首页 | 本学科首页   官方微博 | 高级检索  
相似文献
 共查询到20条相似文献,搜索用时 171 毫秒
1.
Background Chronic heart failure(CHF)and diabetes mellitus portend high morbidity and mortality because of an interrelated pathophysiologic process.This large cohort study aimed to analyze the prevalence,clinicaI characteristics and long-term outcome of patients with CHF and diabetes.Methods A totaI of 1119 patients with NYHA functionaI class Ⅱ-Ⅳ and left ventricular ejection fraction(LVEF)〈45% between January 1995 and May 2009 were recruited.Clinical variables, biochemical and echocardiographic measurements were retrospectively reviewed,and composite major cardiac events (MCE) including death,headtransplantation, and refractory heart failure requiring multiple hospitalizations were recorded.Results The prevalence of CHF with diabetes was progressively increased with time (16.9% in 1995-1999;20.4% in 2000-2004,and 29.1% in 2005-2009)and age(1 8.5% in〈60 years,26.6% in 60-80 years,and 26.6% in〉80 years).Compared with CHF patients without diabetes,those with diabetes had worse cardiac function,more abnormal biochemical changes.and higher mortality.Treatment with glucose-lowering agents significantly improved LVEF and decreased MCE.An elevated serum HbA1c level was associated with large left ventricular end-systolic diameter (P〈0.05),decreased LVEF(P〈0.01)and reduced survival(P〈0.05).Multivariable Logistic regression analysis revealed that after adjustment for confounding factors,NYHA functional class(OR2.65,95%CI 1.14-6.16,P=0.024)and HbA1c level≥7%(OR2.78, 95%CI 1.00-7.68,P=0.049)were independent risk factors for adverse outcomes in CHF patients with diabetes.Conclusions Prevalence of CHF with diabetes was increasing during past decades,and patients with CHF and diabetes had worse clinical profiles and prognosis.Aggressive anti-CHF and diabetes therapies are needed to improve overall outcomes for these patients.  相似文献   

2.
Background Metabolic syndrome (MetS) and atrial fibrillation (AF) are causally related. This study aimed to determine the prevalence of MetS in patients with AF in the absence of structural heart disease from a tertiary hospital in China.
Methods In a single center, 741 inpatients with AF in the absence of structural heart disease prior to catheter ablation were retrospectively reviewed. Among them, 588 (79.4%) patients had paroxysmal AF. Subgroup analyses were performed in paroxysmal AF and persistent/permanent AF.
Results MetS was found in 343 (46.3%) patients (200 males, 143 females); 0, 1, 2, 3, 4, 5 components of the MetS were found in 59 (8.0%), 140 (18.9%), 199 (26.9%), 203 (27.4%), 103 (13.9%) and 37 (5.0%) patients, respectively. The prevalences of overweight/obesity, high blood pressure, high glucose level, high triglyceride level and low high density lipoproteins cholesterol level were 53.8%, 47.6%, 23.2%, 40.6% and 72.1%, respectively. The prevalence of MetS was not significantly different between the paroxysmal AF group and the persistent/permanent AF group (44.6% vs 52.9%, P=0.064). The five components of MetS except overweight/obesity (69.3% vs 49.8%, P 〈0.001) were not significantly different between the aforementioned two groups. The left atrium diameter increased with the sum of the MetS components. The left atrium diameter in the MetS group was significantly higher than that in the non-MetS group both in patients with paroxysmal AF and in patients with persistent/permanent AF.
Conclusions The prevalence of MetS in patients with AF prior to catheter ablation is high. Further study and prevention are needed.  相似文献   

3.
Objective To evaluate the clinical value of alarm symptoms in diagnosis of lower gastrointestinal diseases. Methods Data of consecutive autochthonous patients referred to the endoscopy center of Renji Hospital during the period of Oct. 2002 to Dec. 2003 were retrospectively analyzed. The prevalence of alarm symptoms in Shanghai patients with colorectal malignancies or other organic or functional lower gastrointestinal diseases was investigated. Results 83 (4. 9% ) cases of colorectal malignancies were found in 1681 patients referred to the center for colonoscopy because of lower gastrointestinal symptoms. All these malignancies were verified to be in the progressive stage. The prevalence of alarm symptoms was 81.9% (68/83). Hematochezia ( OR 4. 1, 95% CI 3.3 -5.2, P 〈0. 001), melena (0R6.4, 95%CI3. 7-11. 0, P 〈0. 001) and anemia (OR 9.6, 95?3. 7 - 25. 0, P 〈 0. 001 ) were the most common and specific alarm symptoms. All the patients without alarm symptoms were above the age of 40 years. 264 (15. 7% ) cases of organic colorectal diseases other than malignancies and 1334 ( 79. 4% ) cases with no causal pathology identified were found in 1681 patients, and the prevalence of alarm symptoms in these two groups was 48. 5% (128/264) and 14. 8% (197/1334), respectively. Conclusion Alarm symptoms including hemotochezia, melena, and anemia were useful in distinguishing organic from functional colorectal diseases in patients over 40 years old at the onset of symptoms. Furthermore, hematochezia, melena, anemia, severe weight loss, and abdominal mass were helpful in differentiating malignant from non-malignant colorectal diseases. Colonoscopy should be recommended for patients regardless of age with these alarm symptoms, and so do patients above the age of 40 years with no alarm symptoms before the diagnosis of functional diseases are made.  相似文献   

4.
Backround N-terminal pro-brain natriuretic peptide (NT-proBNP) is a reliable predictor in acute coronary artery disease (CAD). Little is known about patients with stable CAD, especially Chinese patients with CAD. The aim of the present study was to investigate the association of NT-proBNP levels with the severity of CAD in patients with normal left ventricular ejection fraction. Methods A total of 658 consecutive patients were divided into two groups based on angiograms: CAD group (n=484) and angiographic normal control group (n=174). The severity of CAD was evaluated by modified Gensini score, and its relationship with NT-proBNP was analyzed. Results The prevalence of risk factors such as age, male gender, diabetes mellitus (DM), dyslipidemia, smoking, and family history of CAD in the CAD group were higher than that in the control group. In multivariate regression model analysis, age, gender, and DM were determinants of the presence of CAD. NT-pro BNP was found to be an independent predictor for CAD (OR:1.66 (95% CI: 1.06-2.61), P 〈0.05). In a receiver operating characteristic (ROC)curve analysis, an NT-proBNP value of 641.15 pmol/L was identified as a cut-off value in the diagnosis or exclusion of CAD (area under curve (AUC)=0.56, 95% CI: 0.51-0.61). Furthermore, NT-proBNP was positively correlated with Gensini score (r=0.14, P 〈0.001) in patients with CAD. Conclusion NT-proBNP was an independent predictor for Chinese patients with CAD, suggesting that the NT-proBNP level might be associated with the presence and the severity of CAD.  相似文献   

5.
Embolic events in 93 elderly Chinese patients with atrial fibrillation   总被引:3,自引:2,他引:1  
Objectives To evaluate the prevalence of embolic events and relevant factors in elderly Chinese patients with atrial fibrillation(AF), and to provide evidence on ways to prevent embolic events.Methods Autopsy data from ninety-three continous elderly Chinese patients with AF were analysed. The incidence of embolic events and its relationship to underlying disease, pathologic changes in the heart, and other clinical characteristics were examined.Results Embolism were observed in 27 of 93 cases, with an incidence of 29.03%. The incidence of embolic events was higher in elderly patients with rheumatic heart disease than those with coronary artery disease, hypertensive myocardiopathy and heart diseases. Patients with chronic AF,with a course of AF≥3 years, and those with heart failure or diabetes had a higher incidence of embolic events than those without these complications. There was significant difference in incidence between paroxysmal and chronic AF. Patients with left atrial or ventricular enlargement, mural thrombosis in cardiac chambers, valvular calcification and valvular vegetation also had a higher incidence of embolic events. Oral dipyridamole (75-150 mg/d) or aspirin (50-150 mg/d) showed no definite effects in preventing embolism in some patients.Conclusions There was a high incidence of embolic events in elderly Chinese patients with AF. Anticoagulation therapy should be provided to the elderly patients with AF, especially to the patients with risk factors for embolism.  相似文献   

6.
The safety and efficacy of combined low dose aspirin and warfarin therapy in patients with atrial fibrillation after mechanical heart valve replacement were evaluated. A total of 1016 patients (620 females, mean age of 36.8-4-7.7 years) admitted for cardiac valve replacement and complicated with atrial fibrillation after surgery were randomly divided into study (warfarin plus 75-100 mg aspirin) or control (warfarin only) groups. International normalized ratio (INR) and prothrombin time were main- tained at 1.8-2.5 and 1.5-2.0 times the normal values, respectively. Thromboembolic events and major bleedings were registered during the follow-up period. Patients were followed up for 24±9 months. The average dose of warfarin in the study and control groups was 2.91±0.83 mg and 2.88±0.76 mg, respec- tively (P〉0.05). The incidence of overall thromboembolic events in study group was lower than that in control group (2.16% vs. 4.35%, P=0.049). No statistically significant differences were found in hem- orrhage events (3.53% vs. 3.95%, P=-0.722) or mortality (0.20% vs. 0.40%, P=0.559) between the two groups. Combined low dose aspirin and warfarin therapy in the patients with atrial fibrillation following mechanical heart valve replacement significantly decreased thromboembolic events as compared with warfarin therapy alone. This combined treatment was not associated with an increase in the risk of major bleeding or mortality.  相似文献   

7.
Background Atrial fibrillation (AF) occurs commonly in patients with acute myocardial infarction (MI) and is associated with an increased long-term mortality. This study aimed to investigate the clinical characteristics and outcomes of AF in in-hospital elderly Chinese patients with acute MI.
Methods A total of 967 patients with acute MI, aged 〉65 years, were categorized on the basis of the absence or presence of AF. Patients with documented AF were classified into two subgroups: the ongoing AF group and the new-onset AF group. We retrospectively evaluated the clinical profile, in-hospital outcomes, and effects of revascularization on the incidence of AF in elderly patients with acute MI.
Results AF was documented in 100 (11.53%) patients and the incidence of new-onset AF was 6.51% during hospitalization. History of old MI and cerebrovascular events were more common in patients with AF than in those without AF (P 〈0.001, P 〈0.01, respectively). The incidence of AF was higher in patients with non-ST elevated MI (P=0.014), inferior wall MI (P=0.004) and cardiac function of Killip class Ⅲ or Ⅳ (P=-0.008). Patients with AF had more complication of pneumonia (P=0.003) and longer hospital stay. Left circumflex coronary artery involvement was more common in patients with AF (compared with patients without AF, P 〈0.001). Percutaneous coronary intervention or coronary artery bypass grafting significantly decreased the incidence of new-onset AF from 7.97% to 3.82% (P=0.017). AF depended to heart failure, increased the in-hospital mortality.
Conclusions AF is common in elderly patients with acute MI and is associated with poorer clinical outcomes. Revascularization reduces the incidence of AF and thus improves the clinical outcomes in these patients.  相似文献   

8.
Women in 180 U.S. counties see decrease in lifespan   总被引:1,自引:0,他引:1  
Recurrent atrial tachycardia (AT) is often observed late .after heart surgery and it contributes significantly to the morbidity and mortality of this group of patients. In patients with structurally normal hearts the most prevalent type of AT is a macroreentrant atrial tachycardia (MAT), more specifically known as common atrial flutter (AFL). In contrast, in patients with repaired structural heart disease other ATs may occur due to the existence of variable and multiple arrhythmogenic substrates, related to the underlying heart disease and/or the surgical incisions.  相似文献   

9.
Objective To investigate the relevant factors of coronary artery disease (CAD) in young people under 40 years of age. Methods The study population was 292 young patients accepting coronary angiography in Fuwai Hospital from July to December 2006, including 272 men and 20 women, with the mean age being 36.7±3.7 years. The diagnosis of CAD was made in the cases presenting ~ 50% stenosis in coronary lumen in coronary angiography. Based on the diagnosis, 217 patients (204 men, 13 women) were assigned to CAD group, and 75 (68 men, 7 women) to non-CAD group. Clinical data and metabolic characteristics of the patients were collected and analyzed using t-test, Z2 test, and multinomial logistic regression with SPSS 8.0 software. Results Most study subjects were current smokers (209/292, 71.6%), and more than half had body mass index (BMI)〉24 kg/m2 (230/292, 78.8%) and usually took high-fat diet (162/292, 55.5%). The proportion of heavy smokers (smoking history ≥10 years and t〉20 cigarettes per clay) were significantly higher in the CAD group than in the non-CAD group [20.7% (45/217) vs. 9.3% (7/75), P=0.015)]. Heavy smoking [odds ratio (OR), 1.89; 95% confidence interval (CI), 1.74-2.05], hypertension (OR, 1.56; 95% CI, 1.48-1.65), alcohol (OR, 1.37; 95% CI, 1.30-1.46), type 2 diabetes mellitus (OR, 1.37; 95% CI, 1.25-1.50), high-fat diet (OR, 1.35; 95% CI, 1.28-1.43), and BMI〉24 kg/m2 (OR, 1.09; 95% CI, 1.03-1.17) were factors related to CAD in the young patients (all P〈0.05). Total cholesterol (4.56_±1.46 mmol/L vs. 4.09_±1.00 mmol/L), low-density lipoprotein cholesterol (2.38±1.11 mmol/L vs. 2.14±0.63 rnmol/L), lipoprotein a (134.97±109.70 mg/L vs. 101.58±58.39 mg/L), uric acid (359.89_±100.09 μmol/L vs. 336.75±94.36 μmol/L), erythrocyte sedimentation rate (9.98± 12.19 ram/hour vs. 4.89_±4.92 mm/hour), high-sensitivity C-reactive protein (3.42±4.39 mg/L vs. 2.80±_3.77 mg/L) and Big endothelin-1 (1.41±1.50 fmol/mL vs. 0.77_±1.13 fmol/mL) in plasma were significantly increased in the CAD group compared with the non-CAD group (all P〈0.05). Conclusions Heavy smoking, hypertension, alcohol consumption, type 2 diabetes mellitus, high-fat diet and BMI〉24 kg/m2 were significantly related to CAD in patients aged ≤40, with heavy smoking presenting the highest OR. Metabolic syndrome and inflammation were also more common in young CAD patients than in non-CAD patients.  相似文献   

10.
Background Hepatitis C virus (HCV) infection may induce autoimmune response and autoantibodies can be detected in chronic hepatitis C (CHC) patients. However, the reported positive rate of autoantibodies in CHC patients in China varies considerably. In this study, we investigated the prevalence of antinuclear antibodies (ANA) and anti-liver-kidney-microsome type 1 autoantibodies (anti-LKM-1) in a large cohort of CHC patients, and analyzed the factors related to the presence of the autoantibodies.
Methods A total of 360 CHC patients were enrolled in this study. Serum ANA and anti-LKM-1 were detected by indirect immunofluorescence and enzyme-linked immunosorbent assay, respectively. Clinical analysis was performed to disclose the related factors to autoantibody production.
Results The prevalence of ANA and anti-LKM-1 in CHC patients was 12.5% (45/360) and 2.5% (9/360), respectively. Women had a higher prevalence than men (18.9% vs 11.4%, P=0.046). Patients with positive autoantibodies had lower HCV RNA levels (1.2×10^7 copies/L vs 7.2×10^7 copies/L, P 〈0.05). Positive ANA was associated with higher serum globulin (P 〈0.05). Stratified analysis showed that there were no significant differences in age, HCV genotype, disease course, clinical stage, prevalence of cirrhosis and interferon therapy between autoantibody-positive and -negative subgroups.
Conclusion Autoantibodies can be induced in the course of CHC, and some CHC patients can even develop autoimmune hepatitis.  相似文献   

11.
目的 获得上海市中心城区50岁以上人群心房颤动的患病率及其相关的危险因素.方法 对社区50岁以上人群进行问卷调查及心电图检查,对其生活习惯、疾病史及房颤发病率进行统计.应用单因素和多因素Logistic回归分析房颤的危险因素. 结果 共计入选50岁以上人群3804人.男性1691人,占总人群的44.4%.平均年龄(70.6±8.84)岁.调查明确诊断房颤患者130例,房颤患病率为3.42%,其中男性3.55%,女性3.31%,男女差异无统计学意义(P=0.69).随着年龄的增长,无论男女,房颤的患病率逐渐升高.Logistic多因素回归分析显示,年龄(OR=1.05,95%CI 1.02-1.07)、既往有冠心病(OR=5.44,95%CI 3.60-8.22)或瓣膜病(OR=5.90,95%CI 2.36-14.77)为房颤的危险因素,P均<0.05.结论 上海中心城区(静安区)50岁以上人群房颤患病率较高,高龄、冠心病或瓣膜病患者更易发生房颤.  相似文献   

12.
目的 探讨心脏再同步化治疗(cardiac resynchronization therapy with pacemaker function / defibrillation function,CRT-P /D) 在射血分数降低的心力衰竭患者中发生超反应的预测因素及不良事件的影响因素.方法 回顾分析我科2015年1月至2017年1月收治的59例因心力衰竭采用CRT-P /D治疗并随访12个月以上的患者,采集一般临床资料、心电图、心脏超声、不良事件发生等临床数据.以术后12个月左室射血分数(left ventricular ejection fraction,LVEF) 升高幅度分3组: 超反应组(幅度≥ 15%,14例),中度反应组(5%≤幅度< 15%, 23例),轻度/无反应组(幅度< 5%, 22例) .采用方差分析及多因素Logistic回归分析筛选CRT-P /D治疗发生超反应的独立预测因素.采用Kaplan-Meier法进行预后分析,COX回归模型明确影响预后的危险因素.结果 超反应组术前心房颤动比例、右房内径(right atrial diameter,RA) 明显低于中度反应组及轻度/无反应组(P<0. 05),双心室起搏比例明显高于中度反应组及轻度/无反应组(P<0. 01) .多因素Logistic回归结果显示病程< 1. 5年(OR = 17. 54, 95%CI = 1. 41 ~ 216. 96,P = 0. 02) 、RA<35 mm(OR = 23. 70, 95%CI = 1. 60 ~ 349. 32,P = 0. 02) 、双心室起搏比例> 96%(OR = 36. 35, 95%CI = 12. 17 ~ 609. 03,P = 0. 01) 是术后发生超反应的独立预测因素.预后分析显示无事件(心衰再住院、恶性心律失常、全因死亡) 生存率超反应组高于中度反应组及轻度/无反应组(Log Rank: P<0. 01),多因素Cox回归分析显示对于复合不良事件的发生,心房颤动是影响预后的独立因素(P<0. 05,HR = 2. 35, 95%CI = 1. 067 ~ 5. 19) .结论 对于CRT-P /D治疗射血分数降低的心力衰竭患者,病程< 1. 5年、RA<35 mm,双心室起搏比率> 96%是发生超反应的重要预测因素,心房颤动是影响术后不良事件发生的独立因素.  相似文献   

13.
原发性高血压发生心房颤动的危险因素   总被引:1,自引:0,他引:1  
目的探讨原发性高血压发生心房颤动的危险因素。方法306例符合纳入标准的单纯性原发性高血压病人整群随访5年,由专科医师进行降压治疗的同时记录随访结果。终检标准:心房颤动。影响心房颤动事件的因素用Cox风险比例模型鉴定。结果5年中,发生心房颤动86例(28.1%),平均年发生率5.6%,Cox回归分析显示年龄(HR=1.095,p=0.024)、左室重量指数(HR=1.137,p=0.000)、左房内径(HR=1.232,p=0.000)是原发性高血压发生心房颤动的独立预报因子。结论年龄、左室重量指数、左房内径是原发性高血压发生心房颤动的危险因素。  相似文献   

14.
目的 探讨2型糖尿病合并冠心病患者血清半乳糖凝集素-3(Galectin-3)与冠脉支架内狭窄(ISR)关系。 方法 研究对象选取2015年1月—2016年1月期间浙江医院住院治疗的2型糖尿病合并冠心病且既往药物洗脱支架(DES)植入的患者,根据复查冠脉造影的结果,分支架内狭窄(ISR)组与非ISR组,采用多因素logistic回归分析临床资料与ISR的关系。 结果 入选357例患者,其中ISR组共36例(10.1%)。与非ISR组相比,ISR组患者在年龄、吸烟患者比例、血清Galectin-3水平更高,支架长度更长,植入支架直径更小,差异有统计学意义(P<0.05)。多因素logistic回归分析结果表明,年龄(OR=1.087,95% CI:1.038~1.134,P<0.001)、支架长度(OR=1.078,95% CI:1.012~1.103,P<0.001)、支架直径(OR=0.425,95% CI:0.243~0.708,P<0.001)及血清Galectin-3水平(OR=1.074,95% CI:1.016~1.121,P<0.001)是ISR的独立危险因素。此外,血清Galectin-3水平与ISR类型相关。 结论 高血清Galectin-3水平增加了2型糖尿病患者ISR发生的风险,可能是导致ISR的独立危险因素,这为血清学标记物应用于评估冠脉病变程度提供了新思路。   相似文献   

15.
OBJECTIVES: To determine (i) factors which predict whether patients hospitalised with acute myocardial infarction (AMI) receive care discordant with recommendations of clinical practice guidelines; and (ii) whether such discordant care results in worse outcomes compared with receiving guideline-concordant care. DESIGN: Retrospective cohort study. SETTING: Two community general hospitals. PARTICIPANTS: 607 consecutive patients admitted with AMI between July 1997 and December 2000. MAIN OUTCOME MEASURES: Clinical predictors of discordant care; crude and risk-adjusted rates of inhospital mortality and reinfarction, and mean length of hospital stay. RESULTS: At least one treatment recommendation for AMI was applicable for 602 of the 607 patients. Of these patients, 411(68%) received concordant care, and 191 (32%) discordant care. Positive predictors at presentation of discordant care were age > 65 years (odds ratio [OR], 2.5; 95% CI, 1.7-3.6), silent infarction (OR, 2.7; 95% CI, 1.6-4.6), anterior infarction (OR, 2.5; 95% CI, 1.7-3.8), a history of heart failure (OR, 6.3; 95% CI, 3.7-10.7), chronic atrial fibrillation (OR, 3.2; 95% CI, 1.5-6.4); and heart rate >/= 100 beats/min (OR, 2.1; 95% CI, 1.4-3.1). Death occurred in 12.0% (23/191) of discordant-care patients versus 4.6% (19/411) of concordant-care patients (adjusted OR, 2.42; 95% CI, 1.22-4.82). Mortality was inversely related to the level of guideline concordance (P = 0.03). Reinfarction rates also tended to be higher in the discordant-care group (4.2% v 1.7%; adjusted OR, 2.5; 95% CI, 0.90-7.1). CONCLUSIONS: Certain clinical features at presentation predict a higher likelihood of guideline-discordant care in patients presenting with AMI. Such care appears to increase the risk of inhospital death.  相似文献   

16.
目的 探讨合并阵发性房颤的急性缺血性脑卒中患者的临床特征及预后情况。 方法 前瞻性收集2017年1—12月在哈尔滨医科大学附属第一医院卒中病房治疗的731例急性缺血性脑卒中患者的基本信息。根据患者的疾病史、入院心电图检查、住院期间心电监测确定有无房颤及类型。随访出院结局和3个月预后。将合并阵发性房颤组分别与无房颤组及合并持续性房颤组对比临床特征及预后。 结果 ①合并阵发性房颤与无房颤的患者相比,入院时神经功能受损更严重(P<0.001),患者严重神经功能受损比例更高(P=0.002)。合并心力衰竭、冠心病、心肌梗死、肾功能异常的比例更高(均P<0.05)。合并阵发性房颤是出院结局及出院3个月预后的危险因素,OR(95%CI)为2.190(1.111,4.316)、3.399(1.701,6.791)。②合并阵发性房颤与合并持续性房颤的患者相比,患心脏瓣膜性疾病的比例更低(P<0.001),住院期间病情明显缓解比例更高(P=0.017)。 结论 合并阵发性房颤相比无房颤患者起病时病情重、伴发疾病更多;相比于持续性房颤患者,仅心脏瓣膜性疾病比例更低;相比于无房颤患者,合并阵发性房颤是急性缺血性脑卒中患者出院结局及3个月预后不良的危险因素。   相似文献   

17.
  目的  通过分析大面积脑梗死出血转化组和无出血转化组中各因素的差异,探讨急性大面积脑梗死非溶栓患者发生出血转化的影响因素,为预后的判断提供依据。  方法  收集2018年1月—2019年12月就诊于安徽医科大学第二附属医院神经内科的急性大面积脑梗死并且未接受静脉溶栓的患者114例,收集患者一般资料,脑卒中危险因素,入院时血钙、血镁水平等,分析出血转化组和无出血转化组之间有无差异。  结果  本研究共纳入患者114例,其中无出血转化组88例,出血转化组26例。单因素分析显示出血转化组合并心房颤动患者显著多于无出血转化组(P<0.05),低密度脂蛋白胆固醇、血钙、血镁水平显著低于无出血转化组(均P<0.05)。多因素logistic分析显示心房颤动与大面积脑梗死非溶栓患者发生出血转化呈正相关(OR=4.731, 95%CI 1.594~14.044,P=0.005),血镁水平与大面积脑梗死非溶栓患者发生出血转化呈负相关(OR=0.000, 95% CI 0.000~0.095,P=0.006)。  结论  房颤、低血镁可能是急性大面积脑梗死出血转化的独立危险因素。   相似文献   

18.
A multicenter risk index for atrial fibrillation after cardiac surgery   总被引:24,自引:2,他引:22  
Context  Atrial fibrillation is a common, but potentially preventable, complication following coronary artery bypass graft (CABG) surgery. Objectives  To assess the nature and consequences of atrial fibrillation after CABG surgery and to develop a comprehensive risk index that can better identify patients at risk for atrial fibrillation. Design, Setting, and Participants  Prospective observational study of 4657 patients undergoing CABG surgery between November 1996 and June 2000 at 70 centers located within 17 countries, selected using a systematic sampling technique. From a derivation cohort of 3093 patients, associations between predictor variables and postoperative atrial fibrillation were identified to develop a risk model, which was assessed in a validation cohort of 1564 patients. Main Outcome Measure  New-onset atrial fibrillation after CABG surgery. Results  A total of 1503 patients (32.3%) developed atrial fibrillation after CABG surgery. Postoperative atrial fibrillation was associated with subsequent greater resource use as well as with cognitive changes, renal dysfunction, and infection. Among patients in the derivation cohort, risk factors associated with atrial fibrillation were advanced age (odds ratio [OR] for 10-year increase, 1.75; 95% confidence interval [CI], 1.59-1.93); history of atrial fibrillation (OR, 2.11; 95% CI, 1.57-2.85) or chronic obstructive pulmonary disease (OR, 1.43; 95% CI, 1.09-1.87); valve surgery (OR, 1.74; 95% CI, 1.31-2.32); and postoperative withdrawal of a -blocker (OR, 1.91; 95% CI, 1.52-2.40) or an angiotensin-converting enzyme (ACE) inhibitor (OR 1.69; 95% CI, 1.38-2.08). Conversely, reduced risk was associated with postoperative administration of -blockers (OR, 0.32; 95% CI, 0.22-0.46), ACE inhibitors (OR, 0.62; 95% CI, 0.48-0.79), potassium supplementation (OR, 0.53; 95% CI, 0.42-0.68), and nonsteroidal anti-inflammatory drugs (OR, 0.49; 95% CI, 0.40-0.60). The resulting multivariable risk index had adequate discriminative power with an area under the receiver operating characteristic (ROC) curve of 0.77 in the validation sample. Forty-three percent (640/1503) of patients who had atrial fibrillation after CABG surgery experienced more than 1 episode of atrial fibrillation. Predictors of recurrent atrial fibrillation included older age, history of congestive heart failure, left ventricular hypertrophy, aortic atherosclerosis, bicaval venous cannulation, withdrawal of ACE inhibitor or -blocker therapy, and use of amiodarone or digoxin (area under the ROC curve of 0.66). Patients with recurrent atrial fibrillation had longer hospital stays and experienced greater infectious, renal, and neurological complications than those with a single episode. Conclusions  We have developed and validated models predicting the occurrence of atrial fibrillation after CABG surgery based on an analysis of a large multicenter international cohort. Our findings suggest that treatment with -blockers, ACE inhibitors, and/or nonsteroidal anti-inflammatory drugs may offer protection. Atrial fibrillation after CABG surgery is associated with important complications.   相似文献   

19.
Li W  Lu M  Feng SJ  Li WZ  Wu B  Fang Y  Wang LC  Zhao SY  Zhao MY  Zhang ST 《中华医学杂志》2008,88(13):892-897
目的 探讨不同类型卒中的危险因素、病因、死亡原因和预后.方法 基于华西医院卒中登记,脑卒中分为出血性和缺血性,缺血性卒中亚型是依据牛津郡社区卒中项目分类原则.分析住院患者的人口学特点、危险因素、死亡原因和1年末结局.结果 2002年3月至2005年9月,共纳入1913例资料完整的卒中患者,其中脑出血599例(31.3%);缺血性脑卒中1314例(68.7%).后者中完全前循环梗死209例(15.9%),部分前循环梗死417例(31.7%),后循环梗死186例(14.2%),腔隙性梗死502例(38.2%).校正年龄和性别,多因素分析显示,房颤是完全前循环梗死的独立预测因素(OR=1.42,95% CI=1.25~2.31);高血压和饮酒是腔隙性梗死(OR=1.24,95% CI=1.02~2.18;OR=1.12,95% CI=1.03~3.04)和脑出血(OR=1.84,95% CI=1.31~3.02;OR=1.04,95% CI=1.01~4.13)的独立预测因素.完全前循环梗死与高血压呈负相关(OR=0.62,95% CI=0.34~0.72),腔隙性梗死与房颤呈负相关(OR=0.46,95% CI=0.26~0.82),脑出血与糖尿病亦呈负相关(OR=0.56,95% CI=0.42~0.76).以腔隙性梗死为参照,完全前循环梗死(OR=6.21,95% CI=2.86~8.42)和脑出血(OR=5.86,95% CI=2.46~8.52)明显增加患者1年死亡风险.结论 不同类型卒中的危险因素、病因和结局不同.确定卒中亚型对于急性期治疗和预防有重要意义.  相似文献   

20.
Chen P  Ma YT  Yang YN  Liu F  Huang D  Li XM  Huang Y  Ma X  Xie X  Yang SJ  Yu ZX 《中华医学杂志》2010,90(44):3115-3118
目的 了解新疆维吾尔族(维族)、哈萨克族(哈族)成年人外周动脉疾病(PAD)的患病率和相关危险因素.方法 2007年10月至2010年5月应用整群抽样法抽取新疆35岁以上汉族、维族、哈族人群14 618名作为研究对象.统计不同民族不同年龄、不同性别人群的PAD患病率,并对PAD的危险因素进行分析.结果 新疆维族、哈族成年人PAD总患病率6.46%(542例),标化患病率6.51%.维族PAD患病率7.05%(315例),哈族为5.79%(227例),经标化后,维族、哈族患病率分别为7.08%、5.83%,差异有统计学意义(x2=5.55,P<0.05).男性患病率4.49%(170例),女性为8.08%(372例),经标化后,男性患病率为4.30%,女性为7.90%,差异有统计学意义(x2=44.26,P<0.01).经多因素Logistic回归分析,年龄(OR=1.01,95%CI1.00~1.02)、女性(OR=1.75,95%CI1.45~2.14)、肥胖或超重(OR=1.04,95%CI1.01~1.06)、糖尿病(OR=1.59,95%CI 1.01~2.36)、收缩压增高(OR=1.02,95%CI1.01~1. 03)、舒张压增高(OR=1. 08,95%CI 1.01~1.11)、冠心病史(OR=1.69,95%CI1.14~2.50)与PAD患病有关.结论 新疆维、哈族成年人PAD患病率较低.女性、年龄、超重或肥胖、糖尿病、收缩压升高、舒张压升高、冠心病史为PAD危险因素.  相似文献   

设为首页 | 免责声明 | 关于勤云 | 加入收藏

Copyright©北京勤云科技发展有限公司  京ICP备09084417号