肥厚型心肌病合并心房颤动患者的危险因素分析  

Risk factor analysis in patients with hypertrophic cardiomyopathy combining atrial fibrillation

作　　者：吴刚[1] 石少波[1] 曲川[1] 林键 周兴宇 鲁菲菲 杨波[1] WU Gang;SHI Shao-bo;QU Chuan(Department of Cardiology,Renmin Hospital of Wuhan University, Cardiovascular Research Institute,Wuhan University,Hubei Key Laboratory of Cardiology,Wuhan 430060,China)

机构地区：[1]武汉大学人民医院心血管内科心血管病湖北省重点实验室

出　　处：《中国心血管病研究》2018年第12期1099-1102,1137,共5页Chinese Journal of Cardiovascular Research

基　　金：湖北省技术创新专项重大项目(项目编号:2016ACA153)

摘　　要：目的 探讨肥厚型心肌病(hypertrophic cardiomyopathy,HCM)合并心房颤动(房颤,atrial fibrillation,AF)患者的危险因素.方法 纳入2015年1月至2018年3月间在我院住院的HCM患者69例(HCM组)及HCM合并AF患者23例(HCM-AF组)为研究对象,统计患者临床资料及相关检查结果.以Logistic回归分析HCM患者发生AF的危险因素.结果 单因素分析结果显示,HCM组与HCM-AF组NYHA分级(2.33±0.69比3.00±0.85)、病程[1.0(1.0,2.0)年比5.5(1.1,17.5)年]、淋巴细胞计数[(1.92±0.73)×109/L比(1.59±0.40)×109/L]、中性粒细胞计数与淋巴细胞计数比值(neutrophil-to-lymphocyte ratio,NLR)(2.27±1.20比3.37±2.32)、氨基末端脑钠肽前体(N terminal pro brain natriuretic peptide,NT-proBNP)[696.50(243.75,1788.00)pg/ml比1746.50(602.25,7719.75)pg/ml]、总胆固醇[(4.28±0.96)mmol/L比(3.54±0.77)mmol/L]、甘油三酯[(1.98±1.68)mmol/L比(1.15±0.53)mmol/L]、低密度脂蛋白胆固醇(low density lipoprotein cholesterol,LDL-C)[(2.34±0.76)mmol/L比(1.84±0.65)mmol/L]、左心房内径[(38.48±6.65)mm比(46.29±11.03)mm]、左心室射血分数[(57.95±6.70)%比(53.86±7.71)%]的差异均有统计学意义(P<0.05).多因素Logistic回归分析发现,NYHA分级(OR=5.15,95%CI 1.03~25.70,P<0.05)、病程(OR=1.20,95%CI 1.04~1.39,P<0.05)、NLR(OR=2.03,95%CI 1.10~3.76,P<0.05)、左心房内径(OR=1.10,95%CI 1.02~1.19,P<0.05)是HCM患者发生AF的独立危险因素.结论 NYHA分级差、病程长、NLR高和左心房内径增大是HCM患者发生AF的独立危险因素.Objective To evaluate the risk factors for atrial fibrillation(AF)in patients with hypertrophic cardiomyopathy (HCM).Methods A total of 92HCM patients enrolled in our hospital from January 2015to March 2018were divided into 2groups:HCM group (n=69)and HCM+AF (HCM-AF)group (n=23).The baseline information was recorded.The risk factors for AF in patients with HCM were assessed by multivariate Logistic analysis.Results Univariate analysis showed that the NYHA class (2.334-0.69vs.3.004-0.85),the disease duration [1.0(1.0,2.0)years vs.5.5(1.1,17.5)years],NLR (2.274±1.20vs.3.374±2.32),N-terminal pro brain natrinretic peptide (NT-proBNP)[696.50(243.75,1788.00)pg/ml vs.1746.50(602.25,7719.75)pg/ml],left atrial diameter [(38.484±6.65)mm vs.(46.214±11.03)mm]in HCM-AF group were significantly higher than those in the HCM group (P<0.05)and lymphocyte count [(1.924±0.73)x 109/L vs.(1.594±0.40)x 109/L],total cholesterol [(4.28±0.96)mmol/L vs.(3.54±0.77)mmol/L],triglycerides [(1.984±1.68)mmol/L vs.(1.15±0.53) mmol/L],low-density lipoprotein cholesterol[(2.34±0.76)mmol/L vs.(1.844±0.65)mmol/L],left ventricular ejection fraction [(57.954±6.70)%vs.(53.864±7.71)%]in HCM-AF group were significantly lower than those in the HCM group (P<0.05).Multivariate Logistic regression analysis indicated that higher NYI-IA class (OR=5.15,95%C11.03-25.70,P<0.05),longer disease duration (OR=1.20,95%CI 1.04-1.39,P<0.05),higher NLR (OR= 2.03,95%CI 1.10-3.76,P<0.05),left atrial diameter (OR=1.10,95%CI 1.02-I.19,P<0.05)were independent risk factors for AF in patients with HCM.Conclusion The higher NYHA class,longer disease duration,higher NLR and enlarged left atrium are indeoendent risk factors for AF in patients with HCM.

关 键 词：肥厚型心肌病 心房颤动 LOGISTIC回归 危险因素 

分 类 号：R542.2[医药卫生—心血管疾病] R541.7[医药卫生—内科学]