心房颤动高CHA2DS2-VASc评分≥75岁住院患者随访1年结果分析

doi:10.3969/j.issn.1004-583X.2023.02.003

摘要/Abstract

摘要：

目的心房颤动(atrial fibrillation, AF)是一种常见的心律失常,随着年龄增加,致缺血性卒中风险也增加。本研究拟通过前瞻性随访≥75岁高CHA2DS2-VASc评分患者,探讨影响其预后的危险因素。方法本研究入选2015年12月至2017年11月河北大学附属医院心内科住院高CHA2DS2-VASc评分老年(≥75岁)患者196例,分为AF组和非AF组,其中AF组90例,非AF组106例。随访1年,主要终点事件为全因死亡,心力衰竭、缺血性脑卒中。采用SPSS 19.0统计软件进行数据分析。结果 ①全因死亡患者31例(15.8%),AF组比非AF组全因死亡、脑卒中、心力衰竭发生率均高,差异有统计学意义(P<0.05)。②年龄、既往心力衰竭为≥75岁高CHA2DS2-VASc评分患者随访1年死亡、心力衰竭的独立危险因素。③女性、高血压病为≥75岁高CHA2DS2-VASc评分患者随访1年脑卒中的独立危险因素。结论本研究显示≥75岁高CHA2DS2-VASc评分患者预后差,合并AF患者预后更差。性别、年龄是评估该类患者预后的独立危险因素。心力衰竭作为独立的危险因素,所占权重大,积极控制可明显改善预后,为目前临床上这类患者的抗凝治疗提供一定的理论依据。

关键词: 心房颤动, 卒中, 死亡, 心力衰竭, 高龄

Abstract:

Objective Atrial fibrillation (AF) is a common arrhythmia that increases the risk of ischemic stroke with age. It is a prospective study to analyze the prognosis of ≥75-year-old AF patients with high CHA2DS2-VASc scores, and to explore the risk factors. Methods A total of 196 elderly patients older than 75 years with high CHA2DS2-VASc scores who were hospitalized in the Department of Cardiology, Affilated Hospital of Hebei University, from December 2015 to November 2017 were recruited, including 90 in the AF group and 106 in the non-AF group. A 1-year follow-up was performed, the primary endpoint events of all-cause death, heart failure (HF), and ischemic stroke were recorded. Data processing was performed using the SPSS19.0 statistical software package. Results ①There were 31 deaths (15.8%) at 1-year follow-up. The incidence of all-cause death, stroke and HF in AF group was significantly higher than that in non-AF group (P <0.05). ②Age and history of heart failure were independent risk factors for death and HF in elderly patients older than 75 years with high CHA2DS2-VASc scores. ③Female gender and hypertension were independent risk factors for stroke at 1-year follow-up in elderly patients older than 75 years with high CHA2DS2-VASc scores. Conclusion Elderly patients (≥75 years old) with high CHA2DS2-VASc scores have a poor prognosis, and those combined with AF have a worse prognosis. Sex and age are the independent risk factors for assessing the prognosis. As an independent risk factor, HF has a significant power, and active control can significantly improve the prognosis. Our prospective and observational study provides some theoretical basis for the current clinical treatment of such patients.

Key words: atrial fibrillation, stroke, all cause death, heart failure, advanced

中图分类号:

R541.75

张芳, 张伊超, 贾辛未, 李建龙, 陈春红. 心房颤动高CHA2DS2-VASc评分≥75岁住院患者随访1年结果分析[J]. 临床荟萃, 2023, 38(2): 117-120.

Zhang Fang, Zhang Yichao, Jia Xinwei, Li Jianlong, Chen Chunhong. Analysis of one-year follow-up results of ≥75-year-old atrial fibrillation inpatients with high CHA2DS2-VASc score[J]. Clinical Focus, 2023, 38(2): 117-120.

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链接本文: https://huicui.hebmu.edu.cn/CN/10.3969/j.issn.1004-583X.2023.02.003

https://huicui.hebmu.edu.cn/CN/Y2023/V38/I2/117

图/表 5

表1 两组临床基线资料及治疗情况比较

Tab.1 Comparison of baseline data and treatment condition between groups

临床特征	AF组( $n$ =90)	非AF组( $n$ =106)	统计值	$P$ 值
男性[例(%)]	42(46.7)	52(49.1)	χ²=0.111	0.739
年龄(岁)	81.83±4.47	78.52±2.81	$t$ =55.789	0.000
合并临床疾病[例(%)]
高血压	68(75.6)	84(79.2)	χ²=0.381	0.537
既往外周栓塞史	12(13.3)	18(17.0)	χ²=0.500	0.480
血管疾病	14(15.6)	22(20.8)	χ²=0.878	0.349
充血性心衰	68(75.6)	34(32.1)	χ²=36.896	0.000
糖尿病	24(26.7)	32(30.2)	χ²=0.296	0.568
既往脑卒中	42(46.7)	30(28.3)	χ²=7.064	0.008
肾功能不全	6(6.7)	34(32.1)	χ²=2.840	0.092
甲状腺功能亢进症	4(4.4)	6(5.7)	χ²=0.249	0.700
基础用药[例(%)]
利尿剂	34(37.8)	44(41.5)	χ²=0.283	0.595
血管紧张素转换酶抑制剂	42(46.7)	50(47.2)	χ²=0.050	0.944
β受体阻滞剂	42(46.7)	38(35.8)	χ²=2.358	0.125
他汀类	72(80.0)	80(75.5)	χ²=0.573	0.449
Ca离子拮抗剂	10(11.1)	10(9.4)	χ²=0.149	0.699
阿司匹林	56(62.2)	82(77.4)	χ²=5.235	0.021
CHA2DS2-VASc 评分[例(%)]
3~4分	38(42.2)	38(35.8)	χ²=0.833	0.361
≥5分	52(57.8)	68(64.2)

表1 两组临床基线资料及治疗情况比较

Tab.1 Comparison of baseline data and treatment condition between groups

临床特征	AF组( $n$ =90)	非AF组( $n$ =106)	统计值	$P$ 值
男性[例(%)]	42(46.7)	52(49.1)	χ²=0.111	0.739
年龄(岁)	81.83±4.47	78.52±2.81	$t$ =55.789	0.000
合并临床疾病[例(%)]
高血压	68(75.6)	84(79.2)	χ²=0.381	0.537
既往外周栓塞史	12(13.3)	18(17.0)	χ²=0.500	0.480
血管疾病	14(15.6)	22(20.8)	χ²=0.878	0.349
充血性心衰	68(75.6)	34(32.1)	χ²=36.896	0.000
糖尿病	24(26.7)	32(30.2)	χ²=0.296	0.568
既往脑卒中	42(46.7)	30(28.3)	χ²=7.064	0.008
肾功能不全	6(6.7)	34(32.1)	χ²=2.840	0.092
甲状腺功能亢进症	4(4.4)	6(5.7)	χ²=0.249	0.700
基础用药[例(%)]
利尿剂	34(37.8)	44(41.5)	χ²=0.283	0.595
血管紧张素转换酶抑制剂	42(46.7)	50(47.2)	χ²=0.050	0.944
β受体阻滞剂	42(46.7)	38(35.8)	χ²=2.358	0.125
他汀类	72(80.0)	80(75.5)	χ²=0.573	0.449
Ca离子拮抗剂	10(11.1)	10(9.4)	χ²=0.149	0.699
阿司匹林	56(62.2)	82(77.4)	χ²=5.235	0.021
CHA2DS2-VASc 评分[例(%)]
3~4分	38(42.2)	38(35.8)	χ²=0.833	0.361
≥5分	52(57.8)	68(64.2)

表2 1年随访的终点事件[例(%)]

Tab.2 1-year follow-up endpoint events (cases[%])

组别	例数	全因死亡	脑卒中	充血性心衰
AF组	90	22(24.4)	29(32.2)	48(53.3)
非AF组	106	9(8.5)	14(13.2)	26(24.5)
χ²值		9.304	10.276	17.185
$P$ 值		0.002	0.001	0

表2 1年随访的终点事件[例(%)]

Tab.2 1-year follow-up endpoint events (cases[%])

组别	例数	全因死亡	脑卒中	充血性心衰
AF组	90	22(24.4)	29(32.2)	48(53.3)
非AF组	106	9(8.5)	14(13.2)	26(24.5)
χ²值		9.304	10.276	17.185
$P$ 值		0.002	0.001	0

表3 1年随访全因死亡危险因素

Tab.3 Risk factors of 1-year follow-up all-cause death

因素	β	$S E$	Wald χ²值	$P$ 值	$O R$ 值	95% $C I$
因素	β	$S E$	Wald χ²值	$P$ 值	$O R$ 值	下限	上限
年龄	0.543	0.203	7.142	0.008	1.721	1.156	2.562
充血性心衰	3.279	1.062	9.532	0.002	26.539	3.311	12.719

表3 1年随访全因死亡危险因素

Tab.3 Risk factors of 1-year follow-up all-cause death

因素	β	$S E$	Wald χ²值	$P$ 值	$O R$ 值	95% $C I$
因素	β	$S E$	Wald χ²值	$P$ 值	$O R$ 值	下限	上限
年龄	0.543	0.203	7.142	0.008	1.721	1.156	2.562
充血性心衰	3.279	1.062	9.532	0.002	26.539	3.311	12.719

表4 1年随访卒中危险因素

Tab.4 Risk factors of 1-year follow-up stroke

因素	β	$S E$	Wald χ²值	$P$ 值	$O R$ 值	95% $C I$
因素	β	$S E$	Wald χ²值	$P$ 值	$O R$ 值	下限	上限
性别	0.653	0.164	15.854	0.000	1.921	1.393	2.650
高血压	0.882	0.193	20.884	0.000	2.416	1.655	3.526

表4 1年随访卒中危险因素

Tab.4 Risk factors of 1-year follow-up stroke

因素	β	$S E$	Wald χ²值	$P$ 值	$O R$ 值	95% $C I$
因素	β	$S E$	Wald χ²值	$P$ 值	$O R$ 值	下限	上限
性别	0.653	0.164	15.854	0.000	1.921	1.393	2.650
高血压	0.882	0.193	20.884	0.000	2.416	1.655	3.526

表5 1年随访心血管死亡危险因素

Tab.5 Risk factors of 1-year follow-up cardiovascular mortality

因素	β	$S E$	Wald χ²值	$P$ 值	$O R$ 值	95% $C I$
因素	β	$S E$	Wald χ²值	$P$ 值	$O R$ 值	下限	上限
年龄	0.441	0.124	12.648	0.001	1.554	1.219	1.982
既往充血性心衰	3.652	1.038	12.378	0.001	38.552	5.041	294.854

表5 1年随访心血管死亡危险因素

Tab.5 Risk factors of 1-year follow-up cardiovascular mortality

因素	β	$S E$	Wald χ²值	$P$ 值	$O R$ 值	95% $C I$
因素	β	$S E$	Wald χ²值	$P$ 值	$O R$ 值	下限	上限
年龄	0.441	0.124	12.648	0.001	1.554	1.219	1.982
既往充血性心衰	3.652	1.038	12.378	0.001	38.552	5.041	294.854

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