高血压合并心房颤动患者尿酸对左心房血栓或自发显影形成的预测价值

Predictive value of serum uric acid level for left atrial thrombus or spontaneous echo contrast in patients with hypertension and atrial fibrillation

目的 分析在高血压合并心房颤动人群中,血尿酸（SUA）对左心房血栓或自发性声学显影形成（LATH/SEC）的预测价值.方法 回顾研究分析2007年7月至2013年1月525例于广东省心血管病研究所住院并接受经食管超声心动图（TEE）检查的高血压合并心房颤动的患者.其中男337例,女188例,平均年龄（61 ±11）岁.阵发性心房颤动436例.根据患者TEE结果分为2组：有LATH/SEC57例和无LATH/SEC 468例.比较两组患者年龄、性别、心房颤动类型、SUA值、超声心动图指标以及所伴随的疾病等资料的差异,采用Logistic回归分析SUA对LATH/SEC形成的危险因素.结果 LATH/SEC组患者比无LATH/SEC组的SUA[（392±98） μmol/L比（349±84） μmol/L,P ＜0.01左心房内径[LAD（42±6）mm比（37±5）mm,P＜0.01]均明显增高,LATH/SEC组患者比无LATH/SEC组持续性心房颤动比例高[50.9％（29/57）比13.7％（64/468）,P＜0.01.以SUA水平所绘制的ROC曲线下面积为0.612 （P =0.006）;约登指数为0.189,所对应的SUA水平为448 μmol/L.Logistic回归分析显示,在高血压合并心房颤动患者中,女性（OR=2.344,95％ CI1.228 ～4.475,P=0.01）、持续性心房颤动（OR=5.993,95％ CI3.127 ～ 11.486,P＜0.001）、SUA＞448 μmol/L（OR=2.890,95％ CI 1.380 ～6.051,P=0.005）、LAD＞ 40 mm（OR=4.845,95％ CI2.528 ～9.284,P＜0.001）和CHA2 DS2-VASc评分（OR=1.422,95％CI1.105～1.829,P=0.006）与TEE检出LATH/SEC形成有显著的相关性.结论 SUA值是高血压合并心房颤动患者LATH/SEC形成的独立危险因素之一,对LATH/SEC形成具有一定的预测价值.

Objective To investigate the predictive value of serum uric acid （SUA） levels for left atrial thrombus （LATH）/spontaneous echo contrast（ SEC ） in patients with hypertension and atrial fibrillation （AF）. Methods The study enrolled 525 patients （ male 337, female 188, mean age of（ 61 ± 11 ） years old, 83 % paroxysmal AF ） with hypertension and AF who underwent transesophageal echoeardiography （TEE） in Guangdong Provincial Cardiovascular Institute from July 2007 to January 2013. Patients were categorized into LATH/SEC group （ n = 57 ） and non-LATH/SEC group （ n = 468 ）, according to the TEE results. The clinical baseline of both groups including age, gender, type of AF, SUA levels, indices of eehocardiography and complications were collected and analyzed. The relationships between the potential risk factors and LATH/SEC were performance using Logistic regression analysis. Results SUA level （392 ±98） μmol/L vs （349±84）μmol/L, P〈0.01） , left atrial diameter（LAD） （42 ±6） mm vs （37±5）mm, P 〈 0.01 ）, proportion of patients with persistent AF （ 50.9 % （ 29/57 ） vs 13.7 % （ 64/468 ）, P 〈 0.01 ） were significantly increased in patients of LATH/SEC group compared with patients of non-LATH/SEC group. ROC curve were presented by SUA level, which indicated area under curve was 0. 612（P =0. 006） and the best SUA cut-point was 448txmol/L. Logistic regression analysis indicated that female（ OR = 2. 344, 95 % CI 1. 228 ± 4. 475, P = 0.01 ）, persistent AF （ OR = 5. 993, 95% CI 3. 127 - 11. 486, P 〈 0. 001 ）, SUA level （ OR = 2. 890,95 % CI 1.380 ± 6.051, P =0. 005 ）, LAD 〉 40 mm（ OR = 4. 845,95 % CI 2. 528 9. 284,P 〈0. 01）, CHA2DS2-VASc score（OR = 1.422,95% CI 1. 105 - 1. 829,P =0. 006）were independent risk factors of LATH/SEC in patients with AF and hypertension. Conclusion SUA level is independent risk factor and predictive index for LATH/SEC in patients with hypertension and AF.