我国心房纤颤的疾病负担

摘要

目的：分析心房纤颤（以下简称房颤）及房颤导致脑卒中的疾病负担，系统了解房颤的管理和治疗的现状，为制定房颤在中国人群的防治策略提供科学依据，有效促进医疗资源的合理分配。方法：使用伤残调整寿命年(disability adjusted life years, DALY)评价房颤的疾病负担，应用人群归因危险度百分比的方法对房颤导致脑卒中的治疗成本进行了估算。结果：在我国，房颤损失的伤残调整寿命年总计4599687，超过了高血压性心脏病损失的伤残调整寿命年（3348925），接近于糖尿病损失的伤残调整寿命年（4769127）。30岁以上人群的伤残调整寿命年为7.15/1000人。脑卒中是造成房颤直接疾病负担的首要原因。据估计，房颤导致脑卒中治疗成本每年达到49亿人民币（约8亿美元），其中，89%的治疗成本来自于60岁以上房颤伴脑卒中患者。结论：房颤给中国社会带来的沉重的疾病负担。脑卒中是造成该病负担的主要原因。我国房颤导致脑卒中造成的伤残调整寿命年损失超过了印度及欧盟国家在众多慢性疾病领域的疾病负担。房颤的诊断和治疗意识亟待增强。正确治疗房颤以恢复窦性心律，从而减少如脑卒中等并发症，将成为未来我国房颤治疗的目标。%Objective: To analyze the atrial fibrillation(AF) and the burden of illness(BOI) led by AF, to scientifically recognize the current situation of management and treatment for AF, to provide scientific references for designing the AF prevention and control strategy for Chinese people and effectively improve the reasonable allocation of medical resources. Methods: The disability adjusted life years(DALY)was used to evaluate the BOI of AF. The method of population attributable risk percent-age was applied to estimate the treatment cost of AF cerebral apoplexy. Results: In China, the loss of DALY brought by AF was 4 599 687 yuan, which is higher than the loss of DALY brought by hypertensive heart disease(3 348 925 yuan)and close to the loss of DALY brought by diabetes(4 769 127 yuan). The DALY of group over 30 is 7.15/1000 person. Cerebral apoplexy is the main reason for the BOI of this disease. It is estimated that the annual treatment cost of AF cerebral apoplexy is 4.9 billion yuan(about 800 million dollars), 89%of treatment cost come from patients over 60 years old with AF and cerebral apoplexy. Conclusion: AF brought heavy BOI to Chinese society. Cerebral apoplexy is the main reason for the burden of this disease. The loss of DALY led by AF cerebral apoplexy is more than the BOI of many chronic disease in India and European countries. The diagnosis and treatment cautious of AF need to be strengthened. The correct treatment results in restoring sinus thymes, so as to decrease complication like cerebral apoplexy. That would be the target of AF treatment in future China.