心房颤动患者近期缺血性卒中后应用依多沙班抗凝治疗的时机和剂量的研究进展

心房颤动（Atrial fibrillation,AF）是成人中常见的持续性心律失常,给医疗保健增加巨大负担。心律失常不仅与生活质量下降和频繁住院有关,而且与缺血性卒中、其他血栓栓塞事件和死亡率增加的风险增加有关。AF患者的缺血性卒中风险因个体风险状况而异,不使用口服抗凝剂（Oral anticoagulant,OAC）的缺血性卒中发生率约为3.20/100人年。与其他卒中病因相比,AF相关卒中患者的预后更差。所有AF患者都必须实施个体卒中风险评估和使用最佳卒中预防策略。依多沙班的适应证是预防AF患者的卒中,该药口服给药,剂量为60 mg,每日1次。本文讨论了AF患者近期缺血性卒中后应用依多沙班抗凝治疗的时机和剂量的研究进展。     

血浆脑钠肽水平变化与心房颤动关系探讨

目的探讨血浆脑钠肽(BNP)水平与心房颤动(AF)的关系。方法选取72例患者,其中特发性AF34例,器质性心脏病AF38例,另选24名健康人组成对照组,采取放射免疫法测定各组BNP水平。结果AF组血浆BNP水平均比健康对照组有升高(P<0.05),随着AF分类级别的升高,血浆BNP水平明显增加(P<0.05),并且AF组转复为窦性心律后血浆BNP水平明显下降(P<0.05)。结论AF患者血浆BNP水平在不同类别的AF中有所不同。     

肺静脉前庭在犬心房颤动中的作用

目的测定诱发心房颤动（AF）或持续电刺激2h前后肺静脉前庭有效不应期（ERP）,探讨其在AF中的作用。方法健康杂种犬10只,S1S2程序刺激测定窦性心律下和诱发AF或持续电刺激2h后肺静脉前庭ERP;并进行AF诱发,并记录AF的发生。结果肺静脉前庭ERP在诱发AF或持续电刺激2h后与窦性心律下相比差异有统计学意义（P〈0.05）。诱发AF或持续电刺激2h后AF诱发率增加（24.38% VS 9.68%,P〈0.05）。结论诱发AF或持续电刺激2h后可以使肺静脉前庭ERP缩短且更易诱发AF,肺静脉前庭在AF中起着重要作用。     

阵发性心房颤动的规律及病因初步探讨

心房颤动(AF)是常见的一种心律失常,而阵发性AF为持续性AF的前驱表现,此类AF对无器质性心脏病患者的死亡率无影响,但可增加冠心病及瓣膜病患者的死亡率。本文回顾分析了30例阵发性心房颤动的发生规律及伴随症状,并初步进行病因探讨。 1 资料与方法     

心房纤颤治疗进展

心房纤颤 (atrialfibrillation ,AF)是人类最常见的一种心律失常 ,可发生在有或无器质性心脏病患者。其发生率随年龄增长而增加。新近Framingham的研究表明 :AF可以成为一种独立的因素使患者病死率增加。AF的治疗包括 3个方面 :①恢复窦性心律和预防房颤发作 ,方法有 :药物和 /     

缺血性卒中／短暂性脑缺血发作患者合并心房颤动的筛查及抗栓治疗中国专家共识

心房颤动（atrial fibrillation,AF）是一种常见的心律失常,可表现为阵发性、持续性和永久性。AF患病率随年龄增加而升高．男性高于女性。欧美国家总体人群中AF患病率为1％～2％,在80岁以上人群中高达5％～15％。     

阵发性心房颤动昼夜分布节律的观察研究

心房颤动（AF）为常见的心律失常。阵发性AF为持续性AF的前驱表现，可持续数分钟至数小时或数周。此类AF对无器质性心脏病患者的死亡率无影响，但可增加冠状动脉硬化性心脏病及瓣膜病患者的死亡率。急性心血管病事件的发生存在24h节律变化已被确认，但对阵发性AF的发生、持续和结束是否存在节律性变化尚很少报道。如果能发现阵发性AF的发生规律，对其药物预防和复律治疗将起到一定的借鉴作用。现就32例孤立性阵发性AF患者进行了临床观察。     

半胱氨酸蛋白酶抑制剂C与心房颤动相关性的临床研究

<正>心房颤动(AF)是临床上最常见的心律失常~([1-3])。随着人口老龄化,AF患者逐渐增加,由于AF患者可诱发脑卒中、心力衰竭和增加病死率,已成为老年患者入院的主要原因之一~([1,2,4])。越来越多的证据表明AF患者与炎症密切相关~([2,4])。有研究证实~([5-7]),多种炎性因子参与了AF的发生发展。半胱氨酸蛋白酶抑制剂-C(CysC)是蛋白酶抑制剂超家族中的成员,不仅是评价肾脏功能较肌酐更为敏感的指标,而且是心血管事件的一个强力的独立预测因子~([7])。新近研究发现CysC与炎症过程或炎症因子密切相关~([7,8])。那么CysC与AF之间是否具有相关性,在     

老年人房颤与血栓形成前状态一项鹿特丹研究

房颤 (AF)是一种最常见的持续性心律失常 ,可以增加血栓栓塞性卒中的危险而成为主要的患病的病因和死因 ,AF的发生率和与心律失常相关连的血栓栓塞危险性随年龄增长而增大。在AF时 ,脑血栓栓塞背后的机制还不完全清楚 ,但是在与健康对照者比较时 ,发现AF患者血栓形成前血浆标志的水平异常 ,从而提示在AF时有关全身的血栓形成前的状态。虽然有学者最近提出AF患者中可能另有心血管疾病而不是伴有血栓形成前标志变化的AF本身。然而 ,在老年人AF的血栓形成前状态尚无充分的研究。Dwayne等在一项大规模的老年人群的社区研究中进行巢式病例…     

眼镜蛇毒活性成分对神经病理性疼痛模型大鼠的镇痛作用及K_(ATP)通道阻滞药对其的影响研究

目的:研究鞘内注射眼镜蛇毒活性成分(AF)对病理性疼痛模型大鼠的镇痛作用,及三磷酸腺苷(ATP)敏感钾(KATP)通道阻滞药对其的影响。方法:采用左侧腰5脊神经结扎并切断,建立神经病理性疼痛模型大鼠;采用鞘内注射方法,考察给予不同剂量(0、0.02、0.04、0.08mg.kg-1)AF后24h内模型大鼠双侧后足的50%机械性撤足反应阈值(PWT)。另将模型大鼠分为对照组、格列苯脲(5mg.kg-1)组、AF(0.04mg.kg-1)组及其联用组,考察各组大鼠给药后24h内双侧后足的50%PWT。结果:与给药前比较,给药后0.5～24h时段0.08mg.kg-1AF组大鼠的50%PWT明显增加(P<0.05),给药后1～6h时段0.04mg.kg-1AF组大鼠的50%PWT明显增加(P<0.05),给药后2～6h时段3个AF剂量组大鼠的50%PWT明显增加(P<0.05);与对照组比较,格列苯脲组50%PWT无明显变化,AF组1～6h时段50%PWT明显增加(P<0.05);与AF组比较,联用组给药后1～6h时段50%PWT明显减少(P<0.05),且手术同侧后足与对侧后足比较无明显差异。结论:鞘内注射AF可缓解外周神经损伤引起的神经病理性疼痛,KATP通道阻滞药可完全阻断其镇痛作用。     

急性心肌梗死伴新发心房纤颤的临床分析

目的研究探讨急性心肌梗死（AMI）伴新发心房纤颤（AF）的临床特点。方法回顾性分析344例急性心肌梗死患者住院期间的资料,其中新发房颤患者53例（AF组）,未发生房颤者291例（NAF组）,AF组按新发AF持续时间分为AF1组23例（心肌梗死24h内发生AF者）,AF2组30例（心肌梗死24h后发生AF者）。比较AF组和NAF组之间的年龄、并发症、CK—MB峰值、心功能（Killp分级）、死亡率以及NAF组和AFl组、AF2组之间心肌梗死部位病变血管情况等因素的对比。结果AF组老年患者多于NAF组（P〈0．01）,AF伴有高血压病、糖尿病者高于NAF组（P〈0．01）,AF组CK—MB峰值、心力衰竭发生率、死亡率显著高于NAF组（P〈0．01）,AF组冠状动脉多支病变的发生率较NAF组高（P〈0．05）,AF1组下壁AMI发生率高于NAF组和AF2组（P〈0．05）,AF2组前壁AMI发生率高于AF1组（P〈0．05）。结论高龄、伴发高血压、糖尿病、梗死面积及多支血管病变是AMI并新发AF的危险因素,AF发生时间与AMI梗死部位相关,AMI并新发AF者严重并发症多,预后差,应给予早期积极干预。     

Incidence and temporal pattern of hospital readmissions for patients with atrial fibrillation

ABSTRACT

Background: Atrial fibrillation (AF) is prevalent and has a high cost burden. Among the main drivers of cost is inpatient care; however, little is known about patterns of hospital readmissions for AF.

Objective: To evaluate the incidence and temporal pattern of readmission in AF patients.

Methods: This retrospective, cohort analysis used claims data from the Integrated Healthcare Information Systems National Managed Care Benchmark Database for 2002–2006. Patients hospitalized for AF (primary discharge diagnosis) were identified. Data on the first readmission for AF over 1 year following an index hospitalization were analyzed for chronic AF (any AF-related claims in 1 year before index hospitalization) and newly-diagnosed AF patients (no prior AF-related claims).

Results: Overall, 4174 patients hospitalized with primary AF were identified; 1637 had chronic AF and 2537 newly-diagnosed AF. Mean age of chronic AF patients was 62.4 years and 61.2% were male; for newly-diagnosed AF, mean age was 61.4 years and 57.8% were male. In the year following index hospitalization, 12.5% of chronic AF patients were readmitted for AF, with a mean time to readmission of 142.5 days (median 108 days). Among newly-diagnosed AF patients, 10.1% were readmitted for AF, with a mean time to readmission of 133.8 days (median 112 days). For chronic AF, 17.6%, 43.4%, and 65.8% of readmissions occurred within 1, 3, and 6 months, respectively, versus 22.7%, 44.5%, and 67.2%, respectively, for newly-diagnosed AF.

Limitations: Limited data were available on patients’ clinical profile, treatment patterns, or the reasons for hospitalization/readmission. The term chronic AF only captured patients with a history of AF and data were not available to classify patients according to the presence of paroxysmal, permanent, or persistent AF.

Conclusions: Patients with newly-diagnosed or chronic AF are often readmitted in the year following hospitalization with most readmissions occurring within 6 months of the index hospitalization.     

The state of patient-reported outcomes in atrial fibrillation : a review of current measures

Atrial fibrillation (AF) is the most common cardiac arrhythmia, affecting approximately 2.2 million people in the US. The presentation of AF ranges from asymptomatic to severely symptomatic. When symptomatic, AF has been shown to have an adverse impact on health-related quality of life (HR-QOL) and to result in increased healthcare costs. The objective of this analysis was to review the current AF literature on patient-reported outcomes (PROs) in order to evaluate the impact of AF on PROs and the applicability of current PRO measures in assessing AF outcomes.HR-QOL and symptoms were the most frequently assessed PROs; however, the sensitivity of the majority of the questionnaires for detecting subtle change is not known. For highly symptomatic patients, interventional procedures reduce symptoms and improve HR-QOL; however, this is a small cohort of patients with AF. For the most part, PROs are equivalent between pharmacological treatments or are not known for the large percentage of patients treated pharmacologically with antiarrhythmic or rate-controlling drugs.PRO assessment in AF patients is an area that needs continued development. AF-specific PRO measures are needed to assess the full range of patient symptoms and treatment outcomes. The impact of paroxysmal AF versus permanent AF is not well delineated, and sex and nationality differences are not known. In addition, the impact of AF on daily activities and HR-QOL is not clearly described.     

PI3K/AKT信号通路在心房颤动中的研究进展

心房颤动（房颤）作为最常见的快速性心律失常,目前主要的治疗手段为抗凝、控制心室率、维持窦性心律。然而房颤的发生机制尚未阐明,上述治疗仍具有一定的局限性。磷脂酰肌醇3-激酶（PI3K）/蛋白激酶（AKT）信号转导通路是参与房颤发生发展的重要通路,其可以通过介导心房纤维化、炎症反应、氧化应激、神经内分泌功能调节参与房颤发生发展的病理生理过程。深入研究PI3K/AKT信号转导通路在房颤中的作用,可为房颤的预防、治疗及预后评估提供有价值的指导。     

非瓣膜性房颤的规范化药物治疗

房颤(AF)是最常见的可持续的心律失常,目前药物治疗仍是其基础治疗,而其中抗凝药物是各种治疗的基础和核心。国内关于AF的规范化药物治疗与国际指南要求尚有一定差距。本文综述AF的规范化药物治疗。     

Risk of atrial fibrillation with high-dose corticosteroids

Atrial fibrillation (AF) is the most common sustained arrhythmia observed in clinical practice. Some drugs have been associated with the onset of AF, but knowledge about the role of drugs in the development of AF is scarce. High-dose corticosteroid therapy has been associated with the development of AF, but this is mainly based on case reports. Therefore, the authors review the available data in the international literature about the cause–effect relationship between corticosteroid therapy and the onset of AF.     

Atrial fibrillation and atrial fibrosis

Atrial fibrillation (AF) is the most common arrhythmia in humans. It affects 5% of the population older than age 65 years and is projected to rise as the population ages. Experimental data from animal models of AF show that AF is associated with progressive structural and electrical remodeling of the atria. Atrial fibrosis alters atrial electrical conduction and excitability and provides a substrate for AF maintenance. However, whether fibrosis is causally related to AF or an epiphenomenon and the precise mechanisms underlying atrial fibrosis remain unclear. A variety of signaling systems involving angiotensin II and related mediators are centrally involved in atrial fibrosis. This article reviews the role that atrial fibrosis plays in AF, the mechanisms of atrial fibrosis, and emerging therapeutic approaches to AF aimed at attenuating atrial fibrosis.     

急性心肌梗死并发心房纤颤的临床特点

目的探讨急性心肌梗死（AMI）并发心房纤颤（AF）的临床特点。方法回顾性分析341例AMI患者住院期间资料,其中新发AF者33例（AF组）,未发生AF者308例（NAF组）,AF组依照AF发生时间分为AF1组13例（AMI发病24h内出现AF者）,AF2组20例（AMI发病24h后现出AF者）。比较AF组和NAF组之间的年龄、并发症、心功能、病死率及NAF组和AF1组、AF2组之间心肌梗死部位的不同。结果AF组老年患者多于NAF组（69．7％vs52．9％,P〈0．01）,伴有高血压病、糖尿病多于NAF组（分别为57．6％VS39．9％、27．3％VS13．0％,均P〈0．01）,AF组心衰发生率、病死率高于NAF组（63．6％YS31．8％、27．3％VS10．7％,均P〈0．01）：AF1组下壁AMI发生率显著高于NAF组和AF2（69．2％Vs40．9％和30．0％,均P〈0．05）,AF2组前壁AMI发生率显著高于AF1组（60．0％vs15．3％,P〈0．05）。结论高龄、高血病、糖尿病是AMI并发AF的危险因素,AF发生时间与AMI梗死部位有关,AMI并发AF者预后更差,应予积极干预。     

环状RNA对房颤患者的影响及其作用机制研究

心房颤动（房颤）是心内科常见的心律失常,主要原因是心脏传导系统异常,严重者可诱发心力衰竭、心源性休克、卒中及血栓栓塞性疾病而危及生命。房颤的早期诊断和预测一直是困扰临床工作者的重要难题,如何尽早甄别和预测房颤为临床重要任务。近年来,随着分子生物学技术的不断发展,越来越多的研究证实环状RNA能够参与房颤的发生并促进疾病的进展。汇总环状RNA对房颤发病过程的影响及其机制,有望为房颤的预防及分子靶向治疗提供新的见解,为患者争取更大的临床获益。     

Risk of atrial fibrillation with high-dose corticosteroids

Atrial fibrillation (AF) is the most common sustained arrhythmia observed in clinical practice. Some drugs have been associated with the onset of AF, but knowledge about the role of drugs in the development of AF is scarce. High-dose corticosteroid therapy has been associated with the development of AF, but this is mainly based on case reports. Therefore, the authors review the available data in the international literature about the cause-effect relationship between corticosteroid therapy and the onset of AF.