非瓣膜性心房颤动合并重度三尖瓣反流的危险因素分析  

Predictors of Severe Tricuspid Regurgitation in Patients With Nonvalvular Atrial Fibrillation

作　　者：李华龙 黄俊 宾武刚 廖志勇 李宜富 李腾 丁立刚[2] 姚焰[2] LI Hualong;HUANG Jun;BIN Wugang;LIAO Zhiyong;LI Yifu;LI Teng;DING Ligang;YAO Yan(Arrhythmia Center,Fuwai Hospital Chinese Academy of Medical Sciences,Shenzhen Hospital,Shenzhen(518000),Guangdong,China)

机构地区：[1]中国医学科学院,阜外医院深圳医院心律失常中心,广东省深圳市518000 [2]中国医学科学院,北京协和医学院,国家心血管病中心,阜外医院心律失常中心

出　　处：《中国循环杂志》2021年第1期34-38,共5页Chinese Circulation Journal

基　　金：深圳市战略性新兴产业发展专项资金(“创新链+产业链”)(ZDYBH201900000007)。

摘　　要：目的:探讨非瓣膜性心房颤动(NVAF)合并重度三尖瓣反流(TR)患者的临床特征及危险因素。方法:连续入选2016年1月至2019年12月就诊于我院的290例合并TR的NVAF患者,87例NVAF合并重度TR患者为重度TR组,男性35例,平均年龄(73.5±9.0)岁;203例NVAF合并轻-中度TR患者作为对照组,男性114例,平均年龄(66.2±10.9)岁。比较两组的临床特征,采用Logistics回归分析评估重度TR的危险因素。结果:290例NVAF患者中,30.0%合并重度TR,41.0%合并中度TR,29.0%合并轻度TR。与对照组相比,重度TR组年龄大[(73.5±9.0)岁vs(.66.2±10.9)岁]、心房颤动病程长[4.5(2.0,10.0)年vs.3.0(2.0,7.0)年]、心功能差、持续性心房颤动(96.6%vs.73.4%)及女性(59.8%vs.43.8%)比例高,同时心房扩大、肺动脉压升高及二尖瓣反流更明显(P均<0.05)。Logistics多因素回归分析显示,重度TR与年龄(OR=1.060,95%CI:1.020~1.102)、女性(OR=4.727,95%CI:1.977~11.306)、持续性心房颤动(OR=6.873,95%CI:1.419~33.297)、右心房左右径(OR=1.202,95%CI:1.117~1.293)相关(P均<0.05)。右心房左右径≥45.5 mm可预测重度TR,诊断敏感度为0.712,特异度为0.697;ROC曲线下面积为0.763(95%CI:0.696~0.831,P<0.001)。结论:NVAF合并重度TR的危险因素包括老年、女性、持续性心房颤动、右心房左右径扩大。Objectives:To explore the clinical features and risk factors of severe tricuspid regurgitation(TR)in patients with nonvalvular atrial fibrillation(NVAF).Methods:290 patients with NVAF and TR,admitted to our center between January 2016 and December 2019,were investigated.87 patients with severe TR were divided into severe TR group,203 patients with mild to moderate TR served as controls.Clinical parameters and echocardiographic measurements were compared between these two groups.Logistic regression analysis was used to assess the risk factors of severe TR.Results:Among 290 patients with NVAF,30.0%had severe TR,41.0%had moderate TR and 29.0%had mild TR.Severe TR occurred more frequently in aged([73.5±9.0]岁vs.[66.2±10.9]岁),female patients(59.8%vs.43.8%),in patients with worse cardiac function,persistent AF(96.6%vs.73.4%)and longer course of AF(4.5[2.0,10.0]years vs.3.0[2.0,7.0]years).Enlarged atrium,increased systolic pulmonary artery pressure and significant mitral regurgitation were more often seen in severe TR group.Multivariate logistic regression analysis indicated that old age(OR=1.060,95%CI:1.020-1.102),woman(OR=4.727,95%CI:1.977-11.306),persistent AF(OR=6.873,95%CI:1.419-33.297)and larger right atrial transverse diameter(OR=1.202,95%CI:1.117-1.293)were significant independent predictors of severe TR.Moreover,right atrial transverse diameter≥45.5 mm might strongly predict severe TR(sensitivity:0.712,specificity:0.697,AUC:0.763[95%CI:0.696-0.831],P<0.001).Conclusions:Factors such as old age,woman,persistent AF and significantly right atrial dilatation are independent risk factors of severe TR in NVAF patients.

关 键 词：心房颤动 三尖瓣反流 危险因素 心房内径 

分 类 号：R54[医药卫生—心血管疾病]