strategy of rhyrhm control and chronic AF, dominantly with approach of rate control. Both antiplatelet and anticoagulant treatments significantly reduced stroke rate. But there was no significant difference between these two kinds of treatments in reducing stroke rate.