РАСПРОСТРАНЕННОСТЬ ФИБРИЛЛЯЦИИ ПРЕДСЕРДИЙ И АССОЦИИРОВАННЫЕ ФАКТОРЫ У БОЛЬНЫХ АРТЕРИАЛЬНОЙ ГИПЕРТЕНЗИЕЙ В УСЛОВИЯХ ПЕРВИЧНОЙ МЕДИКО-САНИТАРНОЙ ПОМОЩИ
Введение. Артериальная гипертензия (АГ) является самым распространенным фактором риска фибрилляции предсердий (ФП). Первичная профилактика ФП признана приоритетным направлением медицинской науки и практики.
Цель: изучить распространенность ФП и основные факторы риска, ассоциированные с ней у больных АГ без перенесенного коронарного события в условиях первичной медико-санитарной помощи (ПМСП).
Методы: В одномоментное поперечное исследование включались пациенты с АГ в возрасте 40 лет и старше, посетившие клиники ПМСП с января по сентябрь 2018г (n=1121). Критерии исключения: пороки сердца, ишемическая болезнь сердца, нарушение функции щитовидной железы, тяжелые соматические заболевания. Потенциальными предикторами ФП были возраст, пол, вес, рост, окружность талии, индекс массы тела, систолическое, диастолическое и пульсовое артериальное давление, статус курения, сахарный диабет (СД), общий холестерин и креатинин сыворотки.
Ассоциации между ФП и указанными переменными изучались с использованием многофакторного логистического регрессионного анализа. Распространенность ФП и отношение шансов (ОШ) представлены с 95% доверительными интервалами (ДИ).
Результаты: Распространенность ФП составила 4,7% (95% ДИ: 3,60-6,10). СД (ОШ=2,80; 95% ДИ: 1,40-5,58), возраст 60-69 лет (ОШ=4,18; 95% ДИ: 1,32-13,26), возраст 70 лет и старше (ОШ=27,68; 95% ДИ: 7,40-103,52), курение (ОШ=5,99; 95% ДИ: 2,62-13,70), окружность талии (ОШ=1,07; 95% ДИ: 1,04-1,10) и рост (ОШ=1,09; 95% ДИ: 1,03-1,15) были значимо связаны c ФП. У женщин ФП встречалась реже (ОШ=0,11; 95% ДИ: 0,04-0,32). Площадь под ROC кривой модели составила 87,3% (p<0,001). Чувствительность и специфичность модели составили 88,7% и 69,5%, соответственно.
Выводы: Распространенность ФП у больных АГ высокая. СД, возраст 60-69 лет, возраст 70 лет и выше, курение, абдоминальное ожирение и высокий рост были значимо связаны с ФП. У женщин распространенность ФП была меньше. Для снижения распространенности ФП у больных с АГ в Казахстане, особенно у мужчин, наряду с контролем АД, целесообразно контролировать выявленные факторы риска ФП.
Женисгуль Ш. Тлегенова 1, https://orcid.org/0000-0002-3707-7365
Бекболат К. Жолдин 1, http://orcid.org/0000-0002-4245-9501
Гульмира З. Кудайбердиева 2, http://orcid.org/0000-0003-4099-8816
Аян С. Абдрахманов 3, https://orcid.org/0000-0001-6315-5016
Андрей М. Гржибовский 1, 4-6, http://orcid.org/0000-0002-5464-0498
1 Западно-Казахстанский медицинский университет имени Марата Оспанова, г. Актобе, Республика Казахстан;
2 Центр последипломного образования и научных исследований, г. Бишкек, Киргизия;
3 Отделение интервенционнойаритмологии, Национальный научный кардиохирургический центр, г. Астана, Республика Казахстан;
4 Северный Государственный медицинский университет, г. Архангельск, Российская Федерация;
5 Северо-Восточный федеральный университет, г. Якутск, Российская Федерация;
6 Казахский Национальный Университет им. Аль-Фараби, г. Алматы, Республика Казахстан
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Тлегенова Ж.Ш., Жолдин Б.К., Кудайбердиева Г.З., Абдрахманов А.С., Гржибовский А.М. Распространенность фибрилляции предсердий и ассоциированные факторы у больных артериальной гипертензией в условиях первичной медико-санитарной помощи // Наука и Здравоохранение. 2019. 2 (Т.21).С. 44-54. Tlegenova Zh.Sh., Zholdin B.K., Kudaiberdieva G.Z., Abdrakhmanov A.S., Grjibovski A.M. Prevalence of atrial fibrillation and its correlates in hypertensive patients without coronary heart disease in primary care setting // Nauka i Zdravookhranenie [Science & Healthcare]. 2019, (Vol.21) 2, pp. 44-54. Тілегенова Ж.Ш., Жолдин Б.К., Кұдайбердиева Г.З., Абдрахманов А.С., Гржибовский А.М. Біріншілік медико-санитарлық көмек беру деңгейінде артериялық гипертензиясы бар науқастардағы жүрекшелер жыбырының таралуы және байланысты факторлары // Ғылым және Денсаулық сақтау. 2019. 2 (Т.21). Б. 44-54.Похожие публикации:
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