队列人群心电图ST-T异常与死亡及心脑血管事件关系的前瞻性观察

A prospective cohort study on the relationship of abnormal ST-T on electrocardiogram with death, coronary and cerebrovascular events

目的 评估我国北京、广州 35～ 5 4岁工人、农民人群心电图ST T异常与远期死亡、冠心病和脑血管病事件的关系。方法 分析中美心血管病流行病学和危险因素合作研究 1983年、1984年至 2 0 0 0年我国北京、广州 35～ 5 4岁工人、农民样本人群 (除外心绞痛、心肌梗死、脑卒中 )共 92 6 0人的基线调查和随访资料。心电图按标准化方法Minnesota编码 ,终点事件为全病因死亡或首次发生冠心病或脑血管病事件 ,评估ST T异常的影响采用生存分析 (survivalanalysis)和Cox比例风险(proportionalhazards)分析。结果 ST T异常的发现率在广州地区、农村人群、女性人群较高 ,北京地区、城市人群、男性人群较低 ,T波异常明显多于ST段异常。ST T异常组死亡率和冠心病事件发病率依次为 75 9 18/10万和 134 97/10万 ,均高于无异常组的 5 38 5 3/10万和 5 7 93/10万 (P <0 0 5 )。ST T异常组平均生存期 193 8个月 ,发生冠心病事件平均时间为 16 6 6个月 ,均短于无异常组 (P =0 0 2 3和 0 0 18) ;发生脑血管病事件平均时间亦短于无异常组 ,但无统计学差异。ST T异常组死亡和冠心病事件的Cox比例危险度分别为无异常组的 1 6 0倍和 5 34倍 (P =0 0 0 9和 0 0 0 0 ) ,脑血管病事件是无异常组的 1 4 9倍 (P =0 14 3)。

Objective To evaluate the influence of ST T abnormalities on electrocardiogram (ECG) to death, coronary and cerebrovascular events in long term prospective cohorts of Chinese population. Methods An analysis on the baseline and follow up data of the PRC USA collaborative epidemiology study on cardiovascular disease from 1983/1984 through 2000 was performed,which covered 9260 participants aged 35 54 in Beijing and Guangzhou, excluded cases with angina pectoris, myocardial infarction and stroke history. ECG tracings from the baseline were coded with Minnesota Code and the follow up end points included all cause death or first attack of coronary or cerebrovascular event. Survival analysis and proportional hazards were employed. Results The frequencies of ECG ST T abnormalities were higher in Guangzhou, rural and women than those in Beijing, urban and men respectively. T wave abnormalities were much more than ST segment. In abnormal ST T group, the mortality and the incidence of coronary event were 759 18/100 000 and 134 97/100 000, higher than those in normal group 538 53/100 000 and 57 93/100 000( P <0 05)respectively. The average survival time was 193 8 months and the time to first attack of coronary event was 166 6 months in abnormal group, both were shorter than those in normal group ( P =0 023 and 0 018). The time to first cerebrovascular attack in abnormal group was also shorter than that in normal group but without statistical significance. The Cox proportional hazards odds ratio of death and coronary event in abnormal ST T group were 1 6 and 5 34 times higher than those in normal group respectively( P =0 009 and 0 000);that of cerebrovascular event was 1 49 times but with no statistical significance ( P =0 143).The impact of ST abnormality was stronger than that of T wave. Conclusions ECG ST T abnormalities may also increase the all cause death rate, the incidence and the risks of coronary and cerebrovascular events in Chinese population who was relative lower epidemic of coronary heart disease. It shortens the survival time and the time to first attack of coronary and cerebrovascular events.