【摘要】：背景:普通人群中室性早搏(室早)的預后存在一定的爭議。過去認為室早大部分是良性的,但近來一些研究表明室早會影響心臟功能以及生存預后。目前在中國的普通人群中,室早與全因死亡之間的關系尚不清楚。本研究通過初步橫斷面分析觀察室早在人群中的患病率和危險因素,并通過隨訪觀察發(fā)病率、預測因素及室早與全因死亡之間的關系。方法:在參加本隊列研究初次體檢的人群中,排除心電圖診斷缺失以及首次心電圖診斷為預激綜合征及心房顫動、心房撲動的對象后共納入99594名研究對象。以后每2年隨訪一次,觀察患者是否出現(xiàn)新發(fā)的室早,同時通過及時調取醫(yī)保中心及醫(yī)院病歷檔案對終點事件全因死亡進行確認觀察。結果:本隊列中室早的患病率為1.1%,發(fā)病率為2.69/千人年。根據(jù)年齡和性別將研究樣本分為6組。在第一個年齡段(18-35歲)中男女發(fā)患率無統(tǒng)計學差異。但在第二和第三個年齡組中男女患病率則存在明顯差異(35-55歲:0.65%vs.0.84%,p=0.029;大于 55 歲:1.88%vs1.38%,p=0.009)。在 55 歲以下人群,女性的發(fā)病率并不低于甚至高于男性。但在55歲以上人群男性的發(fā)病率則明顯高于女性。室早患病的危險因素為年齡、高血壓、空腹血糖升高及高尿酸血癥,新發(fā)的預測因素為年齡、男性、高血壓及空腹血糖升高。本隊列中未患室早的死亡率為7.72/千人年,而患室早的則為20.60/千人年。多因素校正的Cox回歸分析結果提示,本隊列中患有室早者較不患室早者死亡風險升高約 30%以上(HR=1.35,95%CI:1.15-1.58,P0.001)。結論:本隊列研究發(fā)現(xiàn),室早患病及發(fā)病與年齡相關,隨著年齡的升高室早的發(fā)病率明顯升高,尤其是在65歲及以上的中老年人群中。在55歲以下人群女性的發(fā)病率并不低于甚至高于男性。但在55歲以上人群男性的發(fā)病率則明顯高于女性。經過平均7.82年的隨訪研究,發(fā)現(xiàn)室早會增加全因死亡風險。
[Abstract]:Background: the prognosis of ventricular premature beats in the general population is controversial. Ventricular premature disease has been thought to be mostly benign, but recent studies have shown that it affects heart function and survival outcomes. The relationship between ventricular premature and all-cause death is unclear among the general population in China. In this study, the prevalence and risk factors were analyzed by preliminary cross-sectional analysis, and the incidence, predictive factors and the relationship between ventricular premature and all-cause death were observed by follow-up. Methods: in this cohort, 99594 subjects were included in the study after exclusion of the absence of electrocardiogram diagnosis and the diagnosis of preexcitation syndrome and atrial fibrillation by the first electrocardiogram. The patients were followed up every 2 years to observe whether the patients had new room morning or not. At the same time, the terminal events were confirmed and observed by the medical insurance center and the hospital medical records. Results: in this cohort, the prevalence rate of ventricular premature was 1.1 and the incidence rate was 2.69 / 1000 person-year. The study samples were divided into six groups according to age and sex. In the first age group (18-35 years), there was no significant difference in the incidence of hair between men and women. But in the second and third age groups, the prevalence rate of male and female was significantly different (35-55 years old: 0.65, vs.0.84, p0.029; > 55 years old, 1.88 vs 1.38, P 0.009). In people under 55 years of age, the incidence among women is no lower or even higher than that of men. However, the incidence rate of males was significantly higher than that of females in the population over 55 years of age. The risk factors of ventricular premature disease were age, hypertension, high fasting blood glucose and hyperuricemia. The new predictors were age, male, hypertension and elevated fasting blood glucose. In this cohort, the mortality rate was 7.72 / 1000 and 20.60 / 1000, respectively. The multivariate adjusted Cox regression analysis showed that the risk of death was increased by more than 30% (HR=1.35,95%CI:1.15-1.58,P0.001) in this cohort. Conclusion: in this cohort study, the incidence of ventricular premature disease is associated with age, and the incidence of ventricular premature disease increases with age, especially in the middle-aged and elderly aged 65 years and over. The incidence among women under 55 years of age is no lower than or even higher than that of men. However, the incidence rate of males was significantly higher than that of females in the population over 55 years of age. After an average follow-up study of 7.82 years, it was found that early ventricular involvement increased the risk of all-cause death.
【學位授予單位】：大連醫(yī)科大學
【學位級別】：碩士
【學位授予年份】：2017
【分類號】：R541.7
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本文編號：2219764