北京市非瓣膜病心房颤动患者血栓栓塞事件的发病风险及影响因素

摘要

目的:分析北京市2007至2009年,非瓣膜病心房颤动(NVAF)患者1年内血栓栓塞事件的发病风险及其影响因素.方法:入选北京市出院患者信息系统中,出院日期在2007年1月1日至2009年12月31日之间,18岁及以上且出院诊断包含NVAF的北京市户籍病例,排除接受了射频消融术以及住院期间死亡的病例.通过将出院患者信息系统和北京市死因监测系统进行数据链接和查重,收集1年内这些NVAF患者中发生的血栓栓塞事件.采用Kaplan-Meier法比较不同性别和CHA2DS2-VASc评分患者血栓栓塞事件的发生风险,绘制风险曲线,并进行Log-rank检验.采用多因素Cox回归模型分析NVAF患者血栓栓塞事件发生的影响因素.结果:本研究共纳入NVAF患者28 871例,平均年龄(72.7±10.2)岁,其中女性占48.2％,女性患者伴随更多的高血压、充血性心力衰竭和糖尿病.在1年的随访期间,有2 313例(8.0％)患者发生了血栓栓塞事件;发生事件的患者年龄更大,CHA2DS2-VASc评分分值更高,伴随更多的高血压、缺血性脑卒中、短暂性脑缺血发作(TIA)、以及糖尿病(P均＜0.001),而伴随充血性心力衰竭(P ＜0.001)、血管疾病(P=0.002)的患者更少.血栓栓塞事件的人年发病率为8.4/100人年,且随CHA2 DS2-VASc评分分值的升高而升高.Log-rank检验结果显示,男性患者中,CHA2DS2-VASc评分在2分以上时血栓栓塞的风险显著增加(P＜0.001),而女性患者CHA2DS2-VASc评分在3分以上时血栓栓塞的风险显著增加(P =0.004).多因素Cox回归分析显示,高龄、基线伴随高血压、糖尿病、既往血栓栓塞病史是血栓栓塞事件发生的危险因素.讨论:北京市NVAF患者血栓栓塞事件的人年发病率高于国外人群水平,高龄、基线伴随高血压、糖尿病、既往血栓栓塞病史是事件发生的危险因素,提示应加强对NVAF患者的抗凝治疗和伴随疾病的防治,以降低血栓栓塞事件的发病风险.%Objective:To examine incidence and risk factors of thromboembolism in patients hospitalized with nonvalvular atrial fibrillation (NVAF) in Beijing during 2007-2009.Methods:Patients identified from Beijing Hospital Discharge Information System with a discharge diagnosis of NVAF in Beijing aged 18 or older discharged between 1 January 2007 and 31 December 2009 were enrolled,excluding patients receiving radio frequency catheter ablation and patients expired during hospitalization.Thromboembolic events were registered during one-year followed-up by linking enrolled records and thromboembolism records identified from Beijing Hospital Discharge Information System and Vital Registration Monitoring System.Using Kaplan-Meier method,thromboembolism risk by sex and CHA2DS2-VASc score were plotted and compared with Log-rank test.Risk factors for thromboembolism were analyzed using multivariate Cox regression model.Results:A total of 28 871 NVAF patients were enrolled,with an average age of (72.7 ± 10.2) years and 48.2％ of females.Female patients were more likely to have hypertension,congestive heart failure and diabetes.During the one-year follow-up period,thromboembolic events were identified among 2 313 patients (8.0％),who were older and more likely to have higher CHA2DS2-VASc score,hypertension,ischemic stroke,transient ischemic attack (TIA) and diabetes (all P ＜ 0.001) but less likely to have congestive heart failure (P ＜ 0.001) and vascular disease (P =0.002).The incidence rate of thromboembolism was 8.4 per 100 person-years and increased with CHA2DS2-VASc score.Log-rank test showed male patients with a CHA2DS2-VASc score ≥ 2 (P ＜ 0.001) and female patients with a CHA2DS2-VASc score ≥ 3 (P =0.004) had significantly increased thromboembolism risk compared with male or female patients with lower CHA2DS2-VASc score.In multivariate Cox regression analysis,advanced age,baseline concomitant hypertension,diabetes,and previous history of thromboembolism were risk factors for the incidence of thromboembolic events.Conclusion:The annual incidence rate of thromboembolism for patients with NVAF in Beijing was higher than that in other countries.Advanced age,baseline concomitant hypertension,diabetes,and previous history of thromboembolism are associated with increased risk for thromboembolism.These findings imply that anticoagulant therapy and concomitant disease treatment for patients with NVAF should be strengthened to lower thromboembolism risk.