【摘要】 目的观察潜在型克山病(KD)患者的10年转归情况并分析其进展为慢型KD的危险因素。方法对448例新发潜在型KD进行10年跟踪随访,用多因素COX比例风险生存模型,分析患者年龄、性别、心电图、血硒、血压、体质量指数(BMI)、心率及跟踪随访期内新发生的高血压、继发性心电图异常等因素是否为影响预后的危险因素。10年随访期间的慢型KD累积发病率和累积危险率采用Kaplan-Meier法,组间累积慢型KD发生率比较采用logrank检验。结果最终有效病例414例,平均随访时间(112.9±17.5)月。在随访期内,慢型KD发病率为22.2%(92例)。年龄在15岁以上、男性、有KD家族史、有吸烟史、血硒质量浓度低于60μg/L、有主要心电图改变、18.5kg/m2≤BMI≤23.9kg/m2的潜在型KD患者在随访10年间进展为慢型KD的累积发病率和累积危险率均较高。经COX比例风险模型分析发现,主要心电图异常改变、低硒、BMI、高血压及继发性室性早搏均为潜在型KD进展为慢型KD的危险因素。谷胱甘肽过氧化物酶(GPx)活性和血硒质量浓度呈正相关(r=0.719,P<0.01)。结论主要心电图改变、低硒、BMI、高血压及继发性室性早搏均是潜在型KD进展为慢型KD的危险因素。更多还原

【Abstract】 Objective To observe ten-year prognosis of patients with latent Keshan disease(KD)and to determine its associated risk factors.Methods A total of 448 patients with newly diagnosed latent KD were monitored and followed up for 10 years.Their ECG abnormalities were classified as major or minor using the Minnesota Code.COX proportional hazards regression models were established to identify risk factors associated with the development of chronic KD.Results A final sample of 414 cases was included in analyses,with an average of(112.9±17.5)months of follow-up.At the end of follow-up,92(22.2%)patients developed chronic KD.Older age(>15years),male,family history of KD,smoking,lower level of blood selenium(<60μg/L),major ECG abnormalities,and 18.5kg/m2≤body mass index(BMI)≤23.9kg/m2 were associated with higher cumulative incidence of chronic KD.The COX regression models showed that major ECG abnormalities,BMI,selenium deficiency,hypertension,and ventricular premature complex(VPC)abnormalities contributed to increased risk of chronic KD.A positive linear correlation(r=0.719,P <0.01)between GPx activity and blood selenium concentration was found.Conclusion Major ECG abnormalities,BMI,selenium deficiency,hypertension and VPC abnormalities are associated with the development of chronic KD.更多还原