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目的分析上海高行社区老年人束支传导阻滞的患病率及其影响因素。方法于2013年6月~10月间对上海市浦东高行社区老年居民进行系统抽样调查,共纳入受试者3950例,男性1745例,女性2205例。根据年龄分为三组:65~69岁(1850例),70~79岁(1492例),≥80岁(608例)。根据束支传导阻滞情况分为:正常组(3717例)、左束支传导阻滞(LBBB)组(53例)、右束支传导阻滞(RBBB)组(180例)。问卷调查收集入选者的一般资料,收集静脉血检测实验室指标,同型半胱氨酸(Hcy)、糖化血红蛋白(Hb A1c)、高密度脂蛋白胆固醇(HDL-C)、血肌酐(Cr)以及检测左室射血分数(LVEF)等。结果随年龄增加,三组空腹血糖、Hcy、Cr和尿酸呈逐渐升高的趋势,差异有统计学意义(P均<0.05)。≥80岁入选者较65~69岁吸烟比例下降,HDL-C、Hb A1c、收缩压、高血压和心血管病比例升高,差异有统计学意义(P均<0.05)。束支传导阻滞总患病率为5.9%,RBBB患病率为4.6%,LBBB患病率则为1.3%。亚组分析:男性RBBB、LBBB患病率均高于女性,5.8%vs.3.6%,1.9%vs.0.9%,差异有统计学意义(P均<0.05);随着年龄升高,LBBB、RBBB患病率均有显著上升趋势,差异有统计学意义(P均<0.05)。与正常组比较,LBBB组和RBBB组年龄、男性比例、Hcy、Cr、尿酸升高,差异有统计学意义(P均<0.05)。LBBB组较正常组高血压、心肌梗死、心脏瓣膜病比例升高,LVEF降低,差异有统计学意义(P均<0.05)。经多因素Logistic回归分析发现,年龄(OR=1.081,95%CI:1.038~1.126)、高血压病(OR=1.973,95%CI:1.007~3.866)、心肌梗死(OR=5.807,95%CI:1.616~20.862)、心脏瓣膜病(OR=5.566,95%CI:1.152~26.892)、性别(OR=2.089,95%CI:1.106~3.945)是高行社区老年居民患有LBBB的危险因素,LVEF(OR=0.968,95%CI:0.937~0.999)为保护因素;年龄(OR=1.079,95%CI:1.053~1.105)、男性(OR=1.608,95%CI:1.102~2.346)是高行社区老年居民患有RBBB的危险因素。结论上海高行社区老年居民束支传导阻滞的总患病率是5.9%。LBBB与心血管疾病显著相关,应注意加强干预。
Objective To analyze the prevalence and influential factors of bundle branch block in the elderly in Shanghai Gaohang community. Methods A systematic sample survey of elderly residents in Shanghai Pudong Gaoxing Community was conducted between June and October 2013. A total of 3950 subjects were enrolled, including 1745 males and 2205 females. They were divided into three groups according to their age: 65-69 (1850), 70-79 (1492), and ≥80 (608). According to the condition of bundle branch block, it was divided into normal group (3717 cases), left bundle branch block (53 cases) and right bundle branch block (RBBB) group (180 cases). The questionnaire survey collected general information of the participants, collected venous blood test laboratory indicators, homocysteine (Hcy), glycosylated hemoglobin (Hb A1c), high density lipoprotein cholesterol (HDL-C), serum creatinine (Cr) and Detection of left ventricular ejection fraction (LVEF) and so on. Results With the increase of age, the fasting blood glucose, Hcy, Cr and uric acid in the three groups tended to increase gradually with a significant difference (all P <0.05). The prevalence of smoking among those aged> 80 years was lower than that of those aged 65-69 years (P <0.05). HDL-C, Hb A1c, systolic blood pressure, hypertension and cardiovascular disease were all significantly increased. The total prevalence of bundle branch block was 5.9%, the prevalence of RBBB was 4.6%, and the prevalence of LBBB was 1.3%. Subgroup analysis: The prevalence rates of RBBB and LBBB in males were higher than those in females, 5.8% vs.3.6% and 1.9% vs.0.9%, respectively (all P <0.05). With age, the prevalence of LBBB, The prevalence of RBBB increased significantly, with statistical significance (P <0.05). Compared with the normal group, the age, male ratio, Hcy, Cr, uric acid increased in LBBB group and RBBB group, the difference was statistically significant (all P <0.05). Compared with the normal group, the LBBB group had a higher proportion of hypertension, myocardial infarction and valvular heart disease, and a lower LVEF (P <0.05). Multivariate logistic regression analysis showed that there were significant differences in age (OR = 1.081, 95% CI: 1.038-1.126), hypertension (OR = 1.973, 95% CI 1.007-3.866), myocardial infarction (OR = 2.066, 95% CI: 1.152-26.892), sex (OR = 2.089, 95% CI: 1.106-3.945) were the risk factors for LBBB in senior citizens in Gaohang community, (OR = 1.079, 95% CI: 1.053-1.105), male (OR = 1.608, 95% CI: 1.102-2.346) Community-aged residents have risk factors for RBBB. Conclusion The overall prevalence of bundle branch block in elderly residents in Shanghai Gaohang community is 5.9%. LBBB is significantly associated with cardiovascular disease, attention should be paid to strengthen the intervention.