血浆大内皮素-1水平与心尖肥厚型心肌病伴发心房颤动的相关性研究

Relationship Between Big Endothelin-1 and Occurrence of Atrial Fibrillation in Patients With Apical Hypertrophic Cardiomyopathy

目的:探讨血浆大内皮素-1(Big ET-1)水平与心尖肥厚型心肌病(AHCM)患者伴发心房颤动(房颤)的相关性。方法:入选我院2005年3月至2016年12月收治的AHCM患者373例。所有患者经心电图、动态心电图、超声心动图(UCG)检查,并测定血浆Big ET-1水平等指标。根据心电图和(或)动态心电图结果将患者分为房颤组(91例)及窦性心律组(窦律组,282例),进行相关统计学分析。结果:房颤组与窦律组相比,患者年龄更大,UCG测量的左心房前后径更大,血浆Big ET-1水平显著升高(P均<0.05)。多因素Logistic回归分析显示,年龄(OR=1.053,95%CI:1.025～1.081)、UCG测量的左心房前后径(OR=1.206,95%CI:1.138～1.277)及血浆Big ET-1水平(OR=1.466, 95%Cl:1.005～2.317)是AHCM患者伴发房颤的独立预测因素(P均<0.05)。结论:AHCM合并房颤患者的血浆Big ET-1水平明显升高,年龄、左心房前后径及血浆Big ET-1水平均为AHCM伴发房颤的独立预测因素。血浆Big ET-1水平可能在AHCM伴发房颤的预测及治疗中有一定价值。

Objectives: To investigate the relationship between big endothelin-1(Big ET-1) and the occurrence of atrial fibrillation(AF) in patients with apical hypertrophic cardiomyopathy(AHCM).Methods:A total of 373 consecutive hospitalized AHCM patients were enrolled in this study. Plasma level of Big ET-1 was measured, electrocardiogram(ECG), dynamic electrocardiogram and echocardiography were performed in these patients. According to ECG and/or dynamic ECG results, all patients were divided into 2 groups: AF group(n=91) and sinus rhythm(SR) group(n=282). Results:Compared with SR group, patients were older, and level of plasma Big ET-l was higher and echocardiography derived anteroposterior left atrial(LAAP) diameter was larger in AF group(all P<0.05). Multivariable logistic regression analysis demonstrated that age(OR=1.053,95 %CI: 1.025-1.081), LA AP diameter(OR=1.206,95%CI: 1.138-1.277) and Big ET-1(OR=1.466, 95% Cl: 1.005-2.317) were independent predictors for the occurrence of AF in AHCM patients(all P<0.05). Conclusions:Our results showed that AHCM patients with AF had significantly elevated plasma Big ET-l level. Age, LAAP diameter and Big ET-l were independent predictors for the occurrence of AF in AHCM patients. Measurement of plasma level of Big ET-1 might be valuable for the prediction of AF occurrence in patients with AHCM.