心力衰竭患者持续性心房颤动危险因素的单中心研究  

Risk factors for persistent atrial fibrillation in patients with chronic heart failure

作　　者：史云桃[1] 邢玉龙[1] 蒋廷波[2] SHI Yun-tao;XING Yu-long;JIANG Ting-bo(Department of Cardiology, Gaochun People＇s Hospital, Nanjing 211300, China;The First Affiliated Hospital of Sooehow University, Suzhou, Jiangsu 215006, China)

机构地区：[1]南京高淳人民医院心内科,南京211300 [2]苏州大学附属第一医院心内科,江苏苏州215006

出　　处：《岭南心血管病杂志》2018年第2期185-188,共4页South China Journal of Cardiovascular Diseases

基　　金：十三五南京市卫生青年人才培养工程(项目编号:QRX17211)

摘　　要：目的探讨心力衰竭患者阵发性心房颤动(房颤)进展为持续性房颤的相关危险因素。方法收集南京高淳人民医院2013年1月至12月住院房颤及心力衰竭的患者168例,分为阵发性房颤组28例,持续性房颤组140例。应用多因素Logistic逐步回归分析及受试者工作特征(receiver operator characteristic,ROC)曲线分析心力衰竭患者阵发性房颤进展至持续性房颤的危险因素。结果与阵发性房颤组比较,持续性房颤组的左心房内径(left atrial diameter,LAD)[(48.11±7.74)mm vs.(40.42±7.13)mm]、三酰甘油[1.04(0.81~1.13)mmol/L vs.0.87(0.66~1.12)mmol/L)]、总胆固醇[(4.24±0.69)μmmol/L vs.(3.64±0.95)μmmol/L]、血尿酸[444.00(365.00~579.10)μmmol/L vs.374.20(272.00~412.00)μmmol/L)]、男性(52.5%vs.28.6%)、心脏瓣膜病(41.4%vs.21.4%)比例偏高,差异有统计学意义(P<0.05);左心室射血分数(45.07%±11.69%vs.50.93%±13.74%)]偏低,差异有统计学意义(P<0.05)。多因素Logistic回归分析结果显示,LAD、血尿酸是心力衰竭患者阵发性房颤进展至持续性房颤的独立危险因素(OR=1.270,95%CI:1.131~1.426,P=0.000;OR=1.007,95%CI:1.001~1.012,P=0.009);ROC曲线显示LAD最佳截断点为47.5mm(敏感性47.1%,特异性14.3%,ROC曲线下面积0.788,95%CI:0.691~0.885),血尿酸最佳截断点为433.00μmmol/L(敏感性57.1%,特异性14.3%,ROC曲线下面积0.726,95%CI:0.630~0.821)。结论心力衰竭患者阵发性房颤进展至持续性房颤受多种因素影响,其中LAD、血尿酸可能是心力衰竭患者阵发性房颤进展至持续性房颤的独立危险因素。Objectives To study the risk factors for paroxysmal atrial fibrillation（AF）promoting to persistent AF inpatients with chronic heart failure（HF）. Methods Totally 168 patients with AF and HF admitted to Gaochun People′sHospital were divided into paroxysmal AF group（n=28）and persistent AF group（n=140）. The risk factors for persis-tent AF with HF were analyzed by multivariate Logistic regression analysis and receiver operator characteristic（ROC）curve analysis respectively. Results Left atrial diameter（LAD）[（48.11±7.74）mm vs.（40.42±7.13）mm]was larger,serum concentrations of triglycerides[1.04（0.81-1.13）mmol/L vs. 0.87（0.66-1.12）mmol/L）],total cholesterol[（4.24±0.69）μmmol/L vs.（3.64±0.95）μmmol/L],uric acid[444.00（365.00-579.10）μmmol/L vs. 374.20（272.00-412.00）μmmol/L）],male（52.5% vs. 28.6%）and incidence of valvular heart disease（41.4% vs. 21.4%）weresignificantly higher while left ventricular ejection fraction（LVEF）（45.07%±11.69% vs. 50.93%±13.74%）was signifi-cantly lower in persistent AF group than those in paroxysmal AF group（P〈0.05）. Multivariate Logistic regression analy-sis showed that LAD and serum concentration of uric acid were the independent risk factors for patients with persistentAF and HF（OR=1.270,95%CI：1.131-1.426,P=0.000;OR=1.007,95%CI：1.001-1.012,P=0.009）. ROC curverevealed that optimal cut-off point of LAD was 47.5mm and area under ROC curve was 0.788;Optimal cut-off point ofserum concentration of uric acid was 433.00μmol and area under ROC curve was 0.726. Conclusions LAD and serumconcentration of uric acid are independent risk factors for patients with persistent AF and HF.

关 键 词：阵发性心房颤动 持续性心房颤动 危险因素 尿酸 左心房内径 

分 类 号：R541.7[医药卫生—心血管疾病]