LDL-C控制水平在稳定型心绞痛患者降脂治疗中与新发房颤的关系分析

Analysis of the relationship between LDL-C level and atrial fibrillation in patients with stable angina pectoris

目的 探讨稳定型心绞痛患者降脂治疗中不同低密度脂蛋白胆固醇（LDL-C）控制水平与新发房颤的相关性.方法 选取2010年1月至2013年1月常熟市第一人民医院收治既往无房颧病史的400例稳定型心绞痛患者为研究对象,随机分为A、B两组,分别给予阿托伐他汀20、40 mg/d持续口服,LDL-C分别降至2.09～2.59 mmol/L和1.57～2.07 mmol/L,随访3年,记录各组主要不良心血管事件（MACE）及新发房颤情况.采用多因素Logistic回归分析判断LDL-C水平对稳定型冠心病患者新发房颤的独立预测价值.结果 A、B组新发房颤发生率分别为6.50％和13.50％,两组比较差异有统计学意义（x2=5.444,P=0.02）.A组MACE发生率为18.50％,与B组MACE发生率15.50％比较未见统计学差异（x2=0.713,P=0.40）.多元Logistic回归分析显示,LDL-C水平为稳定型心绞痛患者新发房颤的独立预测因素（P＜0.05）.结论 稳定型心绞痛患者降脂治疗中过度降低LDL-C水平,不能降低MACE发生率,新发房颤发生率可能增加.LDL-C水平为稳定型心绞痛患者新发房颤的独立预测因素.

Objective To explore the correlation between LDL-C level and atrial fibrillation in patients with stable angina pectoris. Methods 400 patients with stable angina pectoris from January 2010 to January 2013 admitted to Changshu No.1 People＇s Hospital were selected and they were randomly divided into group A and B. Patients in the A, B group were treated with continuous oral Atorvastatin 20 mg/d, 40 mg/d, LDL-C decreased to 2.09-2.59 mmol/L, 1.57-2.07 mmol/L. Followed up for 3 years, prevalence of major adverse cardiovascular events （MACE） and atrial fibrillation were recorded. Multivariate logistic regression analysis was used to analyzed the correlation in LDL-C and atrial fibrillation. Results The incidence of atrial fibrillation in A, B group was 6.50%, 13.50%, which showed significant differences between two groups （X^2=5.444, P=0.02）. The incidence of MACE in A group was 18.50%, which was no significant different from that in group B 15.50%（X^2=0.713, P= 0.40）. Logistic regression analysis showed that LDL-C level was independent predictor of atrial fibrillation in pa- tients with stable angina pectoris. Conclusion The results show that excessive lowering LDL-C levels in lipid- lowering therapy in patients could not reduce the incidence of MACE, but increase incidence of atrial fibrillation, LDL-C level is independent predictor of atrial fibrillation.