新疆地区不同民族心脏瓣膜病流行病学研究
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摘要
目的：
心脏瓣膜病（valvular heart disease，VHD）是新疆地区一种常见的危害健康的心血管疾病。本研究目的在于了解新疆地区成年人心脏瓣膜病的患病率情况及其分布特征，探讨新疆地区老年人群退行性心脏瓣膜病的患病率情况及可能存在的危险因素，探讨新疆地区成年人退行性心脏瓣膜病与动脉粥样硬化的关系，为心脏瓣膜病的防治提供科学依据。
方法：
应用四阶段随机整群抽样法，在整个新疆地区抽取首府乌鲁木齐市及其周边的阜康市，北疆地区的克拉玛依市、阿勒泰地区、伊犁地区，东疆地区的的吐鲁番地区，南疆地区的和田地区等地的年龄在35岁以上成年人样本，男女均衡。统计不同民族组、不同年龄组、不同性别组、不同地区组35岁以上成年人群心脏瓣膜病的患病率，分析心脏瓣膜病伴发的心血管基础疾病情况。统计不同年龄组、不同民族组、不同性别组60岁以上老年人群退行性心脏瓣膜病的患病率，分析瓣膜钙化患病率与高血压的关系，应用多因素Logistic逐步回归分析退行性心脏瓣膜病患病的相关危险因素。统计不同民族组、不同性别组、不同年龄组颈动脉粥样硬化患病率，统计不同民族、不同性别、不同年龄颈动脉粥样硬化组瓣膜钙化患病率，不同民族、不同性别、不同年龄瓣膜钙化组颈动脉粥样硬化患病率，探讨颈动脉粥样硬化与退行性心脏瓣膜病的关系.
结果：
（1）共抽取35岁以上成年人群14618人，实际完成心脏超声检查的14478人，新疆地区心脏瓣膜病的总体患病率为9.65%，其中男性为9.65%，女性为9.63%，不同民族人群心脏瓣膜病患病率为：汉族13.5%，维吾尔族2.7%，哈萨克族12.3%。经年龄标准化后，汉族、维吾尔族、哈族患病率分别为10.57%、2.36%、12.22%，不同民族心脏瓣膜病患病率比较差异有统计学意义；城镇人群与农牧区人群心脏瓣膜病患病率比较差异有统计学意义；汉族与哈萨克族人群城乡心脏瓣膜病患病率比较无统计学差异，维吾尔族城镇人群与农牧区人群心脏瓣膜病患病率比较差异有统计学意义；心脏瓣膜病患病率随年龄增长逐渐升高。全部心脏瓣膜病患者中合并高血压病者63.2%，糖尿病者7.6%，冠心病者7.5%，心脏瓣膜病者3.2%。
（2）共抽取60岁以上老年人样本3773人，新疆地区60岁以上老年人群退行性心脏瓣膜病的总体患病率是9.0%，其中男性为10.2%，女性为7.9%，不同性别老年退行性心脏瓣膜病患病率比较差异有统计学意义；维吾尔族患病率为3.7%，汉族为13.2%，哈族为8.5%，不同民族老年退行性心脏瓣膜病患病率比较差异有统计学意义；老年退行性心脏瓣膜病发生风险随年龄增高逐渐升高；在发生钙化的瓣膜中，单纯主动脉瓣钙化占67.4%，单纯二尖瓣钙化占17.9%，二尖瓣+主动脉瓣联合钙化占14.7%；男性与女性瓣膜钙化都是以主动脉瓣钙化为主；汉族与哈萨克族都是以主动脉瓣钙化为主；不同性别、不同民族瓣膜钙化组与无瓣膜钙化组高血压、冠心病等常见心血管疾病患病率比较差异有统计学意义，不同民族、不同性别高血压组与无高血压组瓣膜钙化患病率比较差异有统计学意义；经logistic多因素逐步回归分析显示：年龄、民族、吸烟、高血压、心衰是老年退行性心脏瓣膜病的危险因素，其中年龄是最大的危险因素，高血压、吸烟、心衰的人群患老年退行性心脏瓣膜病的风险分别是无高血压、无吸烟、无心衰人群的1.019、1.612、1.874倍。
（3）共抽取35岁以上成年人样本14618人，实际完成颈动脉超声检查的13896人，新疆地区成年人群颈动脉粥样硬化患病率为35.5%，其中男性为41.5%，女性为30.2%，不同性别颈动脉粥样硬化患病率比较差异有统计学意义；维吾尔族颈动脉粥样硬化患病率为30.9%，哈萨克族为42.1%，汉族为34，3%，不同民族颈动脉粥样硬化患病率比较差异有统计学意义；颈动脉粥样硬化患病率随年龄增长而逐渐升高；在汉族与维吾尔族检出的颈动脉粥样硬化人群中，不同性别颈动脉粥样硬化患病率比较差异有统计学意义；颈动脉粥样硬化组与无颈动脉粥样硬化组瓣膜钙化患病率比较差异有统计学意义，瓣膜钙化组与无瓣膜钙化组颈动脉粥样硬化患病率比较差异有统计学意义。
结论：
（1）新疆地区成年人心脏瓣膜病的患病率高于国内有关研究结果，心脏瓣膜病患病率随年龄升高，并存在民族、城乡差异；汉族与哈萨克族城乡心脏瓣膜病患病率城乡差别不大，维吾尔族人群存在着明显的城乡差异；新疆地区成年人心脏瓣膜病患者合并的主要心血管基础疾病是高血压、糖尿病、冠心病。
（2）新疆地区60岁以上老年人老年退行性心脏瓣膜病的患病率接近国内相关研究结果，老年退行性心脏瓣膜病患病率随年龄升高，并且存在着民族和性别差异；高血压、冠心病等疾病组更易出现心脏瓣膜钙化，同时心脏瓣膜钙化组也更易出现高血压，提示二者可能具有一定的相关性；年龄、民族、吸烟、高血压、心衰是老年退行性心脏瓣膜病的主要危险因素。
（3）新疆地区成年人颈动脉粥样硬化患病率接近国内相关研究结果，颈动脉粥样硬化患病率随年龄增高，颈动脉粥样硬化者更容易发生心脏瓣膜钙化，同时退行性心脏瓣膜病钙化组也更容易发生颈动脉粥样硬化，提示颈动脉粥样硬化与退行性心脏瓣膜病这两种疾病可能具有一定相关性。
Objective:
Valvular Heart Diseases (VHD) is a common disease with high death rate and pooroutcome and it not only endangered people's life but also influenced the quality of life ofpeople and at the same time, it brought heavy burden and pressure to the family andsociety. With improved of diagnosis and treatment technology of cardiovascular disease,the early mortality of cardiovascular disease has greatly reduced, which was high fatalityrate in acute phase of heart disease in the past. However, the incidence and mortality ratesof heart valve disease which still threat seriously to human health has still high.Andtherefore to realize fully the present situation of heart valve disease, to diagnose thisdisease in time and to definite clearly its etiology is the precondition of specific therapy.This study is order to investigate prevalence and distribution of valvular heart diseaseamong adult population in different ethnic groups in Xiniang region, to analyze possiblerisk factors and the correlation between valvular heart disease and carotid atherosclerosis,giving some reliable epidemiological data for the diagnosis and treatment strategies ofvalvular heart disease.
Materials and methods:
(1) Study of prevalence and distribution among adult population in different ethnicgroups in Xinjiang: To investigate the prevalence and distributing feature of heartvalvular diseases (VHD) in Xinjiang adult population: Four-stage selected randomsamples from age35and over were used to analyze the prevalence and distributingfeature of heart valvular diseases in different nationality, age, sex and the sampled adultpopulation were collected6locality (Urumqi, Kelamayi, Fukang, the Turfan Basinlocality, Hetian locality, Altay locality, Yili Hazakh autonomous prefecture) from23municipalities,7locality and5autonomous county in Xinjiang. The proportion of male to female accounted for50%.Every subject filled a questionnaire and received Dopplerechocardiographic examination for an observation of the function of valve, opening andclosing activities of valve and evaluating degree of valvular stenosis and valvularregurgitation. Statistic analysis and calculate the prevalence and distribution of valvularheart disease in different sexes, different ethnic groups and different age groups amongadult population in Xinjiang, as well as to analyzed complications of cardiovasculardisease in different populations.
(2) Epidemiological cross-sectional survey of correlated factors and prevalence ondegenerated valvular heart diseases among older population in different ethnic groups inXinjiang: The same population were enrolled and60years old or above individuals wererandomly selected. And then the sample individuals were divided into different ethnicgroups, different age groups, different sex groups.The sampled population were collected6locality (Urumqi, Ke lamayi, Fu kang, the Turfan Basin locality, He tian locality, Altaylocality, Yi li Hazakh autonomous prefecture) from23municipalities and7locality and5autonomous county in Xin jiang. Each individual filled a questionnaire and receivedDoppler echocardiographic examination for an observation of the function of valve,opening and closing activities of valve and evaluating degree of valvular stenosis andvalvular regurgitation. A logistic regression analysis is also made to identify possible riskfactors with SDVHD and to analyze relationship between hypertension and valvecalcification.
(3) Study on the correlation between degenerative valvular heart disease and carotidatherosclerosis: The same population were enrolled and each individual received Dopplerultrsonic examination for observation of the heart and carotid artery. To statistic analyzeand calculate of the prevalence of CAS and DVHD and relationship between CAS andDVHD.
Result:
(1) The prevalence of valvular heart disease was7.67%(male:7.31%vs female:8.00%). The prevalence of valvular heart disease was10.57%,2.36%, and12.22%inHan, Uygur and Kazakh population, respectively. The prevalence of valvular heartdisease was more lower in Uygur than Hazak and Han people. Among Uygur population,the prevalence of valvular heart disease was more higher in urban areas than inagricultural and pastoral areas.The differences of prevalence of valvular heart diseaseamong Han and Kazakh population between in urban areas and in agricultural and pastoral areas was no statistically significant. Common complications of valvular heartdisease was hypertension (63.2%), diabetes (7.6%), coronary heart disease (7.5%), andfibrillation atrial (3.2%).
(2) The prevalence of senile degenerative valvular heart disease among older peoplein Xinjiang is9.0%, of which males taked10.2%while females taked14.7%.Amongthem, there are significant difference between different age groups, and there aresignificant difference between different gender, and there are significant differencebetween different nationalities population. In all341cases of calcificated valve, aoticvalvular calcification is67.4%of, mitral valve calcification is17.9%of, mitral valvewith combined aotic valvular calcification is14.7%of. Most common types of valvecalcification among male and female population are aortic valve calcification; there areno significant difference between male and female. Most of valvular calcification in Hanpeople and Kazkh people were aotic valve calcification, and valvular calcification inUygur people were aotic valve calcification and mitral valve with combined aoticvalvular calcification, taked of44.7%, respectively. The prevalence of valve calcificationis higher in hypertension groups in different gender and different ethnic groups, and theprevalence of hypertension is higher in valve calcification groups.Logistic regressionanalysis showed that the risk factors of SDVHD are age, nationality, smoking,hypertension and heart failure.
(3) The prevalence rates of CAS among adult people in Xinjiang were35.5%androse with increasing age. In non-carotid atherosclerosis group, The prevalence rate ofvalvular calcification in non-carotid atherosclerosis groups is2.5%, and the prevalencerate of valvular calcification in carotid atherosclerosis groups is3.7%, and the differenceof prevalence between the two groups was statistically significant.The prevalence rate ofCAS in non-valvular calcification is35.2%, and the prevalence rate of CAS in valvularcalcification is45.1%, and the difference of prevalence between the two groups wasstatistically significant.
Conclution:
(1) The prevalence rates of valvular heart disease increased substantially with age.There was difference between different nationalities and areas. Common complicationsof valvular heart disease was hypertension, diabetes, coronary heart disease andfibrillation atrial.
(2) The prevalence of SDVHD increased substantially with age.crease of age. The fact that valvular calcification groups had higher prevalence rate of hypertension and thathypertension groups had higher prevalence rate of valvular calcification, suggested thatthe two diseases may be related to each other.SDVHD risk factors include age,nationality, smoking, hypertension, and heart failure.
(3) The prevalence rates of CAS among the adult population in Xinjiang rose withincreasing age. The fact that carotid atherosclerosis groups had higher prevalence rate ofheart valvular calcification and that heart valvular calcification groups had higherprevalence rate of carotid atherosclerosis, suggested that the two diseases may be relatedto each other.
心脏瓣膜病（valvular heart disease，VHD）是新疆地区一种常见的危害健康的心血管疾病。本研究目的在于了解新疆地区成年人心脏瓣膜病的患病率情况及其分布特征，探讨新疆地区老年人群退行性心脏瓣膜病的患病率情况及可能存在的危险因素，探讨新疆地区成年人退行性心脏瓣膜病与动脉粥样硬化的关系，为心脏瓣膜病的防治提供科学依据。
方法：
应用四阶段随机整群抽样法，在整个新疆地区抽取首府乌鲁木齐市及其周边的阜康市，北疆地区的克拉玛依市、阿勒泰地区、伊犁地区，东疆地区的的吐鲁番地区，南疆地区的和田地区等地的年龄在35岁以上成年人样本，男女均衡。统计不同民族组、不同年龄组、不同性别组、不同地区组35岁以上成年人群心脏瓣膜病的患病率，分析心脏瓣膜病伴发的心血管基础疾病情况。统计不同年龄组、不同民族组、不同性别组60岁以上老年人群退行性心脏瓣膜病的患病率，分析瓣膜钙化患病率与高血压的关系，应用多因素Logistic逐步回归分析退行性心脏瓣膜病患病的相关危险因素。统计不同民族组、不同性别组、不同年龄组颈动脉粥样硬化患病率，统计不同民族、不同性别、不同年龄颈动脉粥样硬化组瓣膜钙化患病率，不同民族、不同性别、不同年龄瓣膜钙化组颈动脉粥样硬化患病率，探讨颈动脉粥样硬化与退行性心脏瓣膜病的关系.
结果：
（1）共抽取35岁以上成年人群14618人，实际完成心脏超声检查的14478人，新疆地区心脏瓣膜病的总体患病率为9.65%，其中男性为9.65%，女性为9.63%，不同民族人群心脏瓣膜病患病率为：汉族13.5%，维吾尔族2.7%，哈萨克族12.3%。经年龄标准化后，汉族、维吾尔族、哈族患病率分别为10.57%、2.36%、12.22%，不同民族心脏瓣膜病患病率比较差异有统计学意义；城镇人群与农牧区人群心脏瓣膜病患病率比较差异有统计学意义；汉族与哈萨克族人群城乡心脏瓣膜病患病率比较无统计学差异，维吾尔族城镇人群与农牧区人群心脏瓣膜病患病率比较差异有统计学意义；心脏瓣膜病患病率随年龄增长逐渐升高。全部心脏瓣膜病患者中合并高血压病者63.2%，糖尿病者7.6%，冠心病者7.5%，心脏瓣膜病者3.2%。
（2）共抽取60岁以上老年人样本3773人，新疆地区60岁以上老年人群退行性心脏瓣膜病的总体患病率是9.0%，其中男性为10.2%，女性为7.9%，不同性别老年退行性心脏瓣膜病患病率比较差异有统计学意义；维吾尔族患病率为3.7%，汉族为13.2%，哈族为8.5%，不同民族老年退行性心脏瓣膜病患病率比较差异有统计学意义；老年退行性心脏瓣膜病发生风险随年龄增高逐渐升高；在发生钙化的瓣膜中，单纯主动脉瓣钙化占67.4%，单纯二尖瓣钙化占17.9%，二尖瓣+主动脉瓣联合钙化占14.7%；男性与女性瓣膜钙化都是以主动脉瓣钙化为主；汉族与哈萨克族都是以主动脉瓣钙化为主；不同性别、不同民族瓣膜钙化组与无瓣膜钙化组高血压、冠心病等常见心血管疾病患病率比较差异有统计学意义，不同民族、不同性别高血压组与无高血压组瓣膜钙化患病率比较差异有统计学意义；经logistic多因素逐步回归分析显示：年龄、民族、吸烟、高血压、心衰是老年退行性心脏瓣膜病的危险因素，其中年龄是最大的危险因素，高血压、吸烟、心衰的人群患老年退行性心脏瓣膜病的风险分别是无高血压、无吸烟、无心衰人群的1.019、1.612、1.874倍。
（3）共抽取35岁以上成年人样本14618人，实际完成颈动脉超声检查的13896人，新疆地区成年人群颈动脉粥样硬化患病率为35.5%，其中男性为41.5%，女性为30.2%，不同性别颈动脉粥样硬化患病率比较差异有统计学意义；维吾尔族颈动脉粥样硬化患病率为30.9%，哈萨克族为42.1%，汉族为34，3%，不同民族颈动脉粥样硬化患病率比较差异有统计学意义；颈动脉粥样硬化患病率随年龄增长而逐渐升高；在汉族与维吾尔族检出的颈动脉粥样硬化人群中，不同性别颈动脉粥样硬化患病率比较差异有统计学意义；颈动脉粥样硬化组与无颈动脉粥样硬化组瓣膜钙化患病率比较差异有统计学意义，瓣膜钙化组与无瓣膜钙化组颈动脉粥样硬化患病率比较差异有统计学意义。
结论：
（1）新疆地区成年人心脏瓣膜病的患病率高于国内有关研究结果，心脏瓣膜病患病率随年龄升高，并存在民族、城乡差异；汉族与哈萨克族城乡心脏瓣膜病患病率城乡差别不大，维吾尔族人群存在着明显的城乡差异；新疆地区成年人心脏瓣膜病患者合并的主要心血管基础疾病是高血压、糖尿病、冠心病。
（2）新疆地区60岁以上老年人老年退行性心脏瓣膜病的患病率接近国内相关研究结果，老年退行性心脏瓣膜病患病率随年龄升高，并且存在着民族和性别差异；高血压、冠心病等疾病组更易出现心脏瓣膜钙化，同时心脏瓣膜钙化组也更易出现高血压，提示二者可能具有一定的相关性；年龄、民族、吸烟、高血压、心衰是老年退行性心脏瓣膜病的主要危险因素。
（3）新疆地区成年人颈动脉粥样硬化患病率接近国内相关研究结果，颈动脉粥样硬化患病率随年龄增高，颈动脉粥样硬化者更容易发生心脏瓣膜钙化，同时退行性心脏瓣膜病钙化组也更容易发生颈动脉粥样硬化，提示颈动脉粥样硬化与退行性心脏瓣膜病这两种疾病可能具有一定相关性。
Objective:
Valvular Heart Diseases (VHD) is a common disease with high death rate and pooroutcome and it not only endangered people's life but also influenced the quality of life ofpeople and at the same time, it brought heavy burden and pressure to the family andsociety. With improved of diagnosis and treatment technology of cardiovascular disease,the early mortality of cardiovascular disease has greatly reduced, which was high fatalityrate in acute phase of heart disease in the past. However, the incidence and mortality ratesof heart valve disease which still threat seriously to human health has still high.Andtherefore to realize fully the present situation of heart valve disease, to diagnose thisdisease in time and to definite clearly its etiology is the precondition of specific therapy.This study is order to investigate prevalence and distribution of valvular heart diseaseamong adult population in different ethnic groups in Xiniang region, to analyze possiblerisk factors and the correlation between valvular heart disease and carotid atherosclerosis,giving some reliable epidemiological data for the diagnosis and treatment strategies ofvalvular heart disease.
Materials and methods:
(1) Study of prevalence and distribution among adult population in different ethnicgroups in Xinjiang: To investigate the prevalence and distributing feature of heartvalvular diseases (VHD) in Xinjiang adult population: Four-stage selected randomsamples from age35and over were used to analyze the prevalence and distributingfeature of heart valvular diseases in different nationality, age, sex and the sampled adultpopulation were collected6locality (Urumqi, Kelamayi, Fukang, the Turfan Basinlocality, Hetian locality, Altay locality, Yili Hazakh autonomous prefecture) from23municipalities,7locality and5autonomous county in Xinjiang. The proportion of male to female accounted for50%.Every subject filled a questionnaire and received Dopplerechocardiographic examination for an observation of the function of valve, opening andclosing activities of valve and evaluating degree of valvular stenosis and valvularregurgitation. Statistic analysis and calculate the prevalence and distribution of valvularheart disease in different sexes, different ethnic groups and different age groups amongadult population in Xinjiang, as well as to analyzed complications of cardiovasculardisease in different populations.
(2) Epidemiological cross-sectional survey of correlated factors and prevalence ondegenerated valvular heart diseases among older population in different ethnic groups inXinjiang: The same population were enrolled and60years old or above individuals wererandomly selected. And then the sample individuals were divided into different ethnicgroups, different age groups, different sex groups.The sampled population were collected6locality (Urumqi, Ke lamayi, Fu kang, the Turfan Basin locality, He tian locality, Altaylocality, Yi li Hazakh autonomous prefecture) from23municipalities and7locality and5autonomous county in Xin jiang. Each individual filled a questionnaire and receivedDoppler echocardiographic examination for an observation of the function of valve,opening and closing activities of valve and evaluating degree of valvular stenosis andvalvular regurgitation. A logistic regression analysis is also made to identify possible riskfactors with SDVHD and to analyze relationship between hypertension and valvecalcification.
(3) Study on the correlation between degenerative valvular heart disease and carotidatherosclerosis: The same population were enrolled and each individual received Dopplerultrsonic examination for observation of the heart and carotid artery. To statistic analyzeand calculate of the prevalence of CAS and DVHD and relationship between CAS andDVHD.
Result:
(1) The prevalence of valvular heart disease was7.67%(male:7.31%vs female:8.00%). The prevalence of valvular heart disease was10.57%,2.36%, and12.22%inHan, Uygur and Kazakh population, respectively. The prevalence of valvular heartdisease was more lower in Uygur than Hazak and Han people. Among Uygur population,the prevalence of valvular heart disease was more higher in urban areas than inagricultural and pastoral areas.The differences of prevalence of valvular heart diseaseamong Han and Kazakh population between in urban areas and in agricultural and pastoral areas was no statistically significant. Common complications of valvular heartdisease was hypertension (63.2%), diabetes (7.6%), coronary heart disease (7.5%), andfibrillation atrial (3.2%).
(2) The prevalence of senile degenerative valvular heart disease among older peoplein Xinjiang is9.0%, of which males taked10.2%while females taked14.7%.Amongthem, there are significant difference between different age groups, and there aresignificant difference between different gender, and there are significant differencebetween different nationalities population. In all341cases of calcificated valve, aoticvalvular calcification is67.4%of, mitral valve calcification is17.9%of, mitral valvewith combined aotic valvular calcification is14.7%of. Most common types of valvecalcification among male and female population are aortic valve calcification; there areno significant difference between male and female. Most of valvular calcification in Hanpeople and Kazkh people were aotic valve calcification, and valvular calcification inUygur people were aotic valve calcification and mitral valve with combined aoticvalvular calcification, taked of44.7%, respectively. The prevalence of valve calcificationis higher in hypertension groups in different gender and different ethnic groups, and theprevalence of hypertension is higher in valve calcification groups.Logistic regressionanalysis showed that the risk factors of SDVHD are age, nationality, smoking,hypertension and heart failure.
(3) The prevalence rates of CAS among adult people in Xinjiang were35.5%androse with increasing age. In non-carotid atherosclerosis group, The prevalence rate ofvalvular calcification in non-carotid atherosclerosis groups is2.5%, and the prevalencerate of valvular calcification in carotid atherosclerosis groups is3.7%, and the differenceof prevalence between the two groups was statistically significant.The prevalence rate ofCAS in non-valvular calcification is35.2%, and the prevalence rate of CAS in valvularcalcification is45.1%, and the difference of prevalence between the two groups wasstatistically significant.
Conclution:
(1) The prevalence rates of valvular heart disease increased substantially with age.There was difference between different nationalities and areas. Common complicationsof valvular heart disease was hypertension, diabetes, coronary heart disease andfibrillation atrial.
(2) The prevalence of SDVHD increased substantially with age.crease of age. The fact that valvular calcification groups had higher prevalence rate of hypertension and thathypertension groups had higher prevalence rate of valvular calcification, suggested thatthe two diseases may be related to each other.SDVHD risk factors include age,nationality, smoking, hypertension, and heart failure.
(3) The prevalence rates of CAS among the adult population in Xinjiang rose withincreasing age. The fact that carotid atherosclerosis groups had higher prevalence rate ofheart valvular calcification and that heart valvular calcification groups had higherprevalence rate of carotid atherosclerosis, suggested that the two diseases may be relatedto each other.
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