代谢综合征与原发性高血压患者发生心房颤动风险的关系

Association Between Metabolic Syndrome and the Increased Risk of Atrial Fibrillation in Essential Hypertension Patients

目的探讨代谢综合征(MS)与原发性高血压(EH)患者心房颤动(AF)发生的关系。方法入选住院EH患者1810例,分为EH+非MS组(n=1155)及EH+MS组(n=655),比较两组的相关临床资料、超声心动图及AF的发生情况。结果EH+MS组病人AF发生率明显高于EH+非MS组(14.4%比8.3%,P<0.01)。EH+MS组左房内径(LAD)、左室舒张末期内径(LVEDD)、室间隔厚度(IVS)、左室后壁厚度(LVPW)、左室质量(LVM)、左室质量指数(LVMI)均高于EH+非MS组(均P<0.05),左室射血分数(LVEF)明显低于EH+非MS组(P<0.01)。Logistic回归分析显示原发性高血压患者发生AF的危险与年龄、左房增大、左室扩大及合并MS明显相关(OR分别为1.666、4.446、1.950、1.633,均P<0.05)。AF(n=190)与无AF患者(n=1620)相关指标单因素分析发现AF组MS发生率明显高于无AF组(49.5%比34.7%,P<0.01),体质量指数(BMI)、空腹血糖(FPG)水平亦明显升高(均P<0.05)。进一步Logistic回归分析显示MS组分中肥胖与AF的发生关系最密切(OR:1.913,P<0.01)。结论MS与EH患者发生AF的危险关系密切,可能与左心结构和功能损害有关。减重是MS合并AF病人减轻AF的重要措施。

Objective To investigate the effect of metabolic syndrome（MS） on the atrial fibrillation（AF） in patients with essential hypertension（EH）. Methods A cross-sectional study was conducted in a cohort of 1810 hospitalization essential hypertension patients, which were divided into EH＋ non MS group （n= 1155 ） and EH＋ MS group （n=655} according to MS criteria. Results Incidence of AF in EH＋MS group was higher than that in EH ＋ non MS group（ 14.4 % vs 8.3 %, P〈0.01 ）. Left atrial diameter（ LAD） , left ventricular end-diastolic diameter （LVEDD）, interventricular septum thickness （IVS）, left ventricular posterior wall thickness（ LVPW）, left ventricular mass（ LVM） and left ventrieular mass index（LVMI） were greater in EH ＋ MS group than that in EH ＋ non MS group （P〈0.05）, while left ventricular ejection fraction（LVEF） is lower（P〈0.01 ）. After adjustment for age, LAD, LVEDD, logistic regression analysis showed MS predicted incidence of AFin EH patients （OR： 1. 633, P〈0.05）. AF patients（n= 190） were more likely complicated with MS than that in non AF patients（n= 1620, 49.5% vs 34.7%, P〈0.01） , and greater body mass index（BMI） and fasting plasma glucose（FPG） （P〈0.05）. Further logistic regression analysis suggested that obesity was the only independent predisposing risk factor for incidence of AF（OR. 1. 913, P〈0.01）among the other MS components. Conclusion MS is closely associated with the incidence of AF in EH patients. Obesity is the only predisposing factor for AF in all MS components of MS.