肥厚型梗阻性心肌病患者的峰值耗氧量及其与心房颤动的关联性研究  

Correlation Between Peak Oxygen Consumption and Atrial Fibrillation in Patients With Hypertrophic Obstructive Cardiomyopathy

作　　者：卢涛 蒙延海[2] 朱昌盛[1] 刘方[3] 王水云[1] LU Tao;MENG Yanhai;ZHU Changsheng;LIU Fang;WANG Shuiyun(Adult Cardiac Center,National Center for Cardiovascular Diseases and Fuwai Hospital,Chinese Academy of Medical Sciences and Peking Union Medical College,Beijing 100037,China;Postoperative Recovery Center,National Center for Cardiovascular Diseases and Fuwai Hospital,Chinese Academy of Medical Sciences and Peking Union Medical College,Beijing 100037,China;Function Test Center,National Center for Cardiovascular Diseases and Fuwai Hospital,Chinese Academy of Medical Sciences and Peking Union Medical College,Beijing 100037,China)

机构地区：[1]中国医学科学院,北京协和医学院,国家心血管病中心,阜外医院成人外科中心,北京100037 [2]中国医学科学院,北京协和医学院,国家心血管病中心,阜外医院术后恢复中心,北京100037 [3]中国医学科学院,北京协和医学院,国家心血管病中心,阜外医院功能检测中心,北京100037

出　　处：《中国循环杂志》2024年第4期358-363,共6页Chinese Circulation Journal

基　　金：中央高水平医院临床科研业务费项目(2022-GSP-GG-29);中国医学科学院医学与健康科技创新工程(2023-I2M-1-001)。

摘　　要：目的:分析不同峰值耗氧量(PeakVO_(2))的肥厚型梗阻性心肌病患者的特征及PeakVO_(2)与心房颤动(房颤)的关联性。方法:回顾性分析2018年12月至2021年9月期间在中国医学科学院阜外医院确诊肥厚型梗阻性心肌病且行心肺功能检测的188例患者。收集入选患者的一般资料、临床病史及术前血清学检测、超声心动图,心肺功能检测指标及24小时动态心电图等资料。按中位PeakVO_(2)绝对值[16.45 ml/(kg·min)]为界值将患者分为高PeakVO_(2)组(n=94)和低PeakVO_(2)组(n=94),比较两组患者特征差异,并采用单因素及多因素Logistic回归分析探究肥厚型梗阻性心肌病患者中PeakVO_(2)与房颤的关系。结果:188例患者的中位年龄为51.0(36.0,58.0)岁,平均PeakVO_(2)为(16.42±4.07) ml/(kg·min),31例(16.5%)患者患有房颤。与高PeakVO_(2)组相比,低PeakVO_(2)组患者年龄更大(P<0.001),女性患者比例更高(P=0.001),体重指数更大(P=0.004),左心房内径更大(P<0.001),N末端B型利钠肽原(NT-proBNP)水平更高(P=0.037),心功能更差(P=0.046)。单因素Logistic回归分析发现,年龄、心悸、头晕、左心房内径、左心室流出道压差及PeakVO_(2)均与房颤有显著性关联(P均<0.05)。多因素Logistic回归分析在调整年龄、性别、体重指数等因素后,PeakVO_(2)与房颤存在独立的关联(OR=0.847,95%CI:0.722~0.983,P=0.034)。结论:肥厚型梗阻性心肌病患者的PeakVO_(2)明显降低。PeakVO_(2)与房颤存在独立关联,PeakVO_(2)越低,房颤的患病率越高。Objectives:To explore the characteristics of patients with hypertrophic obstructive cardiomyopathy(HOCM)with different peak oxygen consumption(PeakVO_(2))levels and the correlation between PeakVO_(2) and atrial fibrillation.Methods:A total of 188 patients,who were diagnosed with HOCM and underwent cardiopulmonary function test from December 2018 to September 2021 in the Adult Surgery Centert of Fuwai Hospital,were enrolled in this retrospective study.The general information,clinical history,results of preoperative serological test,echocardiography,cardiopulmonary function test and 24 h electrocardiogram of the patients were collected.Patients were divided into high oxygen consumption group(n=94)and low oxygen consumption group(n=94)according to the median peak oxygen consumption PeakVO_(2).Univariate and multivariate Logistic regression analysis were performed to explore the correlation between PeakVO_(2) and atrial fibrillation in HOCM patients.Results:The median age of the total cohort was 51.0(36.0,58.0)years old,the average PeakVO_(2) was(16.42±4.07)ml/(kg·min),and the incidence of atrial fibrillation was 16.5%.Compared with the high oxygen consumption group,patients in the low oxygen consumption group were older(P<0.001),proportion of female(P=0.001),body mass index(P=0.004),and left atrial diameter(P<0.001)were significantly higher.NT-proBNP(P=0.037)and NYHA classification(P=0.046)were also higher in the low oxygen consumption group than in high oxygen consumption group.Univariate regression analysis showed that age(P=0.021),symptoms of palpitation(P=0.005)and dizziness(P=0.001),left atrial diameter(P<0.001),left ventricular outflow tract pressure(P=0.019)and PeakVO_(2)(P<0.001)were risk factors of atrial fibrillation.After adjusting age,sex,body mass index and other confounders,multivariate regression analysis showed that PeakVO_(2) remained as independent influencing factor of atrial fibrillation in HOCM patients(OR=0.847,95%CI:0.722-0.983,P=0.034).Conclusions:Lower PeakVO_(2) is independently related t

关 键 词：肥厚型梗阻性心肌病 峰值耗氧量 心房颤动 

分 类 号：R54[医药卫生—心血管疾病]