Epidemiology of valvular heart disease in a Swedish nationwide hospital-based register study.
Epidemiology of valvular heart disease in a Swedish nationwide hospital-based register study.
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DOI：
10.1136/heartjnl-2016-310894
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发表时间：
2017-11
期刊：
影响因子：
--
通讯作者：
Smith JG
中科院分区：
文献类型：
--
作者：
Andell P;Li X;Martinsson A;Andersson C;Stagmo M;Zöller B;Sundquist K;Smith JG
临床病例系列报告了 20 世纪发达国家瓣膜性心脏病 (VHD) 谱系的转变，但缺乏大规模的当代人群研究。我们使用全国登记册来识别 2003 年至 2010 年间在瑞典医院首次诊断出 VHD 的所有患者。对每种 VHD 的年龄分层和性别分层发病率以及调整后的合并症概况进行了评估。在瑞典人口（n=10 164 211）中，VHD 的发病率为每 10 万人年 63.9 例，其中主动脉瓣狭窄（AS；47.2%）、二尖瓣关闭不全（MR；24.2%）和主动脉瓣关闭不全（AR；18.0%）占 VHD 诊断的大部分。大多数 VHD 是在老年人中诊断出来的（68.9% 在年龄≥65 岁的受试者中），但肺动脉瓣疾病的发病率在新生儿中达到高峰。男性中 AR、AS 和 MR 的发病率较高，而且在较早的年龄就更容易被诊断出来。女性二尖瓣狭窄 (MS) 的发生率较高。风湿热很少见。一半的 AS 病例伴有动脉粥样硬化性血管疾病 (48.4%)，而二尖瓣疾病和三尖瓣反流中常见心力衰竭和心房颤动。其他常见合并症包括 AR 中的胸主动脉瘤（10.3%）、MS 中的自身免疫性疾病（24.5%）以及 MR（10.7%）和 TR（10.3%）中的腹部疝气或脱垂。临床诊断的VHD主要是老年人的疾病。风湿热在瑞典很少见，但特定的 VHD 显示出一系列不同的合并症特征。在 AR 和 MS 中观察到明显的性别特异性模式，其机制仍不完全清楚。
Transitions in the spectrum of valvular heart diseases (VHDs) in developed countries over the 20th century have been reported from clinical case series, but large, contemporary population-based studies are lacking. We used nationwide registers to identify all patients with a first diagnosis of VHD at Swedish hospitals between 2003 and 2010. Age-stratified and sex-stratified incidence of each VHD and adjusted comorbidity profiles were assessed. In the Swedish population (n=10 164 211), the incidence of VHD was 63.9 per 100 000 person-years, with aortic stenosis (AS; 47.2%), mitral regurgitation (MR; 24.2%) and aortic regurgitation (AR; 18.0%) contributing most of the VHD diagnoses. The majority of VHDs were diagnosed in the elderly (68.9% in subjects aged ≥65 years), but pulmonary valve disease incidence peaked in newborns. Incidences of AR, AS and MR were higher in men who were also more frequently diagnosed at an earlier age. Mitral stenosis (MS) incidence was higher in women. Rheumatic fever was rare. Half of AS cases had concomitant atherosclerotic vascular disease (48.4%), whereas concomitant heart failure and atrial fibrillation were common in mitral valve disease and tricuspid regurgitation. Other common comorbidities were thoracic aortic aneurysms in AR (10.3%), autoimmune disorders in MS (24.5%) and abdominal hernias or prolapse in MR (10.7%) and TR (10.3%). Clinically diagnosed VHD was primarily a disease of the elderly. Rheumatic fever was rare in Sweden, but specific VHDs showed a range of different comorbidity profiles . Pronounced sex-specific patterns were observed for AR and MS, for which the mechanisms remain incompletely understood.
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