Yu Tung-Min, Chuang Ya-Wen, Yu Mei-Ching, Huang Shih-Ting, Chou Che-Yi, Lin Cheng-Li, Chiu Chun-Ching, Kao Chia-Hung
From the Graduate Institute of Clinical Medical Science and School of Medicine, College of Medicine, China Medical University (T-MY, C-HK); Division of Nephrology, Taichung Veterans General Hospital, Taichung (T-MY, Y-WC); Department of Pediatric Nephrology, Chang Gung Children's Hospital at Linkou, Chang Gung University College of Medicine, Taoyuan (M-CY); Management Office for Health Data, China Medical University Hospital, Taichung (C-LL); Neurology and Medical Intensive Care Unit, Changhua Christian Hospital, Changhua (C-CC); College of Medicine, China Medical University (C-LL); and Department of Nuclear Medicine and PET Center, China Medical University Hospital, Taichung, Taiwan (C-HK).
Medicine (Baltimore). 2016 Jan;95(4):e2623. doi: 10.1097/MD.0000000000002623.
Cardiovascular complications remain the major problems contributing to morbidity and mortality in patients with polycystic kidney disease (PKD). Therefore, the authors hypothesized that atrial fibrillation (AF) is closely associated with PKD. The authors conducted a nationwide population-based cohort study to investigate the risk of AF in patients with PKD. Using data from inpatient claims, the authors enrolled 7203 patients aged over 20 years who were diagnosed with PKD from 1998 to 2010 with no history of AF as the PKD cohort. They randomly selected 28,739 people without PKD as controls and frequency matched them with patients with PKD according to their age, sex, and baseline comorbidity. In total, 247 PKD patients were diagnosed with AF, representing an incidence of 7.08 per 1000 person-years, whereas 807 cases of AF occurred in the comparison cohort, yielding an incidence of 4.98 per 1000 person-y, with an adjusted HR (aHR) of 1.31 (95% CI = 1.14-1.51). The risk of AF increased from an aHR of 1.59 (95% CI = 1.15-2.21) to 3.64 (95% CI = 1.93-6.85) when the number of risk factors increased from 1 to more than 5 in comparison with patients without risk factors. A remarkably high incidence rate and risk was observed in patients with PKD when multiple risk factors were combined. A high index of suspicion should be maintained when examining PKD patients with irregular betas. Early prophylactic therapy is warranted in these patients.
心血管并发症仍然是多囊肾病（PKD）患者发病和死亡的主要问题。因此，作者推测心房颤动（AF）与PKD密切相关。作者进行了一项基于全国人口的队列研究，以调查PKD患者发生AF的风险。利用住院理赔数据，作者纳入了7203名年龄超过20岁、在1998年至2010年期间被诊断为PKD且无AF病史的患者作为PKD队列。他们随机选择28739名无PKD的人作为对照，并根据年龄、性别和基线合并症与PKD患者进行频率匹配。总共有247名PKD患者被诊断为AF，发病率为每1000人年7.08例，而在对照组中有807例AF发生，发病率为每1000人年4.98例，调整后的风险比（aHR）为1.31（95%置信区间=1.14-1.51）。与无危险因素的患者相比，当危险因素数量从1个增加到5个以上时，AF风险从aHR为1.59（95%置信区间=1.15-2.21）增加到3.64（95%置信区间=1.93-6.85）。当多种危险因素合并时，PKD患者中观察到非常高的发病率和风险。在检查有不规则β波的PKD患者时应保持高度怀疑指数。这些患者有必要进行早期预防性治疗。
