新疆汉、维吾尔、哈萨克族慢性心力衰竭流行病学调查及其患病率研究

目的 了解新疆成年人慢性心力衰竭(心衰)的患病率和分布特征.方法 应用四阶段整群随机抽样法,在全疆23个市、7个地区、5个自治州抽取乌鲁木齐市、克拉玛依市、阜康市、吐鲁番地区、和田地区、伊犁哈萨克自治州等6个地区年龄在35岁以上样本,男女均衡.统计不同民族组、不同年龄组、不同性别组人群的心衰患病率,并对心衰患者合并心血管基础疾病进行分析.结果 共抽样35岁以上城市及农村游牧居民8459例,心衰患病率为1.26%;其中汉族为0.89%,维吾尔族为1.11%,哈萨克族为2.14%.男性为1.61%,女性为0.93%,男性患病率高于女性(u=2.79,P<0.05).35～44岁、45～54岁、55～64岁、65～74岁、75岁以上各年龄组的心衰患病率分别为0.29%、0.60%、1.32%、2.55%、4.10%,随着年龄增高,心衰发生的风险显著上升.107例心衰患者中合并高血压病者占63.55%,冠心病者占42.99%,糖尿病者占18.69%,心瓣膜病者占5.61%,心房颤动者占4.67%.结论 新疆心衰患病率较高,随年龄增加呈增多趋势,且存在民族差异.高血压病、冠心病、糖尿病为新疆各民族心衰患者共同合并心血管基础疾病.通过对新疆不同人群心衰的流行病学监测和调查,寻找适合新疆人文地域特点的心衰早期诊断方法和干预模式具有重大现实意义.     

新疆地区成年人群颈动脉粥样硬化与退行性心脏瓣膜病的相关性研究

目的探讨35岁以上人群颈动脉粥样硬化(CAS)与退行性心脏瓣膜病(DVHD)的相关性。方法应用整群随机抽样法抽取新疆地区13 896例35岁以上受检者,统计不同民族、性别、年龄人群中CAS和DVHD的患病率,并分析两者的相关性。结果 CAS患病率为35.5%,DVHD患病率为9.6%,两患病率均随年龄增加而逐渐升高,男性高于女性;哈萨克族64岁以下者CAS、DVHD患病率均低于哈萨克族和汉族,65岁以上者CAS、DVHD患病率均高于哈萨克族和汉族(P均<0.05)。患CAS者有更高的DVHD检出率,患DVHD者有更高的CAS检出率(P均<0.05)。结论新疆地区成年人CAS、DVHD患病率与年龄、性别及民族存在相关性;CAS与DVHD可能具有一定相关性。     

社区老年人群心房颤动的现况研究

目的探讨社区老年人群心房颤动(房颤)的现况。方法采用整群随机抽样方法,抽取上海市长宁区社区年龄≥65岁常住居民3758例进行现况调查。以心电图或Holter检查作为诊断标准,根据是否合并房颤分为房颤组218例,非房颤组3540例,设计统一问卷,包括基本情况、生活方式、疾病史以及实验室检查,并计算房颤患者的CHADS2评分。结果入选者中,房颤患病率为5.8%,其中≥85岁房颤患病率高达27.7%,房颤患病率随年龄增长呈上升趋势(P0.01)。房颤组年龄、腰臀比、糖尿病、高血压、高脂血症、心力衰竭比例明显高于非房颤组[(76.78±7.32)岁vs(72.32±5.46)岁,P=0.000;0.90±0.60 vs 0.88±0.10,P=0.002;24.3%vs 17.1%,P=0.007;72.0%vs 45.0%,P=0.000;17.4%vs 11.0%,P=0.012;18.8%vs 10.0%,P=0.000]。多因素logistic回归分析显示,年龄、高血压、心力衰竭是房颤的独立危险因素(P0.01)。房颤组CHADS2评分≥2分176例,占80.7%,年龄与CHADS2评分存在线性趋势关系(P=0.002)。结论社区老年人群房颤患病率随年龄增长明显升高,年龄、高血压、心力衰竭均是老年人房颤发生的危险因素,随着年龄增长,老年房颤脑卒中风险增加。     

P-选择素与冠心病心房颤动

心房颤动(Atrial fibrillation,Af)是临床上常见的房性心律失常,随着年龄的增长,其发生率增高。美国自然人群房颤的患病率为0.95%,年龄低于55岁者,房颤的患病率为0.1%,而80岁以上的人群为9.0%,估计到2050年房颤患者的人数将超过560万[1]。通过对资料的分析,Heeringa等[2]计算的55岁发生房颤的终生危险分别为:男性23.8%,女性22.2%。而我国的调查结果显示[3]:房颤总患病率为0.77%,标准化后的患病率为0.61%,房颤的总患病率和国外相关资料的趋势接近,推测我国目前房颤患者数目接近800万。所有房颤患者中瓣膜型、非瓣膜型及孤立性房颤所占比例分     

心房颤动的分子生物学机制研究进展

心房颤动 (房颤 )是临床上最常见的心律失常之一 ,>5 0岁人群患病率为 0 5 % ,>80岁近 10 % [1] 。房颤可引起患者心悸 ,诱发心力衰竭甚至引起心动过速性心肌病 ,还可引起周围动脉栓塞 ,尤以脑梗死危害最大 ,并且是 >75岁患者缺血性脑卒中的首位原因。房颤的社会经济负担重大 ,但目前临床上对房颤的治疗尚不能令人满意。大多数房颤有一定的危险因素 ,如瓣膜病、心力衰竭、高血压、肺心病、心肌病、冠心病、先天性心脏病、甲状腺功能亢进、年龄等 ,但也存在一定的遗传易感性 ;有 2 %～ 31%的房颤患者年龄相对较轻 ,无明确危险因素 ,称作特发…     

心房颤动的复律探析

心房颤动（房颤）是最常见的基本异位心律和持续性心律。人群房颤的发生率在50～59岁为0．5％，60～69岁为1．8％，70～79岁为4．8％，80～89岁为8．8％；60岁以上老年人房颤发生率为3％～4％，随年龄的增加房颤的发病率增加，80岁以上约为9％。房颤危害严重，房颤是非房颤心力衰竭患者死亡率的2倍；非瓣膜病性房颤患者发生脑卒中的危险是无房颤者的5～7倍，房颤合并瓣膜病时脑卒中的比例比窦性心律高17倍。房颤是缺血性卒中的独立危险因素。     

新疆成年人踝臂指数异常发生率及其相关因素分析

目的 通过测量踝臂指数(ABI)评价新疆成年人汉族、维吾尔族、哈萨克族ABI异常情况及相关危险因素。方法 采用整群随机抽样法,在新疆7个市及地区、26个社区及村抽取年龄在35岁以上样本,男女均衡。统计不同民族组、不同年龄组、不同性别组人群的ABI异常的发生率及相关的危险因素。结果 分析新疆不同民族成年人群14 618名,其ABI异常发生率为5.30％;其中汉族为3.56％,维吾尔族为7.05％,哈萨克族为5.79％。男性为3.74％,女性为6.65％。女性高于男性(x2 =58.79,P=0.00)。预测ABI异常的独立危险因素有性别、民族、收缩压、体质指数。结论 新疆ABI异常的发生率较高,且存在民族差异和性别差异。     

预防心房颤动患者脑卒中的药物治疗新进展

心房颤动(房颤)是最常见的心律失常,有较高的发病率和病死率.患病率随增龄而增加,年龄＜60岁的患者有1%受累,而年龄＞80岁的患者为10%\[1-2].房颤可使栓塞或脑卒中风险增加5倍,每年的绝对风险为1%~20%,取决于患者的年龄和是否存在危险因素,如充血性心力衰竭、高血压、糖尿病和既往栓塞事件[3].     

血清同型半胱氨酸与心房颤动的关系

<正>心房颤动(AF,房颤)是临床最常见的心律失常之一,且随年龄的增长呈上升趋势。房颤引起的血栓栓塞、心力衰竭等并发症严重威胁患者的健康及生活质量。而同型半胱氨酸(Hcy)作为近年发现的一个氧化应激标志物,参与了房颤的发生、发展、预后及复发。1房颤流行病学及发病机制1.1流行病学及分类流行病学研究表明我国房颤的总体患病率为0.77%,标准化后为0.61%;且随年龄的增长呈上升趋势,80岁以上患者的患病率为7.5%[1]。2014年房颤最新指     

老年心房颤动患病率与缺血性卒中及CHA2DS2-VASc评分的相关性

目的:探讨老年(≥65岁)心房颤动(房颤)患病率与缺血性卒中及CHA2DS2-VASc评分的相关性,为其临床防治提供依据。方法:采集我院2013-10至2015-10连续住我科5 016例患者的住院资料,房颤患者437例为房颤组,非房颤患者4 579例为非房颤组。按年龄分为65岁、65~74岁、75~84岁、≥85岁四个年龄段,回顾性分析房颤的危险因素。结果:与非房颤组相比,房颤组患者年龄、男性房颤患者所占比例增加(P均0.001);合并高血压、冠心病、糖尿病、病态窦房结综合征和风湿性心脏病(风心病)的患者比例显著增高(P均0.001)。年龄、男性、冠心病、病态窦房结综合征和风心病是房颤发生的独立危险因素。房颤组患者缺血性卒中的患病率和发病年龄均高于非房颤组患者(P均0.01)。非瓣膜性房颤CHA2DS2-VASc评分≥2分患者所占比例明显高于CHA2DS2-VASc评分2分的患者(P0.001),其抗凝治疗率随增龄而下降(P均0.001)。结论:房颤的发生与年龄、男性、冠心病、病态窦房结综合征和风心病患病率独立相关。非瓣膜性房颤缺血性卒中的发病风险较非房颤者明显增加,需及早开始抗凝治疗。     

持续性心房颤动患者无症状心房颤动的发生情况及影响因素

目的 分析持续性心房颤动(房颤)患者中无症状房颤的发生情况及影响因素.方法 收集经24 h动态心电图监测确诊的持续性房颤患者82例,观察症状的有无及发生比例.经抗心律失常药物治疗3个月后复查24 h动态心电图监测,观察症状的变化情况.采用多无logistic回归分析持续性房颤症状与临床特征的相关性.结果 82例患者中34例(42%)无症状房颤发作,48例有症状房颤发作.应用抗心律失常药物治疗3个月后,48例有症状患者中31例症状完全消失,其中4例转复为窦性心律,27例为无症状房颤发作.34例无症状患者中,5例转复为窦性心律,24例仍为无症状房颤发作.持续性房颤中有症状和无症状患者年龄,瓣膜病比较差异有统计学意义(P＜0.05).其症状与瓣膜病呈正相关(b=1.959,P=0.001),与年龄呈负相关(b=-0.837,P=0.032).结论 持续性房颤患者中无症状房颤的发生率较高.抗心律失常药物既可减少房颤发作,又可减少房颤症状.高龄和非瓣膜病房颤患者易发生无症状房颤.     

A review of the epidemiology of atrial fibrillation in sub‐Saharan Africa

This systematic review summarizes the data on the prevalence, risk factors, complications, and management of atrial fibrillation (AF) in sub‐Saharan Africa (SSA). Bibliographic databases were searched from inception to 31 May 2019, to identify all published studies providing data on AF in populations living in SSA. A total of 72 studies were included. The community‐based prevalence of AF was 4.3% and 0.7% in individuals aged ≥40 years and aged ≥70 years, respectively. The prevalence of AF ranged between 6.7% and 34.8% in patients with ischemic stroke, between 9.5% and 46.8% in those with rheumatic heart disease (RHD), between 5% and 31.5% in patients with dilated cardiomyopathy. The main risk factors for AF were hypertension, affecting at least one‐third of patients with AF, and valvular heart disease (12.3%‐44.4%) and cardiomyopathy (~20%). Complications of AF included heart failure in about two thirds and stroke in 10% to 15% of cases. The use of anticoagulation for stroke prevention was suboptimal. Rate control was the most frequent therapeutic strategy, used in approximately 65% to 95% of AF patients, with approximately 80% of them achieving rate control. The management of AF was associated with exorbitant cost. In conclusion, AF seems to have a higher prevalence in the general population than previously thought and is mostly associated with hypertension, cardiomyopathy, and RHD in SSA. It is associated with a high incidence of heart failure and stroke. The management of AF is suboptimal in SSA, especially with a low uptake of oral anticoagulation.     

Embolic risk in atrial fibrillation that arises from hyperthyroidism: review of the medical literature

Atrial fibrillation, the most common cardiac complication of hyperthyroidism, occurs in an estimated 10% to 25% of overtly hyperthyroid patients. The prevalence of atrial fibrillation increases with age in the general population and in thyrotoxic patients. Other risk factors for atrial fibrillation in thyrotoxic patients include male sex, ischemic or valvular heart disease, and congestive heart failure. The incidence of arterial embolism or stroke in thyrotoxic atrial fibrillation is less clear. There are many reports of arterial thromboembolism associated with hyperthyroidism, including cases of young adults without coexisting risk factors other than thyrotoxic atrial fibrillation. The use of anticoagulative agents to prevent thromboembolic sequelae of thyrotoxic atrial fibrillation is controversial: National organizations provide conflicting recommendations in their practice guidelines. Herein, we review the medical literature and examine the evidence behind the recommendations in order to determine the best approach to thromboembolic prophylaxis in patients who have atrial fibrillation that is associated with hyperthyroidism.     

Retrospective investigation of hospitalised patients with atrial fibrillation in mainland China

OBJECTIVE: To evaluate the epidemiology and status of atrial fibrillation in China. METHODS: Retrospective analysis of hospital records of patients with a primary diagnosis of atrial fibrillation, discharged between January 1999 and December 2001. RESULTS: Data were analysed from 9297 patients (mean age 65.5 years) from 41 hospitals in mainland China. During the period studied, atrial fibrillation admissions (mean 7.9%) increased as a proportion of cardiovascular admissions. The distribution of atrial fibrillation increased with age. Causes and associated conditions were advanced age (58.1%), hypertension (40.3%), coronary heart disease (34.8%), heart failure (33.1%), rheumatic valvular disease (23.9%), idiopathic atrial fibrillation (7.4%), cardiomyopathy (5.4%) and diabetes (4.1%). Permanent atrial fibrillation accounted for almost half of the patients (49.5%), and paroxysmal and persistent atrial fibrillation the remainder (33.7% and 16.7%, respectively). Paroxysmal atrial fibrillation was treated mainly by rhythm control (56.4%). In 82.8% of patients with chronic atrial fibrillation, a rate-control strategy was used. The prevalence of stroke was 17.5%. In non-valvular atrial fibrillation, risk factors associated with stroke included advanced age, history of hypertension, coronary heart disease and type of atrial fibrillation. A total of 64.5% of patients received antithrombotic therapy, predominantly with antiplatelet agents. Patients managed with antiplatelet or anticoagulant drugs had a significantly lower stroke rate than those receiving neither treatment, but there was no significant difference between antiplatelet and anticoagulant agents. CONCLUSION: Most of the atrial fibrillation-related epidemiological factors in this population were similar to those reported in other countries. Antiplatelet and anticoagulant treatment both reduced stroke rate significantly.     

Atrial fibrillation and its relation to cardiac diseases and sudden cardiac death

Atrial fibrillation (AF) is the most common arrhythmia in adults. Many studies have reported an association between atrial fibrillation and other cardiac diseases including sudden cardiac death (SCD). According to the literature, the prevalence and incidence of atrial fibrillation have been increasing and AF is associated with higher mortality and morbidity. An increased incidence of AF has been described in patients with ischemic heart disease, heart failure, and arterial hypertension. These conditions share some pathophysiological mechanisms with atrial fibrillation, which is, reciprocally, one of their risk factors. As a result, mortality is 2–4-fold higher in individuals with AF. Increased mortality from, and a higher incidence of, ventricular arrhythmias, including ventricular fibrillation (VF), have been found in patients with implantable cardiac defibrillators (ICD), as well as in the general population where AF has been independently related to an up to 3-fold increased risk of cardiac arrest due to VF. The mechanism of action is based on a direct proarrhythmogenic effect of atrial fibrillation, increased cardiac workload, tachycardia-induced ischemia, or heart failure. Risk stratification, optimization of therapy, and screening for subclinical structural heart disease play an important role in the care of patients with atrial fibrillation.     

射血分数降低的心力衰竭病人持续性心房颤动危险因素研究

目的探讨射血分数降低的心力衰竭(HFrEF)病人持续性心房颤动(房颤)的相关危险因素。方法收集南京市高淳人民医院2017年1~12月住院治疗的HFrEF合并房颤病人78例,根据病人房颤类型分为阵发性房颤组16例以及持续性房颤组62例。比较2组病人一般情况的差异,并应用多因素Logistic逐步回归分析及ROC曲线分析HFrEF合并持续性房颤的危险因素。结果与阵发性房颤组比较,持续性房颤组的左心房内径(LAD)、血尿酸水平、合并T2DM比例增高,BMI、合并心脏瓣膜病比例降低,差异有统计学意义(P<0.05)。多因素Logistic回归分析结果显示,LAD是心力衰竭病人持续性房颤的独立危险因素(OR=1.256,95%CI1.071~1.473)。ROC曲线显示,LAD最佳截断点为49.5 mm,敏感性为51.6%,特异性为41.5%,AUC为0.871。结论HFrEF病人持续性房颤受多种因素影响,其中LAD可能是HFrEF病人持续性房颤的独立危险因素。     

Prevalence and clinical characteristics of patients with atrial fibrillation: analysis of 20,000 cases in Japan

In Japan, data on the epidemiological and clinical features of atrial fibrillation (AF) are rather sparse; even less data are available on the risk of thromboembolism in nonvalvular AF. The present study enrolled 19,825 patients who visited the cardiovascular clinics of the 13 hospitals in Hokkaido, Japan, between March and July 1995. The prevalence of AF, the clinical characteristics of AF patients, and the occurrence of ischemic events were examined during the 2 year follow-up period. The prevalence of AF increased with age, and the overall prevalence was 14%. Antithrombotic therapy was used in 57% of AF patients and the incidence of ischemic events during the follow-up period was 4.6% in all AF patients. Warfarin reduced the risk of ischemic events in both the valvular and nonvalvular AF groups. A history of cerebrovascular accidents, advanced age, and the presence of underlying heart disease were each associated with a significantly increased risk of ischemic events in the nonvalvular AF group. These results show a lower incidence of ischemic events and more frequent use of antiplatelet drugs in the nonvalvular AF group. Further prospective studies are needed to determine the best preventive methods for thromboembolic complications in Japanese patients with nonvalvular AF.     

The etiology and associated risk factors in a sample of 300 patients with atrial fibrillation]

PURPOSE: To analyze the etiology and the prevalence of risk factors in patients with atrial fibrillation. PATIENTS AND METHODS: Applying an unpaired case controlled study, we examined 300 consecutive patients (143 men) with atrial fibrillation and a mean age of 66 +/- 8 years. This group is compared with a control group of 700 patients (mean age 64 +/- 12 years). RESULTS: In the group with atrial fibrillation the etiology in 32% was arterial hypertension, in 20% coronary heart disease, in 13% valvular heart disease, in 11% heart failure, in 4% hyperthyroidism and in 20% idiopathic. 50% presented hypertension, 29% tobaccoism, 26% left ventricular hypertrophy, 20% consumption of alcohol, 19% hypercholesterolemia and 16% diabetes. Compared with the control group, patients with atrial fibrillation had coronary heart disease (p < 0.05), VHD (p < 0.01), myocardiopathy (p < 0.05), HT (p < 0.001), left ventricular hypertrophy (p < 0.001), diabetes (p < 0.01) and alcohol consumption (p < 0.01) more frequently. In the multivariant analysis heart failure (odds ratio 2.1 [1.2-3.3]), the valvular heart disease (odds ratio 2.2 [1.4-3.5]), the coronary heart disease (odds ratio 1.8 [1.2-2.6]), the arterial hypertension (odds ratio 1.7 [1.2-2.3]), the left ventricular hypertrophy (odds ratio 2.6 [1.7-3.8]), the diabetes (odds ratio 1.9 [1.2-2.9]) and alcoholic habits (odds ratio 2 [1.3-3.9]) were independent risk factors for atrial fibrillation in our population. CONCLUSIONS: Atrial fibrillation in our study, is more frequent in patients with arterial hypertension, coronary heart disease or valvular heart disease. There are other risk factors such as arterial hypertension, diabetes and consumption of alcohol too, the modification of which could diminish the risk of the appearance of atrial fibrillation.     

脉压与发生心房颤动危险性的关系

目的:观察脉压和发生心房颤动(AF)危险性之间的关系。方法:研究共纳入对象5205例年龄35～91岁成人,主要终点为观察偶发AF事件。结果:702例(13.5%)发生AF,脉压<40mmHg的AF 20年累积发生率为6.0%,脉压≥60mmHg的AF发生率为22.2%。多变量分析显示,在校正年龄、性别、平均动脉压和心房颤动的临床危险因素(体质量指数、吸烟、糖尿病等)后,脉压每增加20mmHg,发生心房颤动的危险性增加24%(危险比1.26,95%CI 1.12～1.43,P<0.001)。相反,平均动脉压与偶发AF无关(危险比0.96,95%CI 0.88～1.05,P=0.78)。结论:脉压是偶发心房颤动的重要危险因素,应采取适当措施降低脉压防治心房颤动。