血清尿酸及脑钠肽对射血分数保留的心力衰竭患者发生心房颤动的预测价值  

Predictive Value of Serum Uric Acid and Brain Natriuretic Peptide in Atrial Fibrillation in Patients with Heart Failure with Preserved Ejection Fraction

作　　者：赵东坡 冯倩 师淼 吴泽阳 刘学英 孙小燕 ZHAO Dongpo;FENG Qian;SHI Miao;WU Zeyang;LIU Xueying;SUN Xiaoyan(Department Three of Cardiology,Zhangjiakou First Hospital,Zhangjiakou 075000,China)

机构地区：[1]张家口市第一医院心内三科,河北张家口075000

出　　处：《医学综述》2023年第19期3966-3970,3976,共6页Medical Recapitulate

基　　金：河北省医学科学研究课题(20211610)。

摘　　要：目的分析血清尿酸(SUA)及脑钠肽(BNP)对射血分数保留的心力衰竭(HFPEF)患者心房颤动发生的预测价值。方法选取2020年10月至2022年10月张家口市第一医院收治的108例HFPEF患者为研究对象,根据住院治疗期间是否发生心房颤动将患者分为发生心房颤动组和未发生心房颤动组。收集患者临床资料,检测患者血清SUA、BNP水平。比较两组基线资料以及血清SUA、BNP水平。采用Logistic回归分析影响HFPEF患者发生心房颤动的危险因素。绘制受试者工作特征曲线(ROC曲线),分析血清SUA、BNP对HFPEF患者发生心房颤动的预测价值。结果纳入108例HFPEF患者的心房颤动发生率为42.86%(45/108)。发生心房颤动组患者血肌酐、心肌肌钙蛋白I(cTnI)、高敏C反应蛋白(hs-CRP)、N端脑钠肽前体(NT-proBNP)水平高于未发生心房颤动组[(152±18)mmol/L比(126±20)mmol/L、(40±5)μg/L比(14±4)μg/L、(14.4±2.1)mg/L比(8.2±1.3)mg/L、(5.3±0.8)ng/L比(3.2±0.4)ng/L](P<0.01)。发生心房颤动组血清SUA、BNP水平高于未发生组[(435±43)mg/L比(301±35)mg/L、(1854±100)μg/L比(806±65)μg/L](P<0.01)。Logistic回归分析显示,cTnI、hs-CRP、NT-proBNP、SUA、BNP水平异常是影响HFPEF患者发生心房颤动的危险因素(OR=3.370,95%CI 1.618~5.213;OR=2.971,95%CI 1.316~4.627;OR=2.442,95%CI 1.116~3.769;OR=2.232,95%CI 1.359~3.105;OR=3.865,95%CI 2.368~5.362)(P<0.01)。ROC曲线显示,血清SUA联合BNP预测HFPEF患者发生心房颤动的曲线下面积、灵敏度均高于血清SUA、BNP水平单独预测(0.835比0.736、0.784,93.50%比79.6%、82.8%)。结论血清SUA、BNP水平异常是影响HFPEF患者发生心房颤动的危险因素,且两者联合预测HFPEF患者发生心房颤动的价值更高。Objective To analyze the predictive value of serum uric acid(SUA)and brain natriuretic peptide(BNP)in atrial fibrillation in patients with heart failure with preserved ejection fraction(HFPEF).Methods A total of 108 HFPEF patients admitted to Zhangjiakou First Hospital from Oct.2020 to Oct.2022 were included,and divided into an occurrence group and a non-occurrence group according to whether atrial fibrillation occurred during hospitalization or treatment.The clinical data of the patients were collected and serum SUA and BNP levels were detected.The serum SUA and BNP levels and other basic clinical data were compared between the two groups.Logistic regression was used to analyze the risk factors of atrial fibrillation in HFPEF patients.Receiver operating characteristic(ROC)curve was drawn to analyze the predictive value of serum SUA and BNP levels for the occurrence of atrial fibrillation in HFPEF patients.Results The incidence of atrial fibrillation in the 108 HFPEF patients was 42.86%(45/108).The levels of serum creatinine,cardiac troponim I(cTnI),hypersensitive C-reactive protein(hs-CRP)and N-terminal pro-brain natriuretic peptide(NT-proBNP)in the occurrence group were higher than those in the non-occurrence group[(152±18)mmol/L vs(126±20)mmol/L,(40±5)μg/L vs(14±4)μg/L,(14.4±2.1)mg/L vs(8.2±1.3)mg/L,(5.3±0.8)ng/L vs(3.2±0.4)ng/L](P<0.01).The levels of serum SUA and BNP in the occurrence group were higher than those in the non-occurrence group[(435±43)mg/L vs(301±35)mg/L,(1854±100)μg/L vs(806±65)μg/L](P<0.01).Logistic regression analysis showed that abnormal levels of cTnI,hs-CRP,NT-proBNP,SUA and BNP were risk factors for atrial fibrillation in HFPEF patients(OR=3.370,95%CI 1.618-5.213;OR=2.971,95%CI 1.316-4.627;OR=2.442,95%CI 1.116-3.769;OR=2.232,95%CI 1.359-3.105;OR=3.865,95%CI 2.368-5.362)(P<0.01).ROC curve showed that the area under the curve and sensitivity of serum SUA combined with BNP in predicting atrial fibrillation in HFPEF patients were higher than those predicted by serum SUA and B

关 键 词：心力衰竭 保留射血分数 心房颤动 血尿酸 脑钠肽 

分 类 号：R541[医药卫生—心血管疾病]