慢性心衰患者发生房颤的多因素分析

摘要

Objective To explore multiple factors of atrial fibrillation in patients with chronic heart failure through retrospective analysis of clinical data .Methods Three hundred and thirty patients with chronic heart failure ( NYHAII-IV) treated in the Hospital of Langxi County during the period from January 2009 to January 2011 were assigned into AF group and non AF group according to whether the patients had atrial fibrillation (AF)or not,and the clinical data of the two groups were used for statistical analysis .Results Of 330 pa-tients with chronic heart failure 85 cases (25.76%) with atrial fibrillation were assigned into AF group ,while the other 245 patients without atrial fibrillation were in non AF group .Single factor COX regression analysis showed that severe heart failure ( III+IV level ) , age,diabetes,left ventricular hypertrophy ,left atrialdiameter,blood urea nitrogen,blood creatinine,blood uric acid and spironolactone were risk factors for atrial fibrillation while ACEI ,digitalis,blood sodium and blood chlorine were protective factors for atrial fibrillation . Multivariate COX analysis showed that ACEI was the independent protective factor for primary AF ,while severe heart failure and left at-rialdiameter of left ventricular hypertrophy were risk factors for AF .Conclusions Severe heart failure and left atrial diameter of left ventricular hypertrophy are risk factors for AF .ACEI is an independent protective factor for primary AF in heart failure patients ,which can reduce the incidence of AF .%目的：通过回顾性分析慢性心衰患者的临床资料，对慢性心衰患者发生房颤的因素进行分析。方法选择2009年1月至2011年1月期间该院心脏科收治的慢性心力衰竭（ NYHAII-IV）患者330例，根据患者是否发生心房颤动（ AF）将其分为AF组与非AF组两组，并对两组患者的临床资料进行统计分析。结果330慢性心力衰竭患者中共发生房颤85例（25．76％）为AF组，其余245例未发生房颤者则为非AF组。单因素COX回归分析表明患者重度心衰（ III＋IV级别）、年龄、糖尿病、左室肥厚、左房直径、尿素氮、血肌酐、血尿酸、安体舒通为房颤发生的危险因素。而ACEI、洋地黄、血钠、血氯为房颤发生的保护因素。 Logistic回归分析表明ACEI为心力衰竭患者初发AF的独立保护因素，重度心衰、左心室肥厚左心房直径则为AF发生的危险因素。结论重度心衰、左心室肥厚左心房直径则为AF发生的危险因素；ACEI为心力衰竭患者初发AF的独立保护因素，其能降低AF的发生。