原发性高血压合并心房颤动影响因素分析

Analysis of risk factors in patients with essential hypertension complicated by atrial fibrillation

目的探讨原发性高血压患者并发心房颤动(房颤)的独立危险因素.方法选取2018年10月31日至2019年10月31日在新疆医科大学第一附属医院心血管内科住院的原发性高血压患者510例,按照是否发生房颤分为房颤组160例,非房颤组350例,收集研究对象一般临床资料,包括年龄、性别、吸烟史、饮酒史、民族等,以及尿酸、空腹血糖、高密度脂蛋白、中性粒细胞计数、淋巴细胞计数等实验室检查,采用Logistic回归分析找出房颤的独立危险因素.结果①两组患者中男性均多于女性,但两者构成比相比较,房颤组中男性所占比例高于非房颤组.②不同年龄组的房颤患者及非房颤患者的构成比有差异,在房颤患者中,以60~79岁的老年人为主,在非房颤患者中,以45~59岁的中年人为主.③两组患者中,汉族人群均占大多数,且房颤组的民族构成比与非房颤组无差别.④两组饮酒情况(31.25%比47.43%,P=0.001)、性别(59.38%比69.71%,P=0.022)、年龄[(61.93±10.62)岁比(54.89±10.86)岁,P<0.05]、中性粒细胞计数[(4.12±1.76)×109比(3.25±1.03)×109,P<0.05]、淋巴细胞计数[(2.14±0.87)×109比(2.01±0.64)×109,P=0.009]、左心房内径[(36.09±4.64)mm比(33.20±3.18)mm,P<0.05]、中性粒与淋巴细胞之比[(2.39±2.51)%比(1.73±0.75)%,P=0.009]、尿酸[(359.24±81.19)μmol/L比(335.31±100.87)μmol/L,P=0.026]、空腹血糖[(5.08±1.06)mmol/L比(5.10±0.85)mmol/L,P=0.023]、乳酸脱氢酶[(173.01±42.74)U/L比(170.14±34.80)U/L,P=0.045]比较,差异有统计学意义(P<0.05).两组吸烟情况、高密度脂蛋白、低密度脂蛋白、总胆红素、直接胆红素、间接胆红素、单核细胞计数、红细胞分布宽度、血小板计数、血小板与淋巴细胞比值比较,差异无统计学意义(P>0.05).二元Logistic回归分析显示,年龄、尿酸、左心房内径、中性粒与淋巴细胞比值是房颤的独立危险因素.结论①我院原发性高血压患者中房颤组与非房颤组在性别和年龄构成有差异,但民族分布无差异;②年龄、尿酸、左心房内径、中性粒与淋巴细胞比值是房颤的独立危险因素,又以左心房内径的临床价值最大.

Objective To investigate the independent risk factors of patients with essential hypertension(EH)complicated by atrial fibrillation(AF).Methods A total of 510 patients,who were admitted to our hospital were enrolled,including 160 cases with AF divided as AF group and 350 cases without AF divided as non-AF group.Their clinical data,namely age,gender,smoking,drinking,nation and laboratory examination results,namely uric acid,fasting plasma glucose,high-density lipoprotein,neutrophil count,lymphocytecount,were recorded and analyzed by Logistic regression analysis.Results(l)There were more males than females both in the two groups,but the proportion of male in AF group was higher than that in non-AF group.(2)The composition ratio of atrial fibrillation patients and non-atrial fibrillation patients in different age groups was different.In patients with hypertension and atrial fibrillation,the elderly were mainly 60-79 years old but in patients with simple hypertension were mainly 45-59-year-old middle-aged people.(3)Among patients of the two groups,the Han population accounted for the majority and the ethnic compositions of the two groups did not differ from each other.(4)Comparison of alcohol consumption(31.25%vs.47.43%,P=0.001),gender(59.38%vs.69.71%,P=0.022),age[(61.93±10.62)years old vs.(54.89±10.86)years old,P<0.05],neutrophil count[(4.12±1.76)×10^9 vs.(3.25±1.03)×10^9,P<0.05],lymphocyte count[(2.14±0.87)×10^9,vs.(2.01±0.64)×10^9,P=0.009],left atrial diameter[(36.09±4.64)mm vs.(33.20±3.18)mm,P<0.05],neutrophil to lymphocyte ratio[(2.39±2.51)%vs.(1.73±0.75)%,P=0.009],uric acid[(359.24±81.19)μmol/L vs.(335.31±100.87)μmol/L,P=0.026],fasting blood glucose[(5.08±1.06)mmol/L vs.(5.10±0.85)mmol/L,P=0.023]and lactate dehydrogenase[(173.01±42.74)U/L vs.(170.14±34.80)U/L,P=0.045]between the two groups were statistically significant(P<0.05);the smoking status,high-density lipoprotein,low-density lipoprotein,total bilirubin,direct bilirubin,indirect bile the differences of erythropoietin,monocyte count,red blood cell distribution width,platelet count and platelet to lymphocyte ratio between two groups were not statistically significant(P>0.05).Binary Logistic regression analysis showed that age,uric acid,left atrial diameter and neutrophil to lymphocyte ratio were the independent risk factors for atrial fibrillation.Conclusion(1)There were differences in gender and age distribution between patients with simple essential hypertension and patients with essential hypertension complicated by atrial fibrillation in our hospital,but no difference in ethnic distribution.(2)Uric acid,left atrial diameter and neutrophils to lymphocytes cell ratio are the independent risk fectors for atrial fibrillation and the clinical value of the left atrial diameter is the largest.