冠状动脉慢血流患者发生心房纤颤与NT-proBNP关系
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摘要
目的探究冠状动脉慢血流现象(CSFP)患者并发心房纤颤(AF)与N-末端脑钠肽前体(NT-proBNP)的关系。方法选取2014年1月—2018年6月芜湖市第二人民医院心内科行冠状动脉造影发现CSFP患者79例为CSFP组,根据是否发生AF分为AF亚组26例,非AF亚组53例,同期冠状动脉造影正常患者81例为对照组,比较2组一般临床资料及相关生化指标、超声心动图资料、心率变异性指标(SDNN、SDANN、r-MSSD和PNN50)。结果与对照组相比,CSFP组尿酸、左房内径(LAD)明显增加,而总胆固醇、低密度脂蛋白胆固醇、SDNN、SDANN、PNN50均降低(t/P=2.379/0.019、3.618/0.000、14.148/0.000,2.204/0.045,2.158/0.032,2.411/0.014、2.284/0.027、1.974/0.040)。与非AF亚组相比,AF亚组LAD和Lg(NT-proBNP)水平均升高(t/P=4.522/0.000、7.008/0.000),而左室射血分数、SDNN值均下降(t/P=-4.422/0.000、-4.870/0.000)。多因素回归分析显示Lg(NT-proBNP)是CSFP患者发生AF的独立危险因素(OR=16.412,95%CI 2.317～116.279,P=0.005)。结论 CSFP患者房颤发生率显著增加,NT-proBNP水平是CSFP患者发生房颤的独立危险因素。
Objective To explore the relationship between atrial fibrillation(AF) and N-terminal brain natriuretic peptide precursor(NT-proBNP) in patients with coronary slow flow phenomenon(CSFP).Methods Seventy-nine patients with CSFP were selected from the Department of Cardiology of Wuhu Second People's Hospital from January 2014 to June 2018 as CSFP group. According to whether AF occurred, they were divided into AF subgroup(26 cases), non-AF subgroup(53 cases) and normal coronary angiography group(81 cases) as control group. The general clinical data and related biochemical indexes, echocardiogram data and heart rate variability indexes(SDANN, SDANN, rMSSD and PN50) of the two groups were compared. Results Compared with the control group, the uric acid and left atrial diameter(LAD) were significantly increased in the CSFP group, while total cholesterol, low-density lipoprotein cholesterol, SDNN, SDANN, and PNN50 were decreased(t/P=2.379/0.019, t/P=3.618/0.000, t/P=14.148/0.000, t/P=2.204/0.045, t/P=2.158/0.032, t/P=2.411/0.014, t/P=2.284/0.027, t/P=1.974/0.040). Compared with the non-AF subgroup, the AF subgroup had elevated LAD and Lg(NT-proBNP) levels(t/P=4.522/0.000, t/P=7.008/0.000), while the left ventricular ejection fraction and SDNN values were both decrease(t/P=-4.422/0.000, t/P=-4.870/0.000). Multivariate regression analysis showed that Lg(NT-proBNP) was an independent risk factor for AF in CSFP patients(OR=16.412, 95% CI 2.317-116.279, P=0.005). Conclusion The incidence of atrial fibrillation in CSFP patients increased significantly. NT-proBNP level was an independent risk factor for atrial fibrillation in CSFP patients.
Objective To explore the relationship between atrial fibrillation(AF) and N-terminal brain natriuretic peptide precursor(NT-proBNP) in patients with coronary slow flow phenomenon(CSFP).Methods Seventy-nine patients with CSFP were selected from the Department of Cardiology of Wuhu Second People's Hospital from January 2014 to June 2018 as CSFP group. According to whether AF occurred, they were divided into AF subgroup(26 cases), non-AF subgroup(53 cases) and normal coronary angiography group(81 cases) as control group. The general clinical data and related biochemical indexes, echocardiogram data and heart rate variability indexes(SDANN, SDANN, rMSSD and PN50) of the two groups were compared. Results Compared with the control group, the uric acid and left atrial diameter(LAD) were significantly increased in the CSFP group, while total cholesterol, low-density lipoprotein cholesterol, SDNN, SDANN, and PNN50 were decreased(t/P=2.379/0.019, t/P=3.618/0.000, t/P=14.148/0.000, t/P=2.204/0.045, t/P=2.158/0.032, t/P=2.411/0.014, t/P=2.284/0.027, t/P=1.974/0.040). Compared with the non-AF subgroup, the AF subgroup had elevated LAD and Lg(NT-proBNP) levels(t/P=4.522/0.000, t/P=7.008/0.000), while the left ventricular ejection fraction and SDNN values were both decrease(t/P=-4.422/0.000, t/P=-4.870/0.000). Multivariate regression analysis showed that Lg(NT-proBNP) was an independent risk factor for AF in CSFP patients(OR=16.412, 95% CI 2.317-116.279, P=0.005). Conclusion The incidence of atrial fibrillation in CSFP patients increased significantly. NT-proBNP level was an independent risk factor for atrial fibrillation in CSFP patients.
引文
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[18] 张驰,王丽岳,任浩进,等.不同剂量阿托伐他汀对急性冠脉综合征患者HO-1/HbCO系统、血清sOX40L水平影响及其与炎性因子的相关性分析[J].疑难病杂志,2019,18(5):437-441.DOI:10.3969/j.issn.1671-6450.2019.05.002.
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[20] 王晓玲,张立杰,肖四海,等.冠心病患者血清NT-proBNP、尿酸和hs-CRP水平与冠状动脉病变的关系[J].疑难病杂志,2019,18(3):217-219,242.10.3969/j.issn.1671-6450.2019.03.001.
[21] 王兆东,周保国,马骏,等.N-末端脑钠肽前体对冠状动脉旁路移植术术后房颤的预测价值[J].河北医学,2017,23(8):1310-1316.DOI:10.3969/j.issn.1006-6233.2017.08.022.
[22] Amar D,Zhang H,Shi W,et al.Brain natriuretic peptide and risk of atrial fibrillation after thoracic surgery[J].J Thorac Cardiovasc Surg,2012,144(5):1249-1253.DOI:10.1016/j.jtcvs.2012.06.051.
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[2] 中华医学会糖尿病学分会.中国2型糖尿病防治指南(2017年版)[J].中华糖尿病杂志,2018,10(1):4-67.DOI:10.3760/cma.j.issn.1674-5809.2018.01.003.
[3] 马长生.冠心病介入治疗技术与策略[M].2版.北京:人民卫生出版社,2004:15-16.
[4] 陈新.临床心电图学[M].6版.北京:人民卫生出版社,2009:561-568.
[5] 王帅,薛强,刘毅,等.大样本冠状动脉慢血流的相关因素分析[J].心脏杂志 ,2017,29(2):180-183.DOI:10.13191/j.chj.2017.0047.
[6] 王永,杨慧敏,陈燕,等.冠状动脉慢血流现象临床因素分析与内皮功能评价[J].中国介入心脏病学杂志,2018,26(9):517-522.DOI:10.3969/j.issn.1004-8812.2018.09.008.
[7] Chen Z,Chen X,Li S,et al.Nicorandil improves myocardial function by regulating plasma nitric oxide and endothelin-1 in coronary slow flow[J].Coron Artery Dis,2015,26(2):114-120.DOI:10.1097/MCA.0000000000000179.
[8] 李春来,许贤彬,昊平彬.低密度脂蛋白胆固醇在冠状动脉慢血流发生中的作用[J].岭南心血管病杂志,2013,19(2):151-153.DOI:10.3969/j.issn.1007-9688.2013.02.009
[9] 严健华,孙英刚,陈漫天,等.基于单中心的冠状动脉慢血流危险因素分析及其与炎症反应的相关性[J].中国临床医学,2018,25(2):194-198.DOI:10.12025/j.issn.1008-6358.2018.20180136.
[10] 秦纲,贾永平,吕吉元,等.嗜酸性粒细胞、NLR 对冠状动脉慢血流的预测价值研究[J].中西医结合心脑血管病杂志,2017,15(15):1820-1822.DOI:10.3969/j.issn.1672-1349.2017.15.002.
[11] Simsek H,Yaman M,Babat N,et al.Decreased risk of ventricular arrhythmias with treatment of nebivolol in patients with coronary slow flow[J].Kardiol Pol,2016,74(10):1174-1179.DOI:10.5603/KP.a2016.0060.
[12] Sucu M,Ucaman B,Ozer O,et al.Novel Ventricular Repolarization Indices in Patients with Coronary Slow Flow[J].J Atr Fibrillation,2016,9(3):1446.DOI:10.4022/jafib.1446.
[13] Suner,Cetin M.The effect of trimetazidine on ventricular repolarization indexes and left ventricular diastolic function in patients with coronary slow flow[J].Coron Artery Dis,2016,27(5):398-404.DOI:10.1097/MCA.0000000000000373.
[14] Tenekecioglu E,Karaagac K,Yontar OC.Evaluation of Tp-Te Interval and Tp-Te/QT Ratio in Patients with Coronary Slow Flow Tp-Te/QT Ratio and Coronary Slow Flow[J].Eurasian J Med,2015,47(2):104-108.DOI:10.5152/eurasianjmed.2015.72.
[15] Cakmak HA,Aslan S,Gul M,et al.Assessment of the relationship between a narrow fragmented QRS complex and coronary slow flow[J].Cardiol J,2015,22(4):428-436.DOI:10.5603/CJ.a2015.0007.
[16] 梁飒,黄锐,郑雅格,等.新型口服抗凝剂与华法林在非瓣膜性心房颤动患者中的应用分析[J].疑难病杂志,2017,16(8):769-772.DOI:10.3969/j.issn.1671-6450.2017.08.004.
[17] 卓朝贵,王顺,张楷,等.参松养心胶囊对心房颤动射频消融术后复发的预防作用[J].疑难病杂志,2017,16(3):293-296,301.DOI:10.3969/j.issn.1671-6450.2017.03.019.
[18] 张驰,王丽岳,任浩进,等.不同剂量阿托伐他汀对急性冠脉综合征患者HO-1/HbCO系统、血清sOX40L水平影响及其与炎性因子的相关性分析[J].疑难病杂志,2019,18(5):437-441.DOI:10.3969/j.issn.1671-6450.2019.05.002.
[19] Sinner MF,Stepas KA,Moser CB,et al.B-type natriuretic peptide and c-reactive protein in the prediction of atrial fibrillation risk:The charge-af consortium of community-based cohort studies[J].Europace,2014,16(10):1426-1433.DOI:10.1093/europace/euu175.
[20] 王晓玲,张立杰,肖四海,等.冠心病患者血清NT-proBNP、尿酸和hs-CRP水平与冠状动脉病变的关系[J].疑难病杂志,2019,18(3):217-219,242.10.3969/j.issn.1671-6450.2019.03.001.
[21] 王兆东,周保国,马骏,等.N-末端脑钠肽前体对冠状动脉旁路移植术术后房颤的预测价值[J].河北医学,2017,23(8):1310-1316.DOI:10.3969/j.issn.1006-6233.2017.08.022.
[22] Amar D,Zhang H,Shi W,et al.Brain natriuretic peptide and risk of atrial fibrillation after thoracic surgery[J].J Thorac Cardiovasc Surg,2012,144(5):1249-1253.DOI:10.1016/j.jtcvs.2012.06.051.
[23] Madak N,Nazl Y,Mergen H,et al.Acute phase reactants in patients with coronary slow flow phenomenon[J].Anadolu Kardiyol Derg,2010,10(5):416-420.DOI:10.5152/akd.2010.139.