心房颤动患者临床现状分析
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摘要
目的分析医院就诊心房颤动(AF)患者的临床现状。方法收集2016年1月至2018年1月在山西医科大学第二医院就诊的1 326例心房颤动患者病历资料,包括人口学资料、伴随疾病和心血管危险因素、治疗方案选择以及抗栓治疗情况,进行统计学分析。结果本组患者平均年龄(68±13)岁,70～79岁者占比最高,为31. 4%(416/1 326)。男712例,女614例,性别构成比之间差异无统计学意义(P> 0. 05)。伴随疾病和心血管危险因素中,合并高血压536例(40. 4%),睡眠呼吸暂停综合征107例(8. 1%)。心力衰竭和脑卒中/短暂性脑缺血发作人群中持续性心房颤动占比明显高于阵发性心房颤动,冠状动脉粥样硬化性心脏病(冠心病)人群阵发性心房颤动占比明显高于持续性心房颤动(均P <0. 01)。选择射频消融治疗141例(10. 6%),左心耳封堵2例(0. 2%),其余均选择药物治疗。未接受抗栓治疗243例(18. 3%),接受抗血小板治疗717例(54. 1%),华法林治疗280例(21. 2%),接受华法林治疗患者中国际标准化比值达标率为47. 1%(132/280)。结论本院就诊心房颤动患者以70～79岁为主,性别之间无明显差异;高血压、心力衰竭、冠心病仍为心房颤动主要伴随疾病或心血管危险因素;合并睡眠呼吸暂停综合征需引起关注;接受射频消融治疗比例较低,大多患者选择药物治疗;未接受抗栓治疗比例较高,抗栓治疗及抗栓强度均低于目前指南建议。
Objective To analyze the clinical status of patients with atrial fibrillation( AF) in hospital.Methods Clinical data of 1 326 AF patients admitted to Second Hospital of Shanxi Medical University from January 2016 to January 2018 were retrospectively reviewed. Demographic data, concomitant diseases and cardiovascular risk factors,therapeutic and antithrombotic options were analyzed. Results The mean age of the 1 326 patients was( 68 ± 13) years; patients of 70-79 years old took the largest percentage [31. 4%( 416/1 326) ].There was no significant difference between the composition ratio of males and females( 712 cases vs 614 cases)( P > 0. 05). Among the cardiovascular risk factors,536 patients( 40. 4%) had hypertension and 107 patients( 8. 1%) had sleep apnea syndrome. In patients with heart failure and cerebral stoke/transient ischemic attack,chronic atrial fibrillation accounted for a higher percentage than paroxysmal atrial fibrillation( P < 0. 01). In patients with coronary atherosclerotic heart disease( CHD),paroxysmal atrial fibrillation accounted for a higher percentage than chronic atrial fibrillation( P < 0. 01). Most patients were treated with medication,only 141 patients( 10. 6%) had radiofrequency ablation and 2 patients( 0. 2%) had left atrial appendage occlusion. Ratios of non-antithrombotic treatment,antiplatelet treatment and warfarin treatment were 18. 3%( 243),54. 1%( 717) and 21. 1%( 280); the standard rate of international normalized ratio after taking warfarin was 47. 1%( 132/280).Conclusions Elderly patients( 70-79 years old) take the majority of atrial fibrillation in our hospital and there is no significant difference between gender. Hypertension,heart failure and CHD are the main risk factors associated with atrial fibrillation. Patients with sleep apnea syndrome should be paid attention. Drug treatment is the main therapeutic choice and the rate of radiofrequency ablation is low. Receptance of antithrombotic therapy is low and the effect is unsatisfactory.
Objective To analyze the clinical status of patients with atrial fibrillation( AF) in hospital.Methods Clinical data of 1 326 AF patients admitted to Second Hospital of Shanxi Medical University from January 2016 to January 2018 were retrospectively reviewed. Demographic data, concomitant diseases and cardiovascular risk factors,therapeutic and antithrombotic options were analyzed. Results The mean age of the 1 326 patients was( 68 ± 13) years; patients of 70-79 years old took the largest percentage [31. 4%( 416/1 326) ].There was no significant difference between the composition ratio of males and females( 712 cases vs 614 cases)( P > 0. 05). Among the cardiovascular risk factors,536 patients( 40. 4%) had hypertension and 107 patients( 8. 1%) had sleep apnea syndrome. In patients with heart failure and cerebral stoke/transient ischemic attack,chronic atrial fibrillation accounted for a higher percentage than paroxysmal atrial fibrillation( P < 0. 01). In patients with coronary atherosclerotic heart disease( CHD),paroxysmal atrial fibrillation accounted for a higher percentage than chronic atrial fibrillation( P < 0. 01). Most patients were treated with medication,only 141 patients( 10. 6%) had radiofrequency ablation and 2 patients( 0. 2%) had left atrial appendage occlusion. Ratios of non-antithrombotic treatment,antiplatelet treatment and warfarin treatment were 18. 3%( 243),54. 1%( 717) and 21. 1%( 280); the standard rate of international normalized ratio after taking warfarin was 47. 1%( 132/280).Conclusions Elderly patients( 70-79 years old) take the majority of atrial fibrillation in our hospital and there is no significant difference between gender. Hypertension,heart failure and CHD are the main risk factors associated with atrial fibrillation. Patients with sleep apnea syndrome should be paid attention. Drug treatment is the main therapeutic choice and the rate of radiofrequency ablation is low. Receptance of antithrombotic therapy is low and the effect is unsatisfactory.
引文
[1]Ball J,Thompson DR,Ski CF,et al. Estimating the current and future prevalence of atrial fibrillation in the Australian adult population[J]. Med J Aust,2015,202(1):32-35. DOI:10.5694/mja14. 00238.
[2]王鹏,戴海龙,光雪峰.房颤抗凝治疗进展[J].中国心血管病研究,2017,15(3):200-204. DOI:10. 3969/j. issn. 1672-5301.2017. 03. 003.Wang P,Dai HL,Guang XF. Progress of anticoagulant treatment in atrial fibrillation[J]. Chinese Journal of Cardiovascular Research,2017,15(3):200-204. DOI:10. 3969/j. issn. 1672-5301. 2017. 03. 003.
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[4]January CT,Wann LS,Alpert JS,et al. 2014 AHA/ACC/HRS guideline for the management of patients with atrial fibrillation:a report of the American College of Cardiology/American Heart Association Task Force on practice guidelines and the Heart Rhythm Society[J]. Circulation,2014,130(23):e199-267.DOI:10. 1161/CIR. 0000000000000041.
[5]Rodriguez CJ,Soliman EZ,Alonso A,et al. Atrial fibrillation incidence and risk factors in relation to race-ethnicity and the population attributable fraction of atrial fibrillation risk factors:the Multi-Ethnic Study of Atherosclerosis[J]. Ann Epidemiol,2015,25(2):71-76,e1. DOI:10. 1016/j. annepidem. 2014. 11. 024.
[6]庄文娟.房颤相关遗传学研究进展[J].中国心血管病研究,2018,16(3):201-204. DOI:10. 3969/j. issn. 1672-5301. 2018. 03. 003.Zhuang WJ. The advance of atrial fibrillation correlated genetic research[J]. Chinese Journal of Cardiovascular Research,2018,16(3):201-204. DOI:10. 3969/j. issn. 1672-5301. 2018. 03. 003.
[7]周自强,胡大一,陈捷,等.中国心房颤动现状的流行病学研究[J].中华内科杂志,2004,43(7):491-494. DOI:10. 3760/j.issn:0578-1426. 2004. 07. 005.Zhou ZQ,Hu DY,Chen J,et al. Epidemiological study of atrial fibrillation in China[J]. Chinese Journal of Internal Medicine,2004,43(7):491-494. DOI:10. 3760/j. issn:0578-1426. 2004.07. 005.
[8]Schnabel RB,Yin X,Gona P,et al. 50 year trends in atrial fibrillation prevalence,incidence,risk factors,and mortality in the Framingham Heart Study:a cohort study[J]. Lancet,2015,386(9989):154. DOI:10. 1016/S0140-6736(14)61774-8.
[9]Calkins H,Hindricks G,Cappato R,et al. 2017 HRS/EHRA/ECAS/APHRS/SOLAECE expert consensus statement on catheter and surgical ablation of atrial fibrillation:executive summary[J]. J Interv Card Electrophysiol,2017,50(1):1-55. DOI:10. 1007/s10840-017-0277-z.
[10]Holmqvist F,Guan N,Zhu Z,et al. Impact of obstructive sleep apnea and continuous positive airway pressure therapy on outcomes in patients with atrial fibrillation-Results from the Outcomes Registry for Better Informed Treatment of Atrial Fibrillation(ORBIT-AF)[J].Am Heart J,2015,169(5):647-654,e2. DOI:10. 1016/j. ahj.2014. 12. 024.
[11]中国老年学学会心脑血管专业委员会,非瓣膜病心房颤动患者应用新型口服抗凝药物中国专家共识组.中国房颤抗凝的现状与未来[J].中国心血管病研究,2014,12(9):769-770.DOI:10. 3969/j. issn. 1672-5301. 2014. 09. 001.Professional Committee of Cardiovascular and Cerebrovascular,Chinese Gerontological Society,Chinese Expert Consensus Group on the Application of New Oral Anticoagulants in Patients with Non-valvular Atrial Fibrillation. The current situation and future of the atrial fibrillation anticoagulation in China[J]. Chinese Journal of Cardiovascular Research,2014,12(9):769-770. DOI:10.3969/j. issn. 1672-5301. 2014. 09. 001.
[12]Taylor J. CardioPulse. A focused update to the ESC guidelines for the management of patients with atrial fibrillation[J]. Eur Heart J,2012,33(21):2623-2624. DOI:10. 1093/eurheartj/ehs319.
[13]Nielsen PB,Larsen TB,Skj?th F,et al. Outcomes associated with resuming warfarin treatment after hemorrhagic stroke or traumatic intracranial hemorrhage in patients with atrial fibrillation[J]. JAMA Intern Med,2017,177(4):563-570. DOI:10. 1001/jamainternmed. 2016. 9369.
[14]李晶,石婧,林琴,等.80岁及以上高龄非瓣膜病心房颤动患者抗栓治疗与脑卒中的相关性[J].中华老年医学杂志,2017,36(5):497-501. DOI:10. 3760/cma. j. issn. 0254-9026. 2017. 05. 009.Li J,Shi J,Lin Q,et al. Association between antithrombotic therapy and stroke in elderly patients with non-valvular atrial fibrillation older than 80 years[J]. Chinese Journal of Geriatrics,2017,36(5):497-501. DOI:10. 3760/cma. j. issn. 0254-9026.2017. 05. 009.
[2]王鹏,戴海龙,光雪峰.房颤抗凝治疗进展[J].中国心血管病研究,2017,15(3):200-204. DOI:10. 3969/j. issn. 1672-5301.2017. 03. 003.Wang P,Dai HL,Guang XF. Progress of anticoagulant treatment in atrial fibrillation[J]. Chinese Journal of Cardiovascular Research,2017,15(3):200-204. DOI:10. 3969/j. issn. 1672-5301. 2017. 03. 003.
[3]中华医学会心电生理和起搏分会,中国医师协会心律学专业委员会,心房颤动防治专家工作委员会.心房颤动:目前的认识和治疗的建议2018[J].中国心脏起搏与心电生理杂志,2018,32(4):315-368. DOI:10. 13333/j. cnki. cjcpe. 2018. 04. 001.Society of Cardiac Electrophysiology and Pacing,Chinese Medical Association, Professional Committee of Cardiorhythm, Chinese Medical Doctor Association,Expert Committee on Prevention and Treatment of Atrial Fibrillation. Atrial fibrillation:current understanding and treatment recommendations 2018[J]. Chinese Journal of Cardiac Pacing and Electrophysiology,2018,32(4):315-368.DOI:10. 13333/j. cnki. cjcpe. 2018. 04. 001.
[4]January CT,Wann LS,Alpert JS,et al. 2014 AHA/ACC/HRS guideline for the management of patients with atrial fibrillation:a report of the American College of Cardiology/American Heart Association Task Force on practice guidelines and the Heart Rhythm Society[J]. Circulation,2014,130(23):e199-267.DOI:10. 1161/CIR. 0000000000000041.
[5]Rodriguez CJ,Soliman EZ,Alonso A,et al. Atrial fibrillation incidence and risk factors in relation to race-ethnicity and the population attributable fraction of atrial fibrillation risk factors:the Multi-Ethnic Study of Atherosclerosis[J]. Ann Epidemiol,2015,25(2):71-76,e1. DOI:10. 1016/j. annepidem. 2014. 11. 024.
[6]庄文娟.房颤相关遗传学研究进展[J].中国心血管病研究,2018,16(3):201-204. DOI:10. 3969/j. issn. 1672-5301. 2018. 03. 003.Zhuang WJ. The advance of atrial fibrillation correlated genetic research[J]. Chinese Journal of Cardiovascular Research,2018,16(3):201-204. DOI:10. 3969/j. issn. 1672-5301. 2018. 03. 003.
[7]周自强,胡大一,陈捷,等.中国心房颤动现状的流行病学研究[J].中华内科杂志,2004,43(7):491-494. DOI:10. 3760/j.issn:0578-1426. 2004. 07. 005.Zhou ZQ,Hu DY,Chen J,et al. Epidemiological study of atrial fibrillation in China[J]. Chinese Journal of Internal Medicine,2004,43(7):491-494. DOI:10. 3760/j. issn:0578-1426. 2004.07. 005.
[8]Schnabel RB,Yin X,Gona P,et al. 50 year trends in atrial fibrillation prevalence,incidence,risk factors,and mortality in the Framingham Heart Study:a cohort study[J]. Lancet,2015,386(9989):154. DOI:10. 1016/S0140-6736(14)61774-8.
[9]Calkins H,Hindricks G,Cappato R,et al. 2017 HRS/EHRA/ECAS/APHRS/SOLAECE expert consensus statement on catheter and surgical ablation of atrial fibrillation:executive summary[J]. J Interv Card Electrophysiol,2017,50(1):1-55. DOI:10. 1007/s10840-017-0277-z.
[10]Holmqvist F,Guan N,Zhu Z,et al. Impact of obstructive sleep apnea and continuous positive airway pressure therapy on outcomes in patients with atrial fibrillation-Results from the Outcomes Registry for Better Informed Treatment of Atrial Fibrillation(ORBIT-AF)[J].Am Heart J,2015,169(5):647-654,e2. DOI:10. 1016/j. ahj.2014. 12. 024.
[11]中国老年学学会心脑血管专业委员会,非瓣膜病心房颤动患者应用新型口服抗凝药物中国专家共识组.中国房颤抗凝的现状与未来[J].中国心血管病研究,2014,12(9):769-770.DOI:10. 3969/j. issn. 1672-5301. 2014. 09. 001.Professional Committee of Cardiovascular and Cerebrovascular,Chinese Gerontological Society,Chinese Expert Consensus Group on the Application of New Oral Anticoagulants in Patients with Non-valvular Atrial Fibrillation. The current situation and future of the atrial fibrillation anticoagulation in China[J]. Chinese Journal of Cardiovascular Research,2014,12(9):769-770. DOI:10.3969/j. issn. 1672-5301. 2014. 09. 001.
[12]Taylor J. CardioPulse. A focused update to the ESC guidelines for the management of patients with atrial fibrillation[J]. Eur Heart J,2012,33(21):2623-2624. DOI:10. 1093/eurheartj/ehs319.
[13]Nielsen PB,Larsen TB,Skj?th F,et al. Outcomes associated with resuming warfarin treatment after hemorrhagic stroke or traumatic intracranial hemorrhage in patients with atrial fibrillation[J]. JAMA Intern Med,2017,177(4):563-570. DOI:10. 1001/jamainternmed. 2016. 9369.
[14]李晶,石婧,林琴,等.80岁及以上高龄非瓣膜病心房颤动患者抗栓治疗与脑卒中的相关性[J].中华老年医学杂志,2017,36(5):497-501. DOI:10. 3760/cma. j. issn. 0254-9026. 2017. 05. 009.Li J,Shi J,Lin Q,et al. Association between antithrombotic therapy and stroke in elderly patients with non-valvular atrial fibrillation older than 80 years[J]. Chinese Journal of Geriatrics,2017,36(5):497-501. DOI:10. 3760/cma. j. issn. 0254-9026.2017. 05. 009.