心房颤动患者糖化血红蛋白水平与左心耳血流速度降低关系研究  

Relationship between level of glycated hemoglobin and decrease of left atrial appendage flow velocity in patients with atrial fibrillation

作　　者：陈华 林庚海[1] 吴轲[1] 李雪燕 庄金龙 戴增欢[1] 阮发晖[1] Chen Hua;Lin Genghai;Wu Ke;Li Xueyan;Zhuang Jinlong;Dai Zenghuan;Ruan Fahui(Department of Cardiovascular Medicine,909th Hospital of Chinese PLA Joint Logistics Support Force,Dongnan Hospital of Xiamen University,Zhangzhou 363000,China;不详)

机构地区：[1]联勤保障部队第九〇九医院、厦门大学附属东南医院心血管内科,漳州363000 [2]联勤保障部队第九〇九医院、厦门大学附属东南医院重症医学科,漳州363000

出　　处：《中国循证心血管医学杂志》2023年第6期667-671,共5页Chinese Journal of Evidence-Based Cardiovascular Medicine

基　　金：福建省医学创新课题项目(2018-CX-42)。

摘　　要：目的探讨非瓣膜性心房颤动(房颤)患者的糖化血红蛋白(HbAlc)水平与左心耳血流速度间的关系。方法回顾性分析2016年1月至2020年12月于联勤保障部队第九〇九医院收治的1196例非瓣膜性房颤患者的临床资料。根据全部患者左心耳峰值速值中位数45 cm/s分为左心耳低流速组(n=604)和左心耳高流速组(n=592)。使用Logistic回归分析确定左心耳流速降低相关的独立危险因素,并使用受试者工作特征曲线(ROC)分析危险因素对其预测价值。使用Pearson相关性分析研究各因素与左心耳流速间相关性。结果与左心耳高流速组相比,左心耳低流速组患者年龄更大,非阵发性房颤、慢性心力衰竭(心衰)比例更高,CHA_(2)DS_(2)-VASc评分、HbAlc水平更高、左房直径、左房面积和左房压力更大(P<0.05),而左室射血分数和左心耳峰值血流速更低(P<0.05)。Logistic回归分析显示女性(OR=2.317,95%CI:1.155~4.646,P=0.019),非阵发性房颤(OR=6.587,95%CI:3.122~13.900,P<0.001)和HbAlc(OR=2.028,95%CI:1.230~3.343,P=0.005)是影响房颤患者左心耳流速降低的独立危险因素。在无糖尿病患者亚组,HbAlc(OR=2.743,95%CI:1.365~5.511,P=0.004)、非阵发性房颤(OR=4.993,95%CI:2.399~10.392,P<0.001)和女性(OR=2.362,95%CI:1.479~3.773,P<0.001)仍然是非糖尿病患者左心耳低流速的独立因素。ROC曲线分析HbAlc预测左心耳流速降低的曲线下面积为0.784,敏感度为83.4%,特异度为69.6%。左心耳流速与患者的左房直径(r=-0.402,P=0.001)和左房面积(r=-0.421,P<0.001)具中等程度相关。结论房颤患者HbA1c水平是左心耳流速降低的独立危险因素,并对左心耳流速降低具有较高预测价值。Objective To investigate the relationship between level of glycated hemoglobin(HbAlc)and left atrial appendage flow velocity(LAA-FV)in patients with non-valvular atrial fibrillation(NVAF).Methods The clinical materials of NVAF patients(n=1196)were retrospectively analyzed in the 909th Hospital of Chinese PLA Joint Logistics Support Force from Jan.2016 to Dec.2020.According to the median of peak LAA-FV value(45 cm/s),all patients were divided into low LAA-FV group(n=604)and high LAA-FV group(n=592).The independent risk factors related to LAA-FV degrease were determined by using Logistic regression analysis,and predictive value of these risk factors to LAA-FV degrease was analyzed by using ROC curve analyzed.The correlation among different factors and LAA-FV was studied by using Pearson correlation analysis.Results The patients were older,percentages of patients with non-paroxysmal atrial fibrillation(non-PAF)and chronic heart failure(CHF)were higher,CHA_(2)DS_(2)-VASc score and HbAlc level were higher,left atrial diameter(LAD),left atrial area and left atrial pressure were higher(all P<0.05),and left ventricular ejection fraction(LVEF)and peak LAA-FV was lower in high LAA-FV group than those in low LAA-FV group(all P<0.05).The results of Logistic regression analysis showed that female(OR=2.317,95%CI:1.155~4.646,P=0.019),non-PAF(OR=6.587,95%CI:3.122~13.900,P<0.001)and HbAlc(OR=2.028,95%CI:1.230~3.343,P=0.005)were risk factors influencing LAA-FV decrease in all AF patients.In non-diabetes subgroup,HbAlc(OR=2.743,95%CI:1.365~5.511,P=0.004),non-PAF(OR=4.993,95%CI:2.399~10.392,P<0.001)and female(OR=2.362,95%CI:1.479~3.773,P<0.001)still were independent factors of lower LAA-FV in non-diabetes patients.The results of ROC curve analysis showed that AUC of HbAlc in predicting LAA-FV decrease was 0.784,sensitivity was 83.4%and specificity was 69.6%.LAA-FV was moderately correlated to LAD(r=-0.402,P=0.001)and left atrial area(r=-0.421,P<0.001).Conclusion The level of HbA1c is an independent risk factor of LAA-FV decrease,and

关 键 词：心房颤动 糖化血红蛋白 左心耳血流速度 

分 类 号：R541.75[医药卫生—心血管疾病]