心房颤动患者血清尿酸水平与左房纤维化程度的相关性研究  

Correlation between serum uric acid level and left atrial fibrosis in patients with atrial fibrillation

作　　者：张朝昀 韩亮 刘金明[1] 郝杰[1] ZHANG Chaoyun;HAN Liang;LIU Jinming;HAO Jie(Department of Cardiology,the Second Hospital of Hebei Medical University,Shijiazhuang,050000,China)

机构地区：[1]河北医科大学第二医院心内三科,石家庄050000

出　　处：《临床心血管病杂志》2021年第10期931-935,共5页Journal of Clinical Cardiology

摘　　要：目的:研究心房颤动患者血清尿酸(SUA)水平与左房纤维化程度的相关性。方法:回顾性分析因心房颤动首次接受导管射频消融手术治疗的患者,在进行双侧肺静脉电隔离后、窦性心律时绘制左房电压图,若局部双极信号<0.5 mV,则定义为低电压区(LVAS)。根据LVAS面积占左心房总面积的范围,将患者分为<10%组(57例)与≥10%组(51例)。比较两组间年龄、性别、BMI、糖化血红蛋白(HbA1c)、白细胞计数(WBC)、红细胞计数(RBC)、血小板计数(PLT)、甘油三酯(TG)、总胆固醇(TC)、SUA、左心房直径(LAD)等指标之间是否存在差异。采用多因素logistic回归分析影响心房纤维化的独立危险因素。绘制受试者工作特征(ROC)曲线,观察SUA及其他相关指标预测左房纤维化程度的价值。结果:≥10%组持续性心房颤动比例、SUA、LAD、TG、吸烟史、饮酒史患者所占比例均高于<10%组,且差异具有统计学意义(均P<0.05)。Pearson相关分析显示,SUA和左房纤维化程度呈正相关(r=0.327,P=0.001)。二元logistic回归分析示,SUA(OR=1.01,95%CI:1.003~1.016,P=0.004)、持续性心房颤动(OR=11.041,95%CI:2.479~49.166,P=0.002)、LAD(OR=1.146,95%CI:1.016~1.293,P=0.026)是心房纤维化的独立危险因素。ROC曲线显示,SUA截点值为396.5μmol/L时,预测左房纤维化的敏感度为0.392,特异度为0.965(AUC=0.702,95%CI:0.602~0.803,P<0.001);LAD截点值为37.5 mm时,预测左房纤维化的敏感度为0.706,特异度为0.754(AUC=0.779,95%CI:0.690~0.869,P<0.001)。结论:心房颤动患者SUA水平是左房纤维化的独立危险因素,对预测心房纤维化程度具有一定参考价值。Objective:To study the correlation between the serum uric acid(SUA)level and the degree of left atrial fibrosis in patients with atrial fibrillation.Methods:The patients who received radiofrequency catheter ablation for the first time due to atrial fibrillation were analyzed retrospectively.The left atrial voltage map was drawn during sinus rhythm after bilateral pulmonary vein electrical isolation.If the local bipolar signal was less than 0.5 mV,it was defined as the low voltage area of left atrium(LVAS).According to the range of LVAS area in the total left atrial area,all included patients were divided into<10%group(n=57)and≥10%group(n=51).The differences of age,gender,BMI,glycosylated hemoglobin(HbA1 c),white blood cell count(WBC),red blood cell count(RBC),platelet count(PLT),triglyceride(TG),total cholesterol(TC),SUA,and left atrial diameter(LAD)between the two groups were compared.Multivariate logistic regression was used to analyze the independent risk factors affecting the severity of atrial fibrosis.The receiver operating characteristic(ROC)curve was used to observe the value of SUA and other related indicators in predicting left atrial fibrosis.Results:The proportion of persistent atrial fibrillation,SUA,LAD,TG,smoking history,and drinking history in the group with LVAS≥10%were higher than those in the group with LVAS<10%,the difference was statistically significant(all P<0.05).Pearson correlation analysis showed that SUA was positively correlated with the degree of left atrial fibrosis(r=0.327,P=0.001).Binary logistic regression analysis showed that SUA(OR=1.01,95%CI:1.003-1.016,P=0.004),persistent atrial fibrillation(OR=11.041,95%CI:2.479-49.166,P=0.002),LAD(OR=1.146,95%CI:1.016-1.293,P=0.026)were independent risk factors for atrial fibrosis.ROC curves showed that the sensitivity and specificity of predicting left atrial fibrosis were 0.392 and 0.965 respectively when the SUA cut-off point value was 396.5μmol/L(AUC=0.702,95%CI:0.602-0.803,P<0.001),and the sensitivity and specificity were 0.706 and

关 键 词：心房颤动 血清尿酸 左房低电压区 心房纤维化 

分 类 号：R541.7[医药卫生—心血管疾病]