不同类型非瓣膜性心房颤动与HbA1c的相关性分析

Relationship betwwen non-valvular aterial fibrillation and glycosylated hemoglobin

目的分析老年住院病人不同类型的非瓣膜性心房颤动与HbA1c的相关性。方法纳入我科住院的老年非阵发性房颤病人112例和阵发性房颤病人111例,以同时期住院的535例无房颤病人为对照组,比较分析3组血糖、血压、血脂等生化指标及左房直径(LAD)、合并疾病等基线资料。以Logistic回归校正危险因素后分析阵发性和非阵发性心房颤动与HbA1c的相关性。结果阵发性房颤组和非阵发性房颤组的SBP、DBP、白蛋白(ALB)、TC、TG水平明显低于无房颤组,年龄、LAD、脂蛋白(a)[Lp(a)]、hs-CRP、纤维蛋白原(FIB)明显高于无房颤组,差异均有统计学意义(P<0.05)。阵发性房颤组LAD、Hcy、FPG、HbA1c、尿微量白蛋白肌酐比值(UACR)水平明显低于非阵发性房颤组(P<0.05)。多因素Logistic回归分析示HbA1c(OR=1.718,95%CI1.180~2.500,P<0.01)、LAD(OR 16.631,95%CI7.588~36.453,P<0.01)与非阵发性房颤呈独立正相关;SBP(OR=0.959,95%CI0.938~0.981,P<0.01)与非阵发性房颤呈独立负相关。LAD(OR=4.212,95%CI1.829~9.699,P<0.05)及心功能不全(OR=7.868,95%CI1.685~36.742,P<0.01)是阵发性房颤进展为非阵发性房颤的独立危险因素。结论非阵发性房颤病人具有显著升高的HbA1c和糖尿病患病率,LAD和心功能不全是阵发性房颤进展为非阵发性房颤的危险因素。

Objective To investigate the relationship between glycosylated hemoglobin(HbA1c)and non-valvular atrial fibrillation(AF)of different types in the elderly in-patients.Methods A total of 758 in-patients aged>60 years old were enrolled and divided into non-AF group(n-AF,n=535),the paroxysmal AF group(p-AF,n=111)and the non-paroxysmal-AF(np-AF,n=112).All patients underwent routine collections of medical history,physical examination and blood testing.Logistic regression was used to analysis the correlations between HbA1c and p-AF and np-AF.Results The levels of systolic blood pressure(SBP),diastolic blood pressure(DBP),albumin(ALB),cholesterol(TC),triglyceride(TG)were significantly lower and the age,left atrial diameter(LAD),the levels of lipoprotein(a)[Lp(a)],high sensitivity C reaction protein(hs-CRP),fibrinogen(FIB)were significantly higher in p-AF and np-AF group than those in n-AF group(P<0.05).Compared with np-AF group,the levels of LAD,homocysteine(Hcy),fasting plasma glucose(FPG),HbA1c,urinary microalbumin creatinine ratio(UACR)in p-AF group were significantly lower(P<0.05).Logistic regression analysis showed HbA1c(OR=1.718,95%CI 1.180-2.500,P<0.01)and LAD(OR=16.631,95%CI7.588-36.453,P<0.01)were positively correlated with np-AF independently,while SBP(OR=0.959,95%CI 0.938-0.981,P<0.01)was negatively correlated with np-AF.LAD(OR=4.212,95%CI1.829-9.699,P<0.01)and HF(OR=7.868,95%CI1.685-36.742,P<0.01)were positively correlation with p-AF developing into np-AF independently.Conclusions The concentrations of HbA1c and the prevalence rate of DM in np-AF were elevated significantly.LAD and heart failure were positively correlated with the progression of p-AF developing into np-AF.