中国人非瓣膜病心房颤动患者脑卒中发生率及影响因素的回顾性前瞻研究(摘要)
作者：马长生 周玉杰 马煜 郑知刚 颜红兵 王勇 刘兴鹏 李霄 柯元南
单位：北京市，中日友好医院 心内科(100029)
关键词：
目的 目的：调查分析我国心房颤动(房颤)患者脑卒中的发生率及其影响因素，为现阶段房颤患者抗凝治疗的应用及进一步的前瞻性药物干预试验提供依据。
方法：采用回顾性前瞻试验方法登记注册单一中心非瓣膜病房颤患者，随机调查连续611例患者，其中成功随访520例，男346例，女174例，年龄40～102岁，平均71.2±12.2岁, 随访率100%，平均随访6.75±4.03年，累计随访3 227年例次。520例患者中曾住院318例，门诊患者202例。入选标准：持续性或阵发性房颤，未服用华法林，应用阿司匹林剂量不超过120 mg/d。经统计学处理得出房颤—脑卒中的年阶段发生率，多因素回归分析筛选与脑卒中发生的相关性因素。
, http://www.100md.com
结果：中国人房颤患者在各年龄段(<60岁、60～70岁、71～80岁、>80岁)的脑卒中发生率分别为：全体人群(1.2%、4.0%、6.7%、7.8%)；高危人群(1.6%、5.1%、8.8%、7.7%)；低危人群(1.0%、3.1%、4.0%、7.9%)；合计：全体人群5.3%，高危人群6.9%，低危人群4.0%。高血压、糖尿病作为危险因素与房颤-脑卒中发生率呈正相关(P分别为0.000 01、0.010 1)，脑卒中与既往脑卒中史、心肌梗塞、心功能不全、肥厚型心肌病相关性不显著 (P分别为0.136 1、0.343 9、0.271 9和0.103 0)。
结论：中国人非瓣膜病房颤非抗凝状态下脑卒中发生率为5.3%，与欧美国家处于相同水平(4%～6%)；高血压及糖尿病为房颤发生脑卒中的高危因素。本试验结果表明：①年龄>60岁伴有高血压和(或)糖尿病的房颤患者应给予华法林抗凝治疗；②年龄>70岁房颤患者不伴任何危险因素也应给予华法林抗凝治疗；③<60岁的房颤患者无论是否伴有危险因素均不必抗凝治疗；④年龄为60～70岁且不伴有任何危险因素的房颤患者是否应用华法林抗凝治疗有待进一步临床干预试验的结果确定；⑤由于本试验未能登记短暂脑缺血发作(TIA)史，因此脑卒中发生率与既往卒中史和短暂脑缺血发作史的相关性有待进一步评价。
, 百拇医药
A Retroperspective Study on Incidence of Stroke and its Influence Factors among Chinese Patients with Nonvalvular Atrial Fibrillation (Abstract)
Department of Cardiology, China-Japan Friendship Hospital, Beijing (100029)
Ma Changsheng, Zhou Yujie, Ma Yu, et al.
Objective: To investigate the incidence of stroke and its influence factors among Chinese patients with nonvalvular atrial fibrillation (AF).
, 百拇医药
Methods: This study included 520 consecutive nonvalvular AF patients (male 346, female 174; inpatients 318, outpatients 202) from a single center. The mean age of these patients was 71.2±12.2 (range 40 to 102) years. The mean follow-up period was 6.75±4.03 years with 100% follow-up rate.
Results: The stroke incidence was 5.3% in all patients, 6.9% in patients with high risks and 4.0% in patients with low risks. As risk factors, hypertension and diabetes had a positive correlation with incidence of AF-stroke (p=0.000 01 and 0.010 1, respectively). There was no correlation between stroke and previous stroke, myocardial infarction, heart failure and hypertrophic cardiomyopathy (p=NS).
Conclusions: The stroke incidence among Chinese nonvalvular AF is similar to that of western countries. Hypertension and diabetes are high risk factors of stroke., 百拇医药
单位：北京市，中日友好医院 心内科(100029)
关键词：
目的 目的：调查分析我国心房颤动(房颤)患者脑卒中的发生率及其影响因素，为现阶段房颤患者抗凝治疗的应用及进一步的前瞻性药物干预试验提供依据。
方法：采用回顾性前瞻试验方法登记注册单一中心非瓣膜病房颤患者，随机调查连续611例患者，其中成功随访520例，男346例，女174例，年龄40～102岁，平均71.2±12.2岁, 随访率100%，平均随访6.75±4.03年，累计随访3 227年例次。520例患者中曾住院318例，门诊患者202例。入选标准：持续性或阵发性房颤，未服用华法林，应用阿司匹林剂量不超过120 mg/d。经统计学处理得出房颤—脑卒中的年阶段发生率，多因素回归分析筛选与脑卒中发生的相关性因素。
, http://www.100md.com
结果：中国人房颤患者在各年龄段(<60岁、60～70岁、71～80岁、>80岁)的脑卒中发生率分别为：全体人群(1.2%、4.0%、6.7%、7.8%)；高危人群(1.6%、5.1%、8.8%、7.7%)；低危人群(1.0%、3.1%、4.0%、7.9%)；合计：全体人群5.3%，高危人群6.9%，低危人群4.0%。高血压、糖尿病作为危险因素与房颤-脑卒中发生率呈正相关(P分别为0.000 01、0.010 1)，脑卒中与既往脑卒中史、心肌梗塞、心功能不全、肥厚型心肌病相关性不显著 (P分别为0.136 1、0.343 9、0.271 9和0.103 0)。
结论：中国人非瓣膜病房颤非抗凝状态下脑卒中发生率为5.3%，与欧美国家处于相同水平(4%～6%)；高血压及糖尿病为房颤发生脑卒中的高危因素。本试验结果表明：①年龄>60岁伴有高血压和(或)糖尿病的房颤患者应给予华法林抗凝治疗；②年龄>70岁房颤患者不伴任何危险因素也应给予华法林抗凝治疗；③<60岁的房颤患者无论是否伴有危险因素均不必抗凝治疗；④年龄为60～70岁且不伴有任何危险因素的房颤患者是否应用华法林抗凝治疗有待进一步临床干预试验的结果确定；⑤由于本试验未能登记短暂脑缺血发作(TIA)史，因此脑卒中发生率与既往卒中史和短暂脑缺血发作史的相关性有待进一步评价。
, 百拇医药
A Retroperspective Study on Incidence of Stroke and its Influence Factors among Chinese Patients with Nonvalvular Atrial Fibrillation (Abstract)
Department of Cardiology, China-Japan Friendship Hospital, Beijing (100029)
Ma Changsheng, Zhou Yujie, Ma Yu, et al.
Objective: To investigate the incidence of stroke and its influence factors among Chinese patients with nonvalvular atrial fibrillation (AF).
, 百拇医药
Methods: This study included 520 consecutive nonvalvular AF patients (male 346, female 174; inpatients 318, outpatients 202) from a single center. The mean age of these patients was 71.2±12.2 (range 40 to 102) years. The mean follow-up period was 6.75±4.03 years with 100% follow-up rate.
Results: The stroke incidence was 5.3% in all patients, 6.9% in patients with high risks and 4.0% in patients with low risks. As risk factors, hypertension and diabetes had a positive correlation with incidence of AF-stroke (p=0.000 01 and 0.010 1, respectively). There was no correlation between stroke and previous stroke, myocardial infarction, heart failure and hypertrophic cardiomyopathy (p=NS).
Conclusions: The stroke incidence among Chinese nonvalvular AF is similar to that of western countries. Hypertension and diabetes are high risk factors of stroke., 百拇医药