中国心房颤动现状流行病学研究

了解中国目前心房颤动(简称房颤)患病率、并发症,以及服药情况,为进一步研究奠定基础.材料和方法在全国14个省份选取14个自然人群进行整群抽样调查,采用国际通用的标准化调查方法,在人群中进行以房颤为主要内容的心血管流行病学调查.制作数据库,统计结果.结果中国房颤患病率粗率0.77%,标准化率为0.61%.年龄分组显示患病率有随年龄增加的趋势.男性患者房颤患病率高于女性(0.9%比0.7%,P=0.013).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别为12.9%,65.2%和21.9%.房颤患者中脑卒中以缺血性脑卒中为主,房颤患者脑卒中率明显高于非房颤人群(12.1%比2.3%,P＜0.01).服药情况华法林(1.7%),阿斯匹林(37.9%),洋地黄(37.9%),β-阻断剂(24.6%).结论和讨论中国房颤患病率,年龄分组,性别分组,病因分组等均和国外相关资料趋势接近,脑卒中发病率高,但服药情况十分不理想,房颤需要加强控制.展望未来将对所调查的人群继续随访.     

心房颤动的治疗进展

心房颤动（AF，简称房颤）为目前心律失常的热点之一。近年来高血压、冠心病已超过风湿性心脏病成为房颤的主要病因。胡大一等在我国13个省份进行了房颤大规模流行病学调查。研究表明，中国房颤患病率为0．77％，男性房颤患病率（0．9％）高于女性（0．7％），患病率有随年龄显著增加的趋势，80岁以上人群患病率达7．5％。     

高同型半胱氨酸与非瓣膜心房颤动合并脑卒中的相关性分析

目的：检测房颤、脑卒中、房颤合并脑卒中病人同型半胱氨酸（Hcy）水平,评估高同型半胱氨酸是否为非瓣膜房颤合并脑卒中的独立预测因子。方法选取非瓣膜房颤病人50名,脑卒中病人50例,合并脑卒中的非瓣膜房颤病人48例,正常人群50例,采用美国 AU5400循环酶法测定 Hcy水平。结果与正常组比较,房颤组、脑卒中组、房颤合并脑卒中组 Hcy水平升高（ P ＜0．05）。房颤合并脑卒中组 Hcy水平高于房颤组（ P ＜0．05）;房颤合并脑卒中组 Hcy水平较脑卒中组升高,但差异无统计学意义。以 Hcy＞17μm o l/L为阳性标准,房颤合并脑卒中组与房颤组 Hcy阳性率比较差异有统计学意义（ P ＜0．05）,Hcy明显升高的房颤病人发生脑卒中的危险是 Hcy不升高房颤病人的4．12倍。结论房颤合并脑卒中病人 Hcy明显升高,Hcy升高是预测房颤病人发生脑卒中的可靠指标。     

心房颤动抗凝治疗现状

心房颤动（房颤）是十分常见的心律失常疾病,其发病率与年龄密切相关,在〈50岁的人群中房颤患者罕见,60岁后发病率明显增加,至80岁其发病率接近10%。房颤发病的中位年龄为72岁,男性高于女性。我国首项大规模人群流行病学研究在全国13个省、14个自然人群中抽样29079人，发现中国人房颤患病率约为0．77％，80岁以上人群患病率达7．5％，患者人数接近800万。随着风湿瓣膜性心脏病逐渐减少，非瓣膜性房颤成为目前的主要问题。     

心房颤动抗凝治疗的现状与进展

据Framing,ham心脏研究报道，心房颤动（atrial fibrillation，Air）的终生危险是40岁以后每4人中就有1人会发生Af，其危险度高于心力衰竭（1／5）和女性乳腺癌（1／8）。我国首次Af大规模流行病学研究表明，中国Af患病率为0．77％；患病率随年龄显著增加，80岁以上人群达7．5％。中华医学会组织的国内如家医院房颤回顾性研究表明，非瓣膜性AF脑卒中的平均患病率为24．15％，80岁以上高达32．86％。     

湖北省阳新县心房纤颤的流行病学调查

目的:了解湖北省阳新县目前心房纤颤的患病率、知晓率、脑卒中发病率及服药情况。方法:随机抽取阳新县城一个社区和农村一个行政村,年龄在30岁以上的常住居民2435人。以问卷调查和体格检查的形式进行调查。结果:阳新县心房纤颤患者20例,患病率为0.82%、知晓率为40.0%。随着年龄的增加其患病率、知晓率增高。男性心房纤颤患病率和知晓率明显高于女性(0.91%:0.73%,45.5%:33.3%,P0.01)。心房纤颤病人中瓣膜型与非瓣膜型所占的比例分别为0.16%(4/2435)和0.66%(16/2435)。心房纤颤病人脑卒中率明显高于非心房纤颤人群(20.0%:2.2%,P0.001)。服药情况:绝大多数心房纤颤患者从不服药,在服用的药物中,阿司匹林服药率较高,占30.0%,其次为地高辛20.0%,β受体阻滞剂10.0%,华法令5.0%。结论:阳新县心房纤颤患病率较高、知晓率低、脑卒中发病率较高、服药情况十分不理想,需加强对心房纤颤的控制。     

中国人非瓣膜性心房颤动脑卒中危险因素的病例-对照研究

目的　本研究通过回顾性病例对照研究分析中国人心房颤动 (房颤 )脑卒中的危险因素。方法　在全国 1 8家医院共登记房颤患者 4 51 1例 ,其中风湿瓣膜性房颤 1 0 86例 ,非瓣膜性房颤 342 5例。通过比较房颤合并脑卒中与房颤无脑卒中患者 ,筛选房颤发生脑卒中的危险因素。结果　中国人房颤脑卒中的患病率 2 4 81 % ,房颤合并脑卒中组年龄明显高于对照组 (P <0 0 0 1 ) ,且患病率随年龄增长而明显增加。多因素Logistic分析显示 :年龄≥ 75岁 (OR 1 76 ,95 %CI 1 0 8～ 2 98) ,高血压病史 (OR 1 52 ;95 %CI 1 2 8～ 1 80 ) ,糖尿病史 (OR 1 39,95 %CI 1 1 1～ 1 76) ,动脉收缩压升高(OR 1 71 ,95 %CI1 2 1～ 2 2 8) ,左房血栓 (OR 2 77,95 %CI 1 2 5～ 6 1 3)是脑卒中的独立危险因素。结论　中国人非瓣膜性房颤脑卒中的独立危险因素为年龄、高血压病史、糖尿病史、左房血栓、动脉收缩压升高 ,上述因素对决定房颤患者的抗栓治疗策略具有重要意义     

心房结构重构与心房颤动

房颤是临床最常见的心律失常之一.Feinberg等[1]对全球4个主要人群的流行病学调查结果显示,房颤发生率随年龄的增加而增加.中国一项来源于29 079例30～85岁患者的房颤流行病学调查显示,房颤患病率为0.77％,标准化率为0.61％,年龄分组显示患病率有随年龄增加的趋势[2].随着人口老龄化的发展,房颤的患病率必将不断攀升.然而房颤的确切发病机制并不十分清楚,临床治疗效果仍不理想.因此,从房颤的发生及维持机制方面入手,寻找预防和治疗房颤的新方法、新手段势在必行.     

新疆地区成年人心房颤动的流行病学现状及相关危险因素分析

目的 了解新疆地区成年人目前心房颤动（房颤）的流行病学现状及相关危险因素.方法 应用4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、不同性别组人群的房颤患病率,并对房颤相关危险因素进行分析.结果 共抽取35岁以上城市及农村游牧居民14618人,房颤患病率为0.40%,标准化率为0.35%,其中汉族为0.31%,维吾尔族为0.25%,哈萨克族为0.59%.男性患病率高于女性（0.53%对0.28%,P＜0.05）.年龄分组显示患病率有随年龄增加的趋势.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别31%、36%和33%.多因素Logistic回归分析结果显示,年龄、瓣膜病、心力衰竭与房颤患病率的OR值分别为1.09、1.90、10.65.结论 新疆地区成年人房颤患病率接近于国内外有关研究结果,民族间差异无统计学意义,随年龄增加呈增多趋势;年龄、瓣膜病、心力衰竭是房颤发生的独立危险因素.     

老年非瓣膜性心房颤动患者华法林抗凝治疗的护理

非瓣膜性心房颤动是缺血性脑卒中的独立危险因素,胡大一等在全国18家医院进行的房颤脑卒中病例对照研究显示,我国房颤脑卒中的患病率为24．8％。马长生等对北京地区非瓣膜病房颤患者缺血性脑卒中的发生率报告,非瓣膜病房颤患者非抗凝状态下缺血性脑卒中年发生率为5．3％。     

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.     

Low prevalence of atrial fibrillation in community-dwelling Chinese aged 55 years or older in Singapore: a population-based study

Background

The prevalence of atrial fibrillation (AF) in Asian populations appears to be lower than that in Western populations according to limited data. We conducted a community study to (a) estimate the prevalence of AF in Chinese adults aged 55 years or older in Singapore and (b) examine associated risk factors.

Methods

We conducted a whole-survey area population screening of 1839 Chinese residents aged 55 years or older in the southeast region of Singapore with a single electrocardiographic recording. We performed structured interviews and anthropometric as well as clinical measurements, including blood pressure.

Results

The estimated overall AF prevalence was 1.5% (95% confidence interval = 1.1-2.2); specifically, the prevalence was higher in men (2.6%) than in women (0.6%) and increased sharply to 5.8% only in individuals aged 80 years or older. This latter rate is lower than age-standardized rates in Western populations by approximately half and consistent with similarly low prevalence rates reported for Korea and China. Of the 26 cases of AF in this study, only 10 were known cases; 3 of the 10 patients were receiving anticoagulant therapy, whereas the rest were receiving antiplatelet therapy. Atrial fibrillation was significantly associated in multivariate analyses with male sex (odds ratio [OR] = 4.10), heart failure (OR = 3.11), and stroke (OR = 3.60).

Conclusions

These data add support to the view that the prevalence of AF in Asian populations is lower than that in Western populations. The observations from these contrasting populations warrant attention in future studies.     

Clinical and prognostic implications of atrial fibrillation in patients undergoing transcatheter aortic valve implantation

AIM: To study a cohort of consecutive patients under-going transcatheter aortic valve implantation (TAVI) and compare the outcomes of atrial fibrillation (AF) patients vs patients in sinus rhythm (SR). METHODS: All consecutive patients undergoing TAVI in our hospital were included. The AF group comprised patients in AF at the time of TAVI or with history of AF, and were compared with the SR group. Procedural, echocardiographic and follow-up variables were compared. Likewise, the CHA 2 DS 2-VASC stroke risk score and HAS-BLED bleeding risk score and antithrombotic treatment at discharge in AF patients were compared with that in SR patients. RESULTS: From a total of 34 patients undergoing TAVI, 17 (50%) were allocated to the AF group, of whom 15 (88%) were under chronic oral anticoagulation. Patients in the AF group were similar to those in the SR group except for a trend (P = 0.07) for a higher logistic EuroSCORE (28% vs 19%), and a higher prevalence of hypertension (82% vs 53%) and chronic renal failure (17% vs 0%). Risk of both stroke and bleeding was high in the AF group (mean CHA 2 DS 2-VASC 4.3, mean HAS-BLED 2.9). In the AF group, treatment at discharge included chronic oral anticoagulation in all except one case, and in association with an antiplatelet drug in 57% of patients. During a mean follow-up of 11 mo (maximum 32), there were only two strokes, none of them during the peri-procedural period: one in the AF group at 30 mo and one in the SR group at 3 mo. There were no statistical differences in procedural success, and clinical outcome (survival at 1 year 81% vs 74% in AF and SR groups, respectively, P = NS). CONCLUSION: Patients in AF undergoing TAVI show a trend to a higher surgical risk. However, in our cohort, patients in AF did not have a higher stroke rate compared to the SR group, and the prognosis was similar in both groups.     

中国部分地区心房颤动住院病例回顾性调查

目的 了解中国心房颤动(房颤)患者年龄分布、病因(或相关因素)、房颤类型、脑卒中等流行病学特征及不同类型房颤的治疗现状。方法 对1999～2001年中国内地41家医院诊断的心房颤动患者的住院病历进行回顾性分析和统计。结果 (1)共入选9297例，平均年龄65．5岁，男女比为13：12。三年内房颤占同期心血管住院病人比例呈逐年上升趋势，平均7．9％。随年龄增高病例数进行性递增。(2)房颤病因及相关因素统计(单项％)，老年58．1％，高血压40．3％，冠心病34．8％，心衰33．1％，风湿性瓣膜病23．9％，特发性房颤7．4％，心肌病5．4％和糖尿病4．1％等。其中以高龄与高血压的组合最常见。本组患者中2／3有心房增大，1／3有射血分数降低。(3)房颤类型中阵发性占33．7％，持续性16．7％，持久性49．5％。(4)阵发性房颤56．4％采用节律控制治疗，18．2％用心室率控制方法，应用药物以胺碘酮、洋地黄制剂最多，其次为B受体阻滞剂、普鲁帕酮等。(5)慢性房颤82．8％接受心室率控制治疗，常用药物为地高辛、B受体阻滞剂及钙拮抗剂。在持续性房颤患者中，试行复律者不足1／2，其中31．1％复律后可维持稳定窦性心律，应用药物以胺碘酮最多，其次为普鲁帕酮、奎尼丁、索他洛尔等。(6)本组脑卒中患病率为17．5％。对非瓣膜病房颤患者的脑卒中危险因素调查显示，其与性别、心房大小无显著相关，而与高龄、高血压、心衰及房颤类型密切相关：(7)本组患者64．5％接受了抗血栓治疗，其中抗血小板治疗占57．9％，长期抗凝治疗者仅6．6％。二种抗血栓治疗均有显著较低的脑卒中发生率，但抗凝与抗血小板二组比较其脑卒中发生率差别无显著性。结论中国房颤患者在年龄分布、病因及相关因素、房颤类型、脑卒中危险因素等流行病学特点与国外报道极为相似。阵发性房颤以节律控制治疗为主。慢性房颤绝大多数用心室率控制治疗。虽有64．5％患者接受了抗血栓治疗，但以抗血小板治疗为主。抗凝及抗血小板治疗二组的脑卒中发生率差异无显著性。     

The prevalence of atrial fibrillation in incident stroke cases and matched population controls in Rochester,Minnesota: changes over three decades

OBJECTIVES: We sought evidence of a change in the prevalence of atrial fibrillation (AF) over a 30-year period among residents of Rochester, Minnesota. BACKGROUND: Atrial fibrillation is increasingly encountered in clinical practice, but there is limited data on secular trends of AF over time. METHODS: Within a longitudinal case-control study of ischemic stroke, the prevalence of AF and of selected comorbid conditions among incident stroke cases and age- and gender-matched controls between 1960 and 1989 was determined. RESULTS: The mean age +/- standard deviation for the 1,871 stroke cases (45% men) and matched controls was 75 +/- 11 years. For cases, age-adjusted estimates of AF prevalence for 1960 to 1969, 1970 to 1979, and 1980 to 1989 were 11%, 13%, and 16%, respectively, for men, and 13%, 16%, and 20% for women. For controls, the rates were 5%, 8%, and 12%, respectively, for men, and 4%, 6%, and 8% for women. Increasing AF prevalence was associated with increasing age (doubling of odds per decade of age in both cases and controls) and calendar time adjusted for age and gender (cases: odds ratio [OR] per 5 years 1.13, 95% confidence interval [CI], 1.05 to 1.22; controls: OR per 5 years 1.24, 95% CI 1.12 to 1.37). The rates of increase with calendar time were significant for cases (p = 0.001) and controls (p < 0.001) and comparable between the genders. CONCLUSIONS: The prevalence of AF increased significantly in ischemic stroke patients and their controls from 1960 to 1989 in Rochester, Minnesota, independent of age and gender. The rate of increase did not differ significantly between men and women.     

Warfarin for prevention of thromboembolism in atrial fibrillation: comparison of patient characteristics and outcomes of the “Real-World” Michigan Anticoagulation Quality Improvement Initiative (MAQI<Superscript>2</Superscript>) registry to the RE-LY,ROCKET-AF,and ARISTOTLE trials

Randomized controlled trials (RCTs) examining warfarin use for stroke prevention in atrial fibrillation (AF) may not accurately reflect real-world populations. We aimed to determine the representativeness of the RCT populations to real-world patients and to describe differences in the characteristics of trial populations from trial eligible patients in a real-world setting. We hypothesized that a significant fraction of real-world patients would not qualify for the RE-LY, ROCKET-AF, and ARISTOTLE trials and that real-world patients qualifying for the studies may have more strokes and bleeding events. We compared the inclusion and exclusion criteria, patient characteristics, and clinical outcomes from RE-LY, ROCKET-AF, and ARISTOTLE against data from the Michigan Anticoagulation Quality Improvement Initiative (MAQI²), a regional network of six community- and academic-based anticoagulation clinics. Of the 1446 non-valvular AF patients in the MAQI² registry taking warfarin, approximately 40–60% would meet the selection criteria used in RE-LY (788, 54.5%), ROCKET-AF (566, 39.1%), and ARISTOTLE (866, 59.9%). The most common reasons for exclusion from one or more trial were anemia (15.1%), other concurrent medications (11.2%), and chronic kidney disease (9.4%). Trial-eligible MAQI² patients were older, more frequently female, with a higher rate of paroxysmal AF, and lower rates of congestive heart failure, previous stroke, and previous myocardial infarction than the trial populations. MAQI² patients eligible for each trial had a lower rate of stroke and similar rate of major bleeding than was observed in the trials. A sizable proportion of real-world AF patients managed in anticoagulation clinics would not have been eligible for the RE-LY, ROCKET-AF, and ARISOTLE trials. The expected stroke risk reduction and bleeding risk among real-world AF patients on warfarin may not be congruent with published clinical trial data.     

全国多中心支气管哮喘与过敏性鼻炎门诊患者对蟑螂变应原皮肤反应性的调查

目的 探讨支气管哮喘(简称哮喘)和过敏性鼻炎患者对常见蟑螂(美洲大蠊和德国小蠊)的过敏水平及一些流行病学的特点,同时比较对不同品种蟑螂间的研究,为深入研究昆虫过敏症奠定基础.方法 在全国范围内挑选了25家主要从事变应性疾病防治研究的三级甲等医院,对就诊于呼吸科、儿科或变态反应科门诊的哮喘和(或)过敏性鼻炎患者6081例,采用统一的调查问卷和蟑螂抗原皮肤点刺试验.结果 哮喘和过敏性鼻炎患者对两种蟑螂抗原的反应性是显著相关的,其阳性程度也显著相关(P<0.001);对美洲大蠊抗原的阳性率26.34%高于德国小蠊19.37%,南方地区阳性率高于北方与东部地区,对蜂螂过敏的患者大多在2级水平,强阳性患者极少;男性患者对美洲大蠊和德国小蠊的阳性率分别是28%与19%,均高于女性的25%与15%;成人对美洲大蠊和德国小蠊的阳性率30%与24%也显著高于儿童的23%与14%,对于蜂螂过敏的患者,约有90%同时对屋尘螨抗原阳性.结论 蟑螂是哮喘和过敏性鼻炎患者的主要变应原之一、对美洲大蠊的阳性率高于德国小蠊,成人的阳性率高于儿童,男性高于女性,蟑螂和屋尘螨之间可能存在着抗原交叉的现象.     

中国自然人群下肢外周动脉疾病患病率及相关危险因素

目的 调查中国自然人群下肢外周动脉疾病(peripheral arterial disease,PAD)患病率及相关危险因素,为开展下肢动脉粥样硬化的预防提供科学依据.方法 采用分层整群随机抽样的方法,选取北京、上海、长沙、广东、内蒙古和新疆地区的社区自然人群作为研究对象,由培训过的医师对调查对象进行踝臂指数(ankle brachial index,ABI)测量和资料收集.任一侧肢体ABI≤0.9诊断为PAD.结果 在21 152例受试者中,PAD患病率3.08%,标化患病率3.04%;男性PAD患病率2.52%,标化患病率1.84%;女性PAD患病率3.66%,标化患病率4.31%,男性PAD患病率低于女性(P相似文献   

Risk factor profile in Chinese‐Australian stroke patients living in Sydney

Aim: To examine and compare stroke risk factors and their management in stroke patients of Chinese descent versus English‐speaking background (ESB)‐Australian patients. Methods: Cohort study. Fifty‐one Chinese‐Australians and 119 ESB‐Australians who were admitted to hospitals within Sydney metropolitan area with a recent acute ischaemic or haemorrhagic stroke were recruited. Results: Chinese‐Australian patients tended to have a favourable smoking (0% current smokers vs 15%, P = 0.036) and drinking (5% current medium/heavy drinkers vs 17%, P = 0.005) pattern compared with the Australian patients. The prevalence of diabetes mellitus was higher in Chinese‐Australians (31% vs 10%, P = 0.003). The management of hypertension and atrial fibrillation (AF) in Chinese‐Australians was suboptimal (19% untreated hypertension vs 8%, P = 0.102; 78% AF not on Warfarin vs 51%, P = 0.264). Conclusion: The findings of this study suggest that targeting specific stroke prevention strategies may be useful for Chinese‐Australians. Larger‐scale studies need to be conducted to confirm these findings.