高血压病患者心房颤动发生与血清尿酸水平的关系研究

Study on the relationship between the development of atrial fibrillation and the level of serum uric acid in hypertensive patients

目的：分析高血压病心房颤动（ AF）患者血清尿酸（ UA）水平的变化，并探讨其临床意义。方法入选495例高血压病患者，其中合并AF者61例。排除标准包括充血性心力衰竭、冠心病、瓣膜性心脏病、心肌病、先天性心脏病、糖尿病、肾脏功能衰竭、炎症以及正在应用影响UA代谢（利尿剂除外）药物的患者。记录入选者的一般临床资料特征、实验室检查和经胸多普勒心脏超声检测结果，并对这些数据与AF发生之间的关系进行单因素和多因素分析。结果年龄、高血压病年限、血清UA、血肌酐、左心房前后径、左心室后壁厚度以及室间隔厚度在AF患者明显高于非AF患者（ P＜0.05或P＜0.01），AF患者的左心室射血分数和肾小球滤过率明显低于非AF患者（ P＜0.05）。多因素分析结果中，仅UA成为与AF发生有关的独立变量（OR：1.014，95％ CI：1.009～1.019，P＜0.001）。结论高血压病患者AF的出现与血清UA水平增加有关，机制可能是血清UA水平升高介导了炎症激活和氧化应激程度增强。

Objective To study the relationship between the development of atrial fibrillation （ AF） and the level of serum uric acid in hypertensive patients .Methods 495 hypertensive patients were enrolled .Of these patients,there were 61 with AF.Subjects with congestive heart failure ,coronary artery disease ,valvular heart disease , congenital heart disease,cardiomyopathy,diabetes,renal failure,inflammatory conditions,and those who were taking drugs that affect UA metabolism were excluded .Clinical characteristics and the data of laboratory as well as echocardiographic of all enrolled patients were carefully recorded .Results The age,duration of hypertension ,serum UA,serum creatinine , left atrial diameter （ LAD ） , interventricular septum thickness （ IVST ） , and left ventricular posterior wall thickness （ LVPWT） were significantly higher in patients with AF than in those without AF （ P〈0.05 or P〈0.01）,the left ventricular ejection fraction（LVEF）and the estimated glomerular filtration（eGFR）were lower in patients with AF than in those without AF （ P〈0.05 ） .Multivariable logistic regression analysis showed that serum UA was independent predictors of AF （ OR：1.014 , 95% CI：1.009-1.019 , P 〈0.001 ） .Conclusion Increased serum level of UA is associated with the development of AF in hypertensive patients ,and the mechanism may be that hyperuricaemia is involved in inflammation activation and oxidative stress .