血清NT-proBNP、CRP、cTnⅠ及超声心动图与心房颤动关系的临床研究

Clinical study of the relationship between atrial fibrillation and serum NT-proBNP,CRP,cTnⅠlevel and echocardiography

目的:探讨血清脑利钠肽前体(NT-proBNP)、C反应蛋白(CRP)、肌钙蛋白Ⅰ(cTnⅠ)及超声心动图与心房颤动的关系。方法:选取2018年7月~2019年11月芜湖市第二人民医院住院且确诊为房颤的患者268例,同时选取同期住院非房颤患者148例作为对照,分别检测NT-proBNP、CRP、cTnⅠ和超声心动图,比较两组不同指标的差异,并通过多因素Logistic回归分析房颤的危险因子,绘制ROC曲线,研究血清标志物对房颤的预测价值。结果:两组性别、高血压病史比较差异均无统计学意义(P>0.05),房颤组的年龄大于非房颤组,心律不齐和冠心病病史两组差异均有统计学意义(P<0.05),符合房颤的特征。NT-proBNP、cTnⅠ和CRP含量房颤组高于非房颤组(P<0.05);超声心动图检查结果显示房颤组左心室舒张期内径(LVDd)、左心室收缩期内径(LVDs)、左房内径(LAD)指标均高于非房颤组(P<0.05),而射血分数(EF)和左心室缩短分数(FS)非房颤组高于房颤组(P<0.05)。多因素Logistic回归分析显示,年龄≥65岁(OR=3.395)、心律不齐(OR=36.688)、NT-proBNP异常(OR=21.566)和LAD(OR=4.197)是房颤发生的危险因素。结论:结合心律、年龄、检测NT-proBNP和检查超声心动图,多种技术联合评估,能准确评价房颤患者左心房功能,对患者的复律治疗、远期疗效评估及预后均有重要意义。

Objective:To observe the relationship between atrial fibrillation(AF)and serum N-terminal brain natriuretic propeptide(NT-proBNP),C-reactive protein(CRP),cardiac troponin I(cTnⅠ)level and echocardiography.Methods:268 hospitalized patients diagnosed with AF were included in observational group between July 2019 and November 2019,and another 148 hospitalized patients without atrial fibrillation were recruited in the same period as controls.Patients in the two groups underwent measurement of NT-proBNP,CRP and cTnⅠlevels as well as echocardiography,and compared for the diference of the indicators measured.Multivariate logistic regression model was used to analyze the risk factors of AF,and ROC curve was drawn to predict the value of serum markers for atrial fibrillation.Results:The difference was insignificant in gender and patient′s history of hypertension between groups(P>0.05).The age was older in patients with AF than those without atrial fibrillation group(P<0.05),and arrhythmia and history of coronary heart disease were statistically different between the two groups(P<0.05),which was consistent with the characteristics of AF.Patients with AF had higher levels of NT-proBNP,cTnⅠand CRP than those without atrial fibrillation(P<0.05).Echocardiography showed that the indicators of left ventricular end diastolic dimension(LVDd),left ventricular end systolic dimension(LVDs)and left atrial dimension(LAD)were higher in AF group than in non-atrial fibrillation group,whereas the indicators of ejection fraction(EF)and fractional shorting(FS)were lower in patients with AF(P<0.05).Multivariate logistic regression analysis revealed that age≥65 year old(OR=3.395),arrhythmia(OR=36.688),LAD(OR=4.197)and the level of NT-proBNP(OR=21.566)were the risk factors for AF.Conclusion:Combined evaluation of the indicators,including the rhythm,age and serum NT-proBNP measurement as well as echocardiography can accurately estimate the left atrial function of patients with AF,and particularly is of great significance for cardioversion treatment,estimation of the long-term therapeutic effects and prognosis for such patients.