阵发性心房颤动患者血浆大内皮素-1水平与预后的关系  

Relationship between plasma big endothelin-1 level and prognosis of paroxysmal atrial fibrillation

作　　者：马添翼[1] 钟江华[1] 苏雨江[1] 周志宏[1] 阳慧[1] 杨超英 MA Tian-yi;ZHONG Jiang-hua;SU Yu-jiang;ZHOU Zhi-hong;YANG Hui;YANG Chao-ying(Internal Medicine-Cardiovascular Department of Haikou Affiliated Hospital of Xiangya Medical College of Central South University, Hainan 570208, China)

机构地区：[1]中南大学湘雅医学院附属海口医院心血管内科

出　　处：《天津医药》2019年第8期833-837,共5页Tianjin Medical Journal

基　　金：2014年海南省卫计委科研项目（2014-WSTZ-18-060)

摘　　要：目的探讨阵发性心房颤动(PAF)患者入院时血浆大内皮素-1(BigET-1)水平与预后的关系。方法纳入2010年4月—2013年12月我院收治的200例PAF患者,根据随访结果将患者分为存活组164例和心血管病死亡组36例。收集性别、年龄、BigET-1等临床及实验室资料。采用Cox比例风险模型分析入院时血浆BigET-1水平与PAF患者预后的关系。通过绘制受试者工作特征(ROC)曲线,计算曲线下面积,评估入院时血浆BigET-1水平对PAF患者预后的预测效力。采用Kaplan-Meier法绘制不同血浆BigET-1水平PAF患者心血管病累积死亡率曲线,并采用Log-rank法进行比较。结果存活组在年龄、收缩压、高血压病史、慢性肾功能衰竭史、心力衰竭史、血浆BigET-1、血浆氨基酸B型钠尿肽前体(NT-pro-BNP)、左房内径(LAD)、左室内径(LVD)、CHA2DS2-VASc评分≥2分比例方面低于死亡组(均P<0.05),在肾小球滤过率(eGFR)、射血分数(EF)方面高于死亡组(均P<0.05)。多因素Cox回归分析结果显示,入院时血浆BigET-1水平升高是影响PAF患者心血管病死亡的危险因素(P<0.05)。血浆BigET-1水平为0.75pmol/L时对预测PAF患者预后有一定价值。Kaplan-Meier分析结果显示,血浆BigET-1>0.75pmol/LPAF患者心血管病累积死亡率高于血浆BigET-1≤0.75pmol/LPAF患者(P<0.05)。结论入院时血浆BigET-1水平升高与PAF患者心血管病死亡风险增加密切相关。血浆BigET-1水平可作为预测PAF患者预后的重要生物学标志物。Objective To investigate the relationship between plasma big endothelin-1 (Big ET-1) level and prognosis of paroxysmal atrial fibrillation (PAF) in patients at admission. Methods A total of 200 patients with PAF were enrolled, and divided into survival group (n=164) and cardiovascular death group (n=36) according to the follow-up results. Clinical and laboratory data of sex, age and Big ET-1 level were collected. Cox proportional hazard model was used to analyze the relationship between plasma level of Big ET-1 and prognosis of PAF patients at admission. The prognostic effect of plasma level of Big ET-1 on the prognosis of PAF patients was evaluated by drawing ROC, and then the area under the curve was calculated. The cardiovascular cumulative mortality curves of PAF patients with different plasma levels of Big ET-1 were drawn by Kaplan-Meier method and compared by Log-Rank method. Results There were lower levels of age, systolic blood pressure, hypertension, chronic renal failure, heart failure, plasma Big ET-1, plasma amino-terminal pro-brain natriuretic peptide (NT-pro-BNP), left atrial diameter (LAD), left ventricular diameter (LVD), CHA 2 DS 2 -VAS c score >2 points in survival group than those of the death group (P<0.05), and higher levels of estimated glomerular filtration rate (eGFR) and ejection fraction (EF) in survival group than those of the death group (P<0.05). Multivariate Cox regression analysis showed that the higher plasma level of Big ET-1 was the risk factor for cardiovascular death in PAF patients (P< 0.05). It showed a certain value in predicting the prognosis of PAF when the plasma level of Big ET-1 was 0.75 pmol/L. The results of Kaplan-Meier analysis showed that the cardiovascular cumulative mortality was significantly higher in patients with plasma level of Big ET-1 > 0.75 pmol/L than that of patients with plasma level of Big ET-1 < 0.75 pmol/L (P<0.05). Conclusion The increased plasma level of Big ET-1 at admission is closely related to the increased risk of cardiovascular mortality in

关 键 词：心房颤动 心血管疾病 血浆 预后 ROC曲线 危险因素 大内皮素-1 

分 类 号：R541.75[医药卫生—心血管疾病]