心房颤动的新危险因素

New Risk Factors for Atrial Fibrillation

摘要: 心房颤动(AF)的发病率和流行率均在快速上升，已成为全球的流行病。50年来AF的患病率增加了3倍，这其中与一些新的AF危险因素有关，主要包括：1) 肥胖，体重指数每增加1 kg/m²，AF发生的风险增加5%，腰围每增加9.4 cm、AF风险增加12%。与无肥胖者相比、肥胖者AF风险为18%。2) 老龄化、65岁后发生AF的风险将从2010年的12%增加到2040年的22%。3) 饮酒，中等量饮酒使AF发生的风险增加8%。4) 社会心理因素，工作压力、抑郁、愤怒、焦虑和睡眠障碍等均增高AF风险，心理创伤者AF风险增加13%。5) 癌症、确诊癌症后AF发生率显著增加，乳腺癌AF风险增加14%。化疗者AF发生率为15%~32%。6) 静脉血栓栓塞(VTE)，VTE诊断后AF的发生率和AF诊断后VTE的发生率均≥70%。7) 慢性肾病肾小球滤过率降低者，AF风险增加32%~57%。8) 其他如吸烟、过度体育锻炼等也使AF风险显著增加。上述因素引发AF的机制包括心房扩大、神经内分泌系统的激活、电解剖重构、氧化应激、钾离子通道阻断、儿茶酚胺释放、内皮功能障碍、炎症以及心房纤维化等。

Abstract: Atrial fibrillation (AF) prevalence and incidence are both increasing rapidly, becoming a global epidemic. The AF prevalence has increased by three times in the past 50 years, which is related to some new AF risk factors, including: 1) for obesity, the risk of AF increases by 5% for every 1 kg/m² increase in body mass index (BMI), and the risk increases by 12% for every 9.4 cm increase in waist circumference. The AF risk for obese individuals is 18% higher than that for non-obese individuals. 2) for aging, the risk of AF will increase from 12% in 2010 to 22% in 2040 after the age of 65. 3) for alcohol consumption, moderate alcohol consumption increases the risk of AF by 8%. 4) for social and psychological factors, work pressure, depression, anger, anxiety, sleep disorders, etc. all increase the risk of AF, and the AF risk for those with psychological trauma is 13% higher. 5) for cancer, the incidence of AF significantly increases after a cancer diagnosis, and the AF risk for breast cancer is 14% higher. The AF incidence for cancer patients is 15%~30%. 6) for venous thromboembolism (VTE), the incidence of AF after a VTE diagnosis and the incidence of VTE after an AF diagnosis are both ≥ 70%. 7) for chronic kidney disease, the risk of AF increases by 32%~57% in patients with decreased glomerular filtration rate (GFR). 8) Other factors such as smoking and excessive physical exercise also significantly increase the risk of AF. The mechanisms by which these factors trigger AF include atrial enlargement, activation of the neuroendocrine system, electrical anatomical remodeling, oxidative stress, potassium channel blockade, release of catecholamines, endothelial dysfunction, inflammation, and atrial fibrosis.