完全性左束支传导阻滞733例临床分析

Clinical characteristics of patients with complete left bundle branch block:report of 733 cases

摘要:

目的探讨完全性左束支传导阻滞(CLBBB)合并冠心病患者的临床特点。方法回顾性分析2002年1月至2008年1月733例CLBBB住院患者资料,对比合并冠心病和不合并冠心病患者的临床特点,通过回归分析找出CLBBB患者中与冠心病相关的独立预测因素。结果733例左束支传导阻滞患者中合并高血压、冠心病和扩张型心肌病者分别占49.4%、44.1%和26.5%。合并心脏扩大或心功能不全者58%,合并其他心律失常者19.9%。多元回归分析结果:性别(P<0.01,B=1.991,95%CI:1.375～2.882)、年龄≥65岁(P<0.01,B=2.793,95%CI:1.948～4.005)、高血压(P=0.022,B=1.522,95%CI:1.062～1.640)、糖尿病(P<0.001,B=2.459,95%CI:1.540～3.926)、高血脂(P=0.803,B=1.057,95%CI:0.682～2.180)与冠心病发生正相关,而扩张型心肌病(P<0.001,B=0.072,95%CI:0.045～0.127)、心脏瓣膜病(P=0.027,B=0.253,95%CI:0.075～0.853)、房颤或房扑(P=0.024,B=0.564,95%CI:0.343～0.927)、其他传导阻滞(P<0.001,B=0.418,95%CI:0.263～0.665)与冠心病发生呈负相关。结论CLBBB患者中年龄≥65岁、男性、高血压、糖尿病患者容易合并冠心病;而扩张型心肌病、房颤或房扑、合并其他类型传导阻滞、心脏扩大或心功能不全在未合并冠心病的CLBBB患者中更常见。

Abstract:

Objective To investigate the clinical characteristics of complete left bundle branch block (CLBBB) patients complicated by coronary heart disease (CHD). Methods The data of 733 hospitilized patients (from January 2002 to January 2008) with CCLBBB were retrospectively analyzed. The difference in clinical characteristics between CCLBBB patients complicated with and without CHD were compared. The independent predictors for CHD in CCLBBB patients were determined by regression analysis. Results The CLBBB patients complicated by hypertension,CHD and dilated cardiomyopathy accounted for 49.4%,44.1% and 26.5%,respectively. About 58% of CLBBB patients were complicated with cardiac dilation or myocardial dysfunction,and 19.9% with other arrhythmia. The results of logistic analysis showed that sex (P<0.001,B=1.991,95%CI:1.375-2.882),age ≥65 years(P<0.001,B=2.793,95%CI:1.948-4.005),hypertension(P=0.022,B=1.522,95%CI:1.062-1.640),diabetes mellitus (P<0.001,B=2.459,95%CI:1.540~3.926),hyperlipemia(P=0.803,B=1.057,95%CI:0.682-2.180)were positively related to CHD; dilated cardiomyopathy (P<0.001,B=0.072,95%CI:0.045-0.127),rheumatic valvular disease (P=0.027,B=0.253,95%CI:0.075-0.853),and atrial fibrillation or atrial flutter (P=0.024,B=0.564,95%CI:0.343-0.927) and other atrio-ventricular block(P<0.001,B=0.418,95%CI:0.263-0.665) were negatively related to CHD. Conclusion CLBBB patients,≥65 years,male sex,with hypertension or diabetes mellitus,are more susceptibly to suffer from CHD. While dilated cardiomyopathy,atrial fibrillation or atrial flutter,other atrio-ventricular block,cardiac dilation or myocardial dysfunction are more common in CLBBB patients without CHD.