血清红细胞分布宽度、同型半胱氨酸水平与急性心梗并发房颤的相关性

Correlation of serum red cell distribution width and homocysteine levels with the incidence of acute myocardial infarction complicated by atrial fibrillation

目的研究血清红细胞分布宽度(red cell distribution width,RDW)、同型半胱氨酸(homocysteine,Hcy)与急性心肌梗死(acute myocardial infarction,AMI)并发房颤间的相关性.方法将2017年6月—2019年6月间海口市急救中心收治的97例AMI患者纳为研究对象,统计其入院后新发房颤发生率,并比较房颤组与非房颤组患者基线资料、合并症、心脏超声及实验室检查结果、脑梗死病变血管支数、入院时血清RDW及Hcy水平,并行多因素Logistic回归分析,探究影响AMI患者并发房颤的独立危险因素,绘制受试者工作曲线,分析RDW与Hcy在预测AMI并发房颤中价值.结果97例AMI患者入院后共21例并发房颤,房颤并发率为21.65%;统计房颤组与非房颤组临床资料发现,入院时,房颤组心率(Heart Rate,HR)、收缩末期左心房内径(left atrial di-ameter,LAD)、入院内24 h N末端B型脑利钠肽前体水平(N-terminal pro-brain ntriuretic peptide,NT-proB-NP)、RDW及Hcy水平均显著高于非房颤组(均P<0.05),其余指标水平无显著性差异(均P>0.05);将单因素分析有意义的指标纳入Logistic回归分析模型,发现LAD、24hNT-proBNP、RDW及Hcy均是AMI患者入院后并发房颤的独立危险因素;相关性分析提示,AMI并发房颤者血清RDW与其入院时HR、LAD及24 hNT-proBNP水平均呈明显正相关(P<0.05),血清Hcy水平与LAD及24hNT-proBNP呈明显正相关(P<0.05);绘制ROC曲线发现,RDW在预测AMI并发房颤中的AUC=0.754,95CI(0.659~0.848),Hcy在预测AMI并发房颤中的AUC=0.827,95CI(0.748~0.907).结论AMI患者入院后房颤发生率较高,而RDW及Hcy水平的检测在评估其房颤发生风险中具有重要意义,RDW及Hcy可能通过氧化应激反应参与房颤的发生.

Objective To investigate the correlation of serum red cell distribution width(RDW),homocysteine(Hcy)levels with the incidence of acute myocardial infarction(AMI)complicated by atrial fibrillation(AF)-Methods 97 AMI patients in Haikou Emergency Medical Center from June 2017 to June 2019,and the incidence rate of AF was also record-ed.Various indexes including baseline data,complications,echocardiography and laboratoiy examination results,number of blood vessels in cerebral infarction,the serum levels of RDW and Hcy were recorded.Multivariate logistic regression was used to analyze the independent risk factors of AF in patients with AMI.The receiver operating characteristic curve was drawn to analyze the value of RDW and Hcy in predicting AF in patients with AML Results The complication rate of AF was 21.65%(21/97).The levels of heart rate(HR),left atrium diameter(LAD),24 h N-terminal pro-brain ntriuretic peptide(NT-proBNP),RDW,and Hcy of the AF group were all significantly higher than those of the non-AF group at admission(all P<0.05),and there were no significant differences in other factors between these 2 groups(all P>0.05).Logistic regression analysis showed that LAD,24hNT-proBNP,RDW,and Hcy were independent risk factors for AF in patients with AML Correlation analysis showed that serum RDW was significantly positively correlated with HR,LAD,and 24 h NT-proBNP levels at admission(all P<0.05),and serum Hcy level was significantly positively correlated with LAD and 24 h NT-proBNP(both P<0.05).ROC curve indicated that RDW and Hcy had good pre-dictive value in AF for AMI patients[AUC=0.754,95CI(0.659-0.848);AUG=0.827,95CI(0.748-0.907)].Conclusion The incidence of AF is high in AMI patients after admission,and the detection of RDW and Hcy levels is of great significance in assessing the risk of AF.RDW and Hcy may participate in the occurrence of atrial fibrillation through oxidative stress response.