慢性心房颤动患者血浆脑钠肽水平相关因素分析

Determinants of plasma B-type natriuretic peptide levels in patients with chronic atrial fibrillation

目的探讨影响慢性心房颤动（CAF）患者血浆B型脑钠肽（BNP）水平的相关因素。方法采用免疫荧光定量测定法检测222例CAF患者[按左心室射血分数（LVEF）高低分为LVEF〉150％组147例，与LVEF〈50％组75例的血浆BNP含量；采用多普勒超声心动图判断LVEF；同时测定患者血糖、总胆固醇、甘油三酯、高密度脂蛋白胆固醇、低密度脂蛋白胆固醇、肌酐、尿素氮、肌酸；并记录患者的高血压病史、糖尿病病史、吸烟史。结果BNP含量在LVEF〈50％组较≥50％组明显升高（平均秩，158．00和87．78，Z=-7．705，P〈0．001）；Logistic回归分析提示：男性（OR13．115，95％CI3．382—50．860，P〈0．001）、高血压病史（OR3．710，95％CI1．104～12．472，P=0．034）、低总胆固醇（OR0．397，95％C10．214～0．735，P=0．003）、LVEF（OR0．791，95％C10．723～0．867，P〈0．001）、吸烟史（OR4．660，95％CI1．256—17．281，P=0．021）是BNP升高的独立危险因子。结论在CAF患者中低左心室射血分数、男性、高血压史、低总胆固醇及吸烟史是血浆BNP水平升高的独立预测因子。

Objective To assess the factors influencing plasma B-type natriuretie peptide（BNP） levels in patients with chronic atrial fibrillation （ AF）. Methods Clinical and eehoeardiographic information were detected or collected. Level of plasma BNP were measured through immunofluoreseen＇ee quantitified method in 222 CAF patients. The patients were divided into two groups according to left ventricular ejection fraction （LVEF） ：LVEF≥50% （normal group） and LVEF 〈 50% （case groups ）. LVEF was detected by transthoracic eehoeardiography. Fasting Blood Glucose, total cholesterol, triglyeerides, highdensity lipoprotein cholesterol, lowdensity lipoprotein cholesterol, creatinine, blood urea nitrogen, uric acid, were measured, and history of hypertension, diabetes mellitus and smoking, were recorded. Results Serum levels of BNP in patients of chronic AF with LVEF 〈 50% were significantly higher than those with LVEF≥50% （Mean Rank, 158. 00 and 87. 78,Z = - 7. 705, P 〈 O. 001 ）. In multiple logistic regression analysis, male gender （ OR： 13. 115,95% Cl 3. 382 to 50. 860,P 〈0. 001 ） ,history of hypertension（ OR：3. 710,95% CI 1. 104 to 12. 472,P =0. 034） ,lower TC（ OR： 0. 397,95 % CI 0. 214 to 0. 735, P = 0. 003 ）, LVEF （ OR ：0. 791,95 % CI O. 723 to 0. 867, P 〈 0. 001 ）, history of smoking（ OR：4. 660,95% C1 1. 256 to 17. 281, P = O. 021 ） were significant and independent determinants of BNP elevation. Conclusion Lower LVEF, male gender, history of hypertension and smoking, lower plasma TC are independent predictors of plasma BNP levels in patients with chronic AF.