收缩功能正常的心衰患者低密度脂蛋白水平与房颤发生率的相关性研究

Correlation research of low-density lipoprotein with atrial fibrillation pre-valence in patients with heart failure with preserved ejection fraction

目的研究低密度脂蛋白胆固醇水平与收缩功能正常的慢性心衰患者房颤发生率的相关性及相关机制的探讨。方法人选240例收缩功能正常的慢性心衰患者，入院后24h内记录患者病史，并行十二导心电图检查，根据是否并发房颤分为房颤组和窦律组，测定血清低密度脂蛋白（LDL）水平、游离甲状腺素（FT4）、游离三碘甲状腺原氨酸（FT3）、促甲状腺激素（TSH）；并行超声心动图检查，检查左心室射血分数（LVEF）、左心房内径（LAD）、左心室舒张末期内径（LVEDD）、左心室收缩末期内径（LVESD），分析影响心衰患者发生房颤的相关因素。结果240例心衰患者中并发房颤153例（63．75％），房颤组与窦律组的LDL水平[（1．96±0．77）mmol／Lvs（2．38±0．93）mmol/L，P=0．011]差异有统计学意义，LDL水平与LAD、年龄及FT3有一定相关性（r分别为-0．263、-0．225和r=0．295．P均〈0．01）；Logistic回归分析显示LDL〈2．57mmol／L对应着房颤发生率的增加有统计学意义（OR：0．302，95％CI：0．114～0．803,P=0．016）。结论过低的LDL水平可能增加收缩功能正常的慢性心力衰竭患者发生房颤的风险。

Objective To investigate the correlation of low density lipoprotein level with atrial fibrillation （AF） prevalence in patients suffered from chronic heart failure with preserved ejection fraction （HFpEF） and its related mechanisms. Methods A total of 240 patients with HFpEF enrolled in this study,medical history was recorded and ECG were examined, The patients were divided into AF group and sinus rhythm group according to whether the AF occurred, profile of low-density lipoprotein（LDL）, free triiodothyronine（FT3）, free thyroxine（FT4）, thyroid stimulating hormone （TSH） were measured within 24 hours after admission. Meanwhile, ultrasonic cardiogram were used to examine the left ventricular ejection fraction （LVEF）,left atrial dimension （LAD）, left ventricular end-diastolic dimension （LVEDD） and left ventricular end-systolic dimension （LVESD）. the related factors influencing the incidence of AF in patients with CHF were analysed. Results Among the 240 patients, 153 （63.75%） were complicated with AF, Compared with the patients with sinus rhythm, LDL level （1.96±0.77mmol/L vs 2.38±0.93mmol/L,P=0.011 ）was significantly lower in patients with AF.LDL level was negatively correlated with LAD （r=-0.263,P〈0.01） and age （r=-0.225,P〈0.O01） and correlated with FT3 level positively （r= 0.295,P〈0.001）. Logistic regression analysis showed lower LDL level were associated with the incidence of AF in patients with HFpEF （odds ratio [OR]： 0.302; 95%CI ：0.114 - 0.803 ;P=0.016）. Conclusion Lower LDL level probably increase the risk of incidence of AF in patients with HFpEF.