骨髓增殖性肿瘤患者心房颤动的发生情况及影响因素分析

Incidence and influencing factors of atrial fibrillation in patients with myeloproliferative neoplasms

目的评估骨髓增殖性肿瘤(MPN)患者心房颤动(房颤,AF)的发生情况及相关的影响因素,为骨髓增殖性肿瘤伴心律失常患者的预防以及抗栓治疗策略的选择提供思路。方法连续纳入首都医科大学附属北京安贞医院于2011年9月至2018年9月诊治MPN患者,收集患者临床资料、心电图、心脏超声检查参数并行统计学分析。结果 173例MPN患者中真性红细胞增多症(PV)58例,原发性血小板增多症(ET)103例,原发性骨髓纤维化(PMF)12例。51例患者(29.5%)伴有心律失常,其中AF最为多见,发生率为8.7%。ET、PV、PMF组AF发生率分别为9.7%、6.9%、8.3%,ET组略高于PV及PMF组,差异无统计学意义(P>0.05)。MPN伴AF患者左房增大、左室射血分数(LVEF)<60%、主动脉根部内径(AORD)≥31 mm的比例显著高于不伴AF患者(分别为80%vs. 42.3%、93.3%vs. 59%及66.7%vs. 25.3%),差异有统计学意义(P<0.05)。多因素Logistic分析显示,左房增大与MPN伴AF显著相关(OR=1.089,95%CI:1.006~1.178)。结论 MPN患者易罹患心律失常,以AF最多见;多数MPN伴AF患者左房增大、LVEF减低,多因素分析显示左房增大是MPN患者发生AF的独立危险因素。

Objective To review the incidence and influencing factors of atrial fibrillation(AF) in patients with myeloproliferative neoplasms(MPN), and provide thinking train of prevention and antithrombotic treatment for MPN patients accompanied by arrhythmia. Methods MPN patients were chosen from Beijing Anzhen Hospital affiliated Capital University of Medical Sciences from Sept. 2011 to Sept. 2018, and clinical materials, data of electrocardiogram(ECG) and parameters of cardiac ultrasonography were collected and analyzed statistically. Results Among 173 patients with MPN, 58 with polycythemia vera(PV), 103 with essential thrombocythemia(ET) and 12 with primary myelofibrosis(PMF). There were 51(29.5%) patients accompanied by arrhythmia(commonly AF) and incidence rate was 8.7%. The incidence rate of AF was 9.7% in ET group, 6.9% in PV group and 8.3% in PMF group, and that was slightly higher in ET group than that in PV group and PMF group(P>0.05). The percentages of patients with left atrial enlargement, left ventricular ejection fraction(LVEF) <60% or aortic root diameter(AORD)≥31 mm were higher in MPN patients accompanied by AF than those in MPN patients without AF(80% vs. 42.3%, 93.3% vs. 59%, 66.7% vs. 25.3%, P<0.05). The results of multi-factor Logistic analysis showed that left atrial enlargement was significantly correlated to MPN accompanied by AF(OR=1.089, 95%CI: 1.006~1.178). Conclusion MPN patients are easily complicated by arrhythmia which are commonly AF. The most MPN patients accompanied by AF have left atrial enlargement and LVEF decrease. The results of multi-factor Logistic analysis show that left atrial enlargement is an independent risk factor of AF in MPN patients.