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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。
Objective To observe the 10-year outcomes of patients with latent Keshan disease (KD) and to analyze the risk factors for their progression to chronic KD. Methods A total of 448 newly diagnosed latent KD patients were followed up for 10 years. The age, sex, electrocardiogram, blood selenium, blood pressure, body mass index (BMI), heart rate and follow-up period were analyzed with multivariate COX proportional hazard survival model Newly occurring hypertension, secondary ECG abnormalities and other factors are risk factors affecting the prognosis. The cumulative incidence and cumulative risk of chronic KD during 10-year follow-up were calculated using the Kaplan-Meier method. The incidence of cumulative chronic KD between groups was compared using the logrank test. Results The final effective cases of 414 cases, the average follow-up time (112.9 ± 17.5) months. During the follow-up period, the incidence of chronic KD was 22.2% (n = 92). Aged 15 years or older, male, family history of KD, history of smoking, blood selenium concentration of less than 60μg / L, the main ECG changes, 18.5kg / m2 ≤ BMI ≤ 23.9kg / m2 of potential KD patients were followed up The cumulative incidence and cumulative risk of progression to chronic KD over 10 years were high. COX proportional hazards model analysis found that the main changes in ECG abnormalities, selenium, BMI, hypertension and secondary ventricular premature beats are potential KD progression to chronic KD risk factors. There was a positive correlation between glutathione peroxidase (GPx) activity and blood selenium concentration (r = 0.719, P <0.01). Conclusions The main ECG changes, selenium deficiency, BMI, hypertension and secondary premature ventricular contractions are the risk factors for the progression of latent KD to chronic KD.