高血压伴代谢综合征患者比伴左心室肥厚患者心房颤动发生率更高

Metabolic syndrome imposes higher atrail fibrillation prevalence on hypertensive patients than left ventricular hypertrophy

目的探讨代谢综合征(MS)、左心室肥厚(LVH)与高血压患者心房颤动发生之间的关系。方法回顾分析福建医科大学附属第一医院1995-2009年住院的高血压患者2782例,根据有无MS和LVH诊断标准,分为4组:非LVH+非MS组(n=728)、LVH+非MS组(n=1033)、非LVH+MS组(n=439)、LVH+MS组(n=582)。结果 LVH+MS组和非LVH+MS组心房颤动发生率明显高于非LVH+非MS组和LVH+非MS(依次为15.1%,12.8%,9.2%,6.9%,均P<0.05),LVH+MS组和非LVH+MS组之间、非LVH+非MS组和LVH+非MS之间心房颤动发生率差异无统计学意义(P>0.05)。Logistic回归分析显示:MS、他汀药物、高血压病程、左心房大小、左心室大小与心房颤动的发生密切相关,而LVH与心房颤动的发生无关。MS预测心房颤动的敏感性为49.8%,特异性64.8%,阳性预测值为14.1%,阴性预测值91.7%。结论高血压伴MS患者比高血压伴LVH患者心房颤动发生率更高,MS在预测高血压心房颤动风险中的价值优于LVH。

Objective To investigate the correlation between metabolic syndrome （MS）, left ventricular hypertrophy （LVH）, and atrial fibrillation risk of essential hypertensive （EH） patients. Methods A total of 2782 hospitalized essential hypertensive patients in the First Affiliated Hospital of Fujian Medical University from 1995 to 2009, was retrospectively analysed. According to the diagnostic criteria of metabolic syndrome and atrail fibrillation, patients were divided into four groups：nonLVH＋ notMS group （ n= 728）, LVH ＋ nonMS group （ n = 1033 ）, nonLVH＋MS group （n=439）, and LVH＋MS group （n=582）. Results The prevalence of atrial fibrillation in LVH＋ MS group and nonLVH＋MS group was significantly higher than that in LVH ＋ nonMS group and nonLVH＋notMS group （15.1%, 12.8 %, 9.2 %, 6.9 %, respectively, all P〈0.05）. There was no difference in atrial fibrillation prevalence between LVH＋MS group and nonLVH ＋MS group, and between nonLVH＋nonMS group and LVH＋nonMS group （P〉0.05）. Logistic regression analysis showed that MS, the use of statins, hypertension duration, left atrial diameter, left ventricular end-diastolic diameter were closely related to the AF fre- quency, while LVH has no relation with the occurrence of AF. The sensibility, specificity, positive predictive value, and negative predictive value of AF, which were prognosed by MS, were respectively 49.8%, 64.8%, 14.1%, and 91.7%. Conclusions The AF prevalence of hypertensive patients with MS is higher than that of hypertensive patients with LVH. MS is of more value than LVH in prognosing AF risk in hypertensive patients.