Institute of Endemic Disease, Key Laboratory of Environment and Gene Related to Diseases of Ministry Education, School of Medicine, Xi'an Jiaotong University.
J Epidemiol. 2014;24(5):385-91. doi: 10.2188/jea.je20130180. Epub 2014 Jun 28.
This study aims to determine whether baseline electrocardiography (ECG) abnormalities, the appearance of new ECG abnormalities, or other clinical characteristics are associated with increased rates of progression to chronic Keshan disease (KD) among patients with latent KD.
Four hundred and fourteen new latent KD patients from a monitored population in China were diagnosed and then followed for 10 years. Baseline and 10-year ECG abnormalities were classified according to the Minnesota Code as major and minor. Using Cox proportional hazards regression models, the addition of ECG abnormalities to traditional risk factors were examined to predict chronic KD events.
In 414 latent KD patients with ECG abnormalities, 220 (53.1%) had minor and 194 (46.9%) had major ECG abnormalities. During the follow-up, 92 (22.2%) patients experienced chronic KD events; 32 (14.5%) and 60 (30.9%) of these chronic KD events occurred in the minor and major ECG abnormalities groups, respectively. After adjustment for baseline potential confounders, the hazard ratios and 95% confidence intervals (CIs) for progression to chronic KD in latent KD patients with major ECG abnormalities versus those with minor ECG abnormalities was 2.43 (95% CI 1.58-3.93).
Major ECG abnormalities and new ventricular premature complex abnormalities that occurred during the follow-up were both associated with an increased risk of progression to chronic KD. Atrial fibrillation and right bundle branch block with left anterior hemiblock are the most strongly predictive components of major ECG abnormalities. Depending on the model, adding ECG abnormalities to traditional risk factors was associated with improved risk prediction in latent KD.
本研究旨在确定基线心电图（ECG）异常、新出现的 ECG 异常或其他临床特征是否与潜伏性克山病（KD）患者向慢性 KD 进展的发生率增加有关。
从中国监测人群中诊断出 414 例新发潜伏性 KD 患者，并随访 10 年。根据明尼苏达编码，将基线和 10 年的 ECG 异常分为主要和次要。使用 Cox 比例风险回归模型，将 ECG 异常与传统危险因素相结合，预测慢性 KD 事件。
在 414 例有 ECG 异常的潜伏性 KD 患者中，220 例（53.1%）有轻度异常，194 例（46.9%）有重度异常。在随访期间，92 例（22.2%）患者发生慢性 KD 事件；其中 32 例（14.5%）和 60 例（30.9%）分别发生在轻度和重度 ECG 异常组。调整基线潜在混杂因素后，与有轻度 ECG 异常的患者相比，有重度 ECG 异常的潜伏性 KD 患者进展为慢性 KD 的危险比和 95%置信区间（CI）分别为 2.43（95%CI 1.58-3.93）。
随访期间出现的主要 ECG 异常和新发室性期前收缩异常均与向慢性 KD 进展的风险增加相关。房颤和右束支传导阻滞伴左前分支阻滞是主要 ECG 异常的最具预测性成分。根据模型的不同，将 ECG 异常与传统危险因素相结合，可改善潜伏性 KD 的风险预测。
