高敏C反应蛋白与急性心肌梗死后并发心房颤动的关系

Association between high sensitivity C-reactive protein level and the occurence of atrial fibrillation after acute myocardial infarction

目的分析急性心肌梗死(AMI)并发心房颤动(AF)患者的临床特征,探讨高敏C反应蛋白(hs-CRP)水平与AMI并发AF之间的关系。方法连续入选27例AMI并发AF患者构成AF组,选取每例前后相继入院的2例AMI患者,共54例构成非AF组。人院开始治疗前取静脉血,采用免疫比浊法检测hs-CRP水平,比较两组患者基线临床资料。结果与非AF组比较,AF组hs-CRP水平较高[(12±7)mg/L比(8±5)mg/L,P=0.001],年龄较大[(70±8)岁比(62±13)岁,P=0.002],左心室射血分数(LVEF)较低[(48%±9%)比(57%±10%),P=0.001],血肌酐水平较高[(113±72)μmol/L比(82±24)μmoL/L,P=0.039)]。多因素Logistic回归显示,hs-CRP(OR=1.12,95% CI 1.01～1.23,P=0.025),年龄(OR=1.07,95% CI 1.00～1.13,P=0.036)和LVEF(OR=0.90,95% CI0.85～0.97,P=0.003)是AMI并发AF的独立预测因子。结论 hs-CRP升高与AMI并发AF呈正相关,早期检测hs-CRP水平可预测AMI后发生AF的风险。

Objective To investigate the association between high sensitivity C-reactive protein （hs-CRP） level and the occurence of atrial fibrillation （AF） after acute myocardial infarction （AMI）. Methods A total of 27consecutive AMI patients with AF were enrolled, 54 patients without AF admitted just before or after the corresponding patient with AF were enrolled as control. Blood sample was obtained on admission, and hs-CRP levels were determined by an immunonelometry method,the clinical characteristics of the 2 groups were also compared. Results Compared with patients without AF, patients with AF had higher hs-CRP level[ （ 12 ±7） mg/L vs. （8±5） mg/L,P =0. 001 ], older age [ （70 ± 8） years vs. （62 ±13） years,P =0. 002] , lower left ventricular ejection fraction （LVEF） （48% ±9% vs. 57%±10% , P =0. 001 ） and higher serum creatinine [ （ 113±72）μmol/L vs. （82±24） μmol/L,P =0. 039]. In multivariate logistic regression, hs-CRP （0R=1.12, 95% CI 1.01 -1.23, P=0.025）, age （0R=1.07, 95% CI 1.00-1.13, P= 0. 036） and LVEF （ OR = 0. 90, 95% CI 0. 85 - 0. 97, P= 0. 003 ） were independent predictors of AF after AMI. Conclusions There is a positive association between increased hs-CRP level and the occurence of AF after AMI. We may identify high-risk patients of AF after AMI by the early detection of hs-CRP level.