单核细胞/高密度脂蛋白胆固醇比值和游离甲状腺素/游离三碘甲状腺原氨酸比值与原发性高血压合并心房颤动的相关性  

Correlation between monocyte to high density lipoprotein cholesterol ratio, free thyroxine to free triiodothyronine ratio and essential hypertension combined with atrial fibrillation

作　　者：张安琪 张霄[2] 刘鹏鹏 刘建波[1] 张雷[4] ZHANG Anqi;ZHANG Xiao;LIU Pengpeng;LIU Jianbo;ZHANG Lei(School of Public Health,Hebei Medical University,Shijiazhuang,050000 Hebei,China;不详)

机构地区：[1]河北医科大学公共卫生学院,河北石家庄050000 [2]河北医科大学第一医院心脏中心 [3]河北医科大学第一医院智慧医院建设部 [4]河北医科大学第一医院西南院区综合办公室

出　　处：《上海医学》2023年第3期149-155,共7页Shanghai Medical Journal

基　　金：河北省卫生健康委员会临床医学人才培养项目(LS202109);河北省卫生健康委员会医学科学研究课题(20201162);河北省重点研发计划项目(18277762D)。

摘　　要：目的探讨原发性高血压(EH)合并心房颤动(AF)与单核细胞/HDL-C比值(MHR)、FT4/FT3比值的相关性。方法收集2020年1月—2021年12月在河北医科大学第一医院心脏中心住院治疗的360例EH患者的临床资料,根据是否合并AF分为EH+AF组(110例)和EH组(250例);采用倾向性评分匹配对两组患者进行匹配,匹配后两组均为102例。比较两组患者的一般资料、实验室指标,采用偏相关分析MHR、FT4/FT3比值与各指标的相关性,采用ROC曲线评估MHR、FT4/FT3比值及两指标联合对EH合并AF患者的诊断效能。结果EH+AF组患者的载脂蛋白A1、血钾、血尿酸、血肌酐水平,以及MHR、FT4/FT3比值均显著高于EH组(P值均<0.05);血钠、TG和LDL-C水平均显著低于EH组(P值均<0.05)。偏相关分析结果显示,在控制年龄、收缩压、舒张压、降压药和他汀类降脂药后,MHR与LDL-C水平呈正相关(r=0.303,P<0.01),与载脂蛋白A1、血钠水平呈负相关(r值分别为-0.403、-0.157,P值分别<0.01、0.05),与血钾、血尿酸、血肌酐、TG水平和FT4/FT3比值均无相关性(r值分别为0.035、0.119、0.079、0.099、-0.040,P值均>0.05);FT4/FT3比值与血尿酸水平呈正相关(r=0.183,P<0.05),与载脂蛋白A1水平呈负相关(r=-0.218,P<0.05),与血钠、血钾、血肌酐、TG、LDL-C水平和MHR均无相关性(r值分别为-0.023、-0.104、0.067、-0.091、-0.050、-0.040,P值均>0.05)。与未服用降压药患者相比,EH+AF组服用钙离子拮抗剂和单片复方制剂降压药患者的MHR均显著降低(P值均<0.05);EH组服用ARB/ACEI降压药患者的MHR有降低趋势,但差异无统计学意义(P>0.05)。与未服用他汀类降脂药患者相比,EH+AF组服用中效降脂药和强效降脂药患者的MHR均显著降低(P值均<0.05),EH组服用强效降脂药患者的MHR显著降低(P<0.05);EH+AF组服用强效降脂药患者的MHR较服用中效降脂药患者显著降低(P<0.05)。MHR、FT4/FT3比值、MHR+FT4/FT3比值诊断EH+AF的ROC的AUC分别为0.61Objective To investigate the level and significance of monocyte to high density lipoprotein cholesterol ratio(MHR)and free triiodothyronine/free thyroxine(FT4/FT3)in patients with essential hypertension(EH)combined with atrial fibrillation(AF).Methods A total of 360 EH patients admitted to the First Hospital of Hebei Medical University from January 2020 to December 2021 were enrolled in this study.They were divided into an EH+AF group(n=110)and an EH group(n=250),and 102 pairs were successfully matched with the propensity score matching(PSM).The general data and laboratory indicators were compared between two groups.The correlation between MHR,FT4/FT3 and each indicator was investigated by partial correlation analysis.The receiver operator characteristic(ROC)curve was used to evaluate the diagnostic efficacy of MHR,FT4/FT3 and the combination of the two indicators for EH+AF.Results The levels of apolipoprotein A1(Apo A1),serum potassium,blood uric acid(UA),serum creatinine(sCr),MHR and FT4/FT3 in EH+AF group were significantly higher than those in EH group(all P<0.05).The levels of serum sodium,triglyceride(TG)and low-density lipoprotein cholesterol(LDL-C)in EH+AF group were significantly lower than those in EH group(all P<0.05).Partial correlation analysis showed that after controlling the age,systolic pressure,diastolic pressure,antihypertensive drugs and statins,MHR was positively correlated with LDL-C(r=0.303,P<0.05),negatively correlated with Apo A1(r=-0.403,P<0.01)and serum sodium(r=-0.157,P<0.05),and not correlated with serum potassium,UA,sCr,TG and FT4/FT3(r=0.035,0.119,0.079,0.099,-0.040,all P>0.05).FT4/FT3 was positively correlated with UA(r=0.183,P<0.05),negatively correlated with Apo A1(r=-0.218,P<0.05),and not correlated with serum sodium,potassium,sCr,TG,LDL-C or MHR(r=-0.023,-0.104,0.067,-0.091,-0.050,-0.040,all P>0.05).Compared with those without antihypertensive drugs,patients in the EH+AF group who took CCB and monolithic compound antihypertensive drugs had significantly lower MHR(P<0.05),patien

关 键 词：心房颤动 单核细胞/高密度脂蛋白胆固醇比值 游离甲状腺素/游离三碘甲状腺原氨酸 原发性高血压 

分 类 号：R544[医药卫生—心血管疾病]