大内皮素-1与肥厚型梗阻性心肌病伴发心房颤动相关性研究

Relationship between big endothelin-1 and the occurrence of atrial fibrillation in patients with hypertrophic obstructive cardiomyopathy

目的探讨血浆大内皮素-1（Big ET-1）水平与肥厚型梗阻性心肌病（HOCM）患者伴发心房颤动的相关性。方法入选北京阜外医院2014年9月至2016年5月收治的HOCM患者189例，测定血浆BigET-1水平等化验指标，完善心电图、动态心电图、超声心动图（UCG）及心脏磁共振（CMR）检查。根据心电图结果将患者分为心房颤动组（房颤组）33例及窦性心律组（窦律组）156例，进行相关统计学分析。结果房颤组与窦律组相比，血浆BigET-1显著升高，UCG测量的左房前后径、CMR测量的左房前后径及左室舒张末期横径偏大（均P〈0．05）。相关性分析及多元线性回归显示，Ln BigET-1与HOCM患者的左房前后径（房颤组：r=0．365，P=0．037；窦律组：r=0．184，P=0．021）及LnN末端B型利钠肽原（NT—pro BNP，房颤组：r=0．381，P=0．029；窦律组：r=0．346，P〈0．001）呈正相关。多因素Lcgistic回归显示Ln Big ET-1（OR 3．209，95％CI 1．545～6．665）、CMR测量的左房前后径（OR1．126，95％CI 1．054～1．203）及心悸（OR3．597，95％CI1．434～9．027）为HOCM患者伴发房颤的独立预测指标（均P〈0．05）。以Big ET-1水平诊断HOCM伴发房颤的ROC曲线下面积为0．752（95％CI0．66～0．85，P〈0．001），当Big ET-1的诊断界值为0．285pmol／L时，灵敏度为75．8％，特异度为73．1％。结论HOCM合并心房颤动患者的血浆Big ET-1水平明显升高。LnBig ET-1、左房内径及心悸均为HOCM伴发房颤的独立预测指标。血浆Big ET-1水平可能在HOCM伴发心房颤动的诊断及预测中具有一定价值。

Objective To explore the relationship between big Endothelin-1 （Big ET-1） and the occurrence of atrial fibrillation （AF） in patients with hypertrophic obstructive cardiomyopathy （HOCM）. Methods A total of 189 consecutive HOCM in-hospital patients were divided into 2 groups according to electrocardiogram （ECG） results： AF group（n=33） and sinas rhythum （SIR,） group（n=156）. Plasma level of Big ET-1, ECG, dynamic ECG, echocardiography （UCG） and cardiovascular magnetic resonance （CNLR） were examined and compared among different groups. Results Compared with SR group, patients in AF group had higher level of plasma Big ET-1; left atrial （LA） anteroposterior （AP） diameter measured by both UCG and CMR was larger; left ventricular end-diastolic diameter （LVEDD） measured by CMR was higher （all P〈O.05）. In HOCM patients, Ln Big ET-1 was positively related to LA AP diameter （AF group： r=0.365, P=0.037; SR group： r=0.184, P=0.021） and Ln NT-pro BNP （AF group： r=-0.381, P=0.029; SR group： r=-0.346, P〈0.001）. Multivariable Logistic regression demonstrated that Ln Big ET-1 （OR 3.209, 95%CI 1.545-6.665）, LAAP diameter measured by CMR （OR 1.126, 95%CI 1.054-1.203） and palpitation （OR 3.597, 95%CI 1.434-9.027, all P〈0.05） were independent predictors for the occurrence of AF in HOCM patients. According to the receiver operating characteristic （ROC） curve analysis, the optimal cut-off value of Big ET-l to predict the presence of AF in HOCM patients was 0.285 pmol/L, with a sensitivity of 75.8% and specificity of73.1% （AUC=0.752, 95% CI 0.66-0.85, P〈0.001）. Conclusion HOCM patients with AF had significantly elevated plasma level of Big ET- 1.Ln Big ET- 1, LA AP diameter and palpitation were independent predictors for the occurrence of AF in HOCM patients. The plasma level of Big ET-1 might be valuable for the diagnosis and prediction of AF occurrence in patients with HOCM.