血脂水平与非瓣膜性心房颤动患者并发肺栓塞风险的关联研究

Study on the relationship between serum lipid levels and the risk of pulmonary embolism in patients with non-valvular atrial fibrillation

目的探讨血脂水平与非瓣膜性心房颤动(房颤)患者并发肺栓塞风险的关联.方法回顾性分析2014年1月至2019年1月在天津市胸科医院住院的非瓣膜性房颤患者,根据CT肺血管造影是否存在肺栓塞分为肺栓塞组和对照组两组,比较两组患者的临床资料和血脂参数,评估血脂参数与并发肺栓塞风险的关联.结果肺栓塞组载脂蛋白A1(ApoA1)和高密度脂蛋白胆固醇(HDL-C)水平分别为(1.09±0.25)g/L和(1.03±0.28)mmol/L,均低于对照组((1.24±0.25)g/L和(1.21±0.37)mmol/L(t=3.255、2.972,P=0.002、0.004);极低密度脂蛋白胆固醇(VLDL-C)水平为(0.41±0.24)mmol/L,高于对照组(0.26±0.18)mmol/L(t=-3.761,P=0.000).肺栓塞组入院时心功能分级高于对照组(χ^(2)=13.074,P=0.004)、房颤用药的比例低于对照组(x^(2)=5.445,P=0.020).Logistic回归分析结果显示,低ApoA1(OR=8.793、95%CI:1.815~42.607,P=0.007)和左心功能不全(OR=4.388、95%CI:1.352~14.244、P=0.014)使肺栓塞发生的风险增加,低VLDL-C(OR=0.180,95%CI:0.053~0.610、P=0.006)和房颤用药(OR=0.268、95%CI:0.072~0.992、P=0.049)使肺栓塞发生的风险降低.结论非瓣膜性房颤患者发生肺栓塞与血脂水平相关,调节血脂水平可能降低非瓣膜性房颤患者发生肺栓塞的危险.

Objective To investigate the relationship between serum lipid levels and the risk of pulmonary embolism in patients with non valvular atrial fibrillation.Methods Patients with non-valvular atrial fibrillation admitted to Tianjin Chest Hospital from January 2014 to January 2019 were retrospectively analyzed.According to whether pulmonary embolism was present on CT pulmonary angiography,patients were divided into two groups,the atrial fibrillation with pulmonary embolism group(the AP group)and the control group(the AF group).Clinical data and serum lipid test results were compared between the two groups.The relationship between serum lipid levels and the risk of pulmonary embolism was evaluated.Results Levels of apolipoprotein A1(ApoA1)and high density lipoprotein cholesterol(HDL-Cin the AP group were(1.09±0.25)g/L and(1.03±0.28)mmol/L,which were lower than those in the AF group(1.24±0.25)g/L and(1.21±0.37)mmol/L)(t=3.255.P-0.002;t=2.972.P=0.004,respectively).Levels of very low-density lipoprotein cholesterol(VLDL-C)in the AP group were(0.41±0.24)mmol/L.which were higher than those in the AF group(0.26±0.18)mmol/L)(t=-3.761,P-0.000).The grade of cardiac function on admission in the AP group was higher than that in the AF group(X^(2)=13.074.P=0.004).The proportion of patients treated for atrial fibillation in the AP group was lower than that in the AF group(χ^(2)=5.445.P=0.020).Logistic regression analysis showed that decreased ApoA1 and left cardiac insufficiency were risk factors for pulmonary embolism in patients with non-valvular atrial firillation(OR=8.793.95%CI:1.815~42.607,P=0.007;OR=4.388,95%CI:1.352~14.244,P=0.014,respectively).Decreased VLDL-C and atrial fbillation therapy were protective factors for pulmonary embolism(OR=0.180,95%CI:0.053~0.610.P=0.006;OR=0.268.95%CI:0.072~0.992.P=0.049.respectively).Conclusions Pulmonary embolism in paients with non-valvular atrial fibrillation is related to serum lipid levels.Regulating levels of serum lipids may reduce the risk of pulm on ary embolism in patients with non-valvular atrial fibrillation.