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目的:探讨收缩压(SBP)纵向轨迹与心房颤动(房颤)的关系。方法:以开滦研究中满足标准的对象组成研究队列。通过SAS Proc Traj程序确定观察对象2006~2007、2008~2009、2010~2011年健康体检的SBP纵向轨迹,生成5个不同的SBP轨迹组:低-稳定轨迹组、中-稳定轨迹组、中-高轨迹组、高-中轨迹组和高-稳定轨迹组。采用Log-Rank检验比较不同SBP轨迹组于2012~2013、2014~2015年2次健康体检时的房颤发病率的差异,采用多因素COX回归模型分析不同SBP轨迹组与房颤的关系。结果:(1)40 727例纳入研究,平均年龄(51.81±11.54)岁,其中,男性30 693例(75.4%)。低-稳定轨迹组10 950例,中-稳定轨迹组19 158例,中-高轨迹组3 736例,高-中轨迹组4 702例,高-稳定轨迹组2 181例。(2)低-稳定轨迹组、中-稳定轨迹组、中-高轨迹组、高-中轨迹组和高-稳定轨迹组房颤发病率分别为:0.1%、0.2%、0.5%、0.5%、0.6%(P均<0.05)。(3)在多因素COX回归分析中,校正其他混杂因素后,与低-稳定轨迹相比,中-高轨迹、高-中轨迹、高-稳定轨迹均是新发房颤的危险因素,对应的HR(95%CI)分别为7.58(2.08~27.73)、5.30(1.88~14.95)、8.52(1.96~37.09)(P均<0.05)。排除有心肌梗死病史、脑卒中病史者后,进行敏感性分析,结果与以上主要研究结果趋势一致。结论:SBP纵向轨迹水平升高是新发房颤的危险因素。
Objective: To investigate the relationship between systolic blood pressure (SBP) longitudinal trajectory and atrial fibrillation (AF). Methods: The research object is composed of the research objects that meet the standards in Kailuan. SAS Proc Traj program was used to determine the SBP longitudinal trajectory of the health examination from 2006 to 2007, 2008 to 2009 and 2010 to 2011. Five different SBP trajectory groups were generated: low-stable trajectory group, medium-stable trajectory group, medium- High trajectory group, high-medium trajectory group and high-stable trajectory group. Log-Rank test was used to compare the incidence of atrial fibrillation between different SBP trajectories in two physical examinations from 2012 to 2013 and from 2014 to 2015. Multivariate COX regression model was used to analyze the relationship between different SBP trajectories and atrial fibrillation. Results: (1) 40 727 cases were included in the study, with an average age of 51.81 ± 11.54 years, of whom 30 693 (75.4%) were male. There were 10 950 low-stability trajectories, 19 158 medium-stable trajectories, 3 736 medium-high trajectories, 4 702 high-middle trajectories, and 2 181 high-stability trajectories. (2) The incidences of atrial fibrillation in low-stable group, medium-stable group, medium-high group, high-medium group and high-stable group were 0.1%, 0.2%, 0.5% and 0.5% , 0.6% (all P <0.05). (3) In the multivariate COX regression analysis, after adjusting for other confounding factors, medium-high trajectory, high-medium trajectory and high-stable trajectory are the risk factors of new-onset atrial fibrillation compared with the low-stable trajectory. HR (95% CI) were 7.58 (2.08-27.73), 5.30 (1.88-14.95) and 8.52 (1.96-37.09) respectively (all P <0.05). Exclusion of a history of myocardial infarction, stroke history, sensitivity analysis, the results of the main research results with the above trend. Conclusion: SBP vertical trajectory level is a new risk factor for atrial fibrillation.