慢性心力衰竭患者心肌纤维化与恶性心律失常的关系

Relationship between Myocardial Fibrosis and Malignant Arrhythmia in Patients with Chronic Heart Failure

目的分析慢性心力衰竭(CHF)患者心肌纤维化与恶性心率失常(MVA)的关系。方法收集2018年3月至2020年3月宜宾市第四人民医院收治的CHF患者93例,设为CHF组(根据24 h心动图了解其MVA发生情况,分为无MVA组和MVA组)。另选取本院心内科住院患者78例设为对照组。对比CHF组与对照组心肌纤维化指标、心脏超声参数水平,对比无MVA组和MVA组心肌纤维化指标水平及心脏超声参数;分析心肌纤维化指标与心动图参数之间的相关性,以及导致CHF患者发生MVA的危险因素。结果CHF组患者层黏蛋白(LN)、Ⅲ前胶原氨基端肽(PⅢNP)、透明角质酸(HA)水平均明显高于对照组;左心室舒张末期内径(LVEDD)明显大于对照组,左心室射血分数(LVEF)明显小于对照组(P<0.05)。93例患者中41例(44.09%)发生MVA,52例(55.91%)未发生MVA,MVA组LN、PⅢNP、HA水平均明显高于无MVA组,LVEDD明显大于无MVA组,LVEF明显小于无MVA组(P<0.05);经相关性分析可知LN、PⅢNP、HA与LVEDD均呈正相关,与LVEF均呈负相关(P<0.05);Logistic回归分析可知,LN、PⅢNP、HA、LVEF、LVEDD为影响CHF患者发生MVA的独立危险因素(P<0.05),年龄、性别为非影响因素(P>0.05)。结论CHF患者心肌纤维化指标LN、PⅢNP、HA明显升高,且为MVA发生的独立危险因素,监测患者心肌纤维指标变化可为预防MVA发生提供参考。

Objective To analyze the relationship between myocardial fibrosis and malignant arrhythmia(MVA)in patients with chronic heart failure(CHF).Methods The 93 CHF patients who were admitted to the Fourth People’s Hospital of Yibin from March 2018 to March 2020 were collected and set as the CHF group(understand the occurrence of MVA according to 24 h electrocardiogram,the patients were divided into no MVA group and MVA group).In addition,78 patients in the cardiology department of this hospital were selected as the control group.The levels of myocardial fibrosis indexes and echocardiographic parameters between the CHF group and the control group were compared.The levels of myocardial fibrosis index and the echocardiographic parameters of the non-MVA group and the MVA group were compared.The correlation between myocardial fibrosis indexes and cardiogram parameters and the risk factors of MVA in CHF patients were analyzed.Results The levels of laminin(LN),procollagen amino terminal peptide(PⅢNP),and hyaluronic acid(HA)in CHF group were significantly higher than those in the control group;left ventricular end diastolic diameter(LVEDD)values were significantly higher than those in the control group,and left ventricular ejection fraction(LVEF)was significantly lower than that in the control group(P<0.05);41 out of 93 patients(44.09%)had MVA,52 cases(55.91%)did not have MVA.The levels of LN,PⅢNP,and HA in the MVA group were significantly higher than those in the non-MVA group;the LVEDD value was significantly greater than that in the non-MVA group,and the LVEF was significantly lower than that in the non-MVA group(P<0.05).Correlation analysis showed that LN,PⅢNP and HA were all positively correlated with LVEDD,and were negatively correlated with LVEF(P<0.05).Logistic regression analysis showed that LN,PIIINP,HA,LVEF,and LVEDD were independent risk factors of MVA in CHF patients(P<0.05),age and gender were not influencing factors(P>0.05).Conclusion The myocardial fibrosis indexes LN,PⅢNP and HA of CHF patients significantly increases,and they are independent risk factors for the occurrence of MVA.Monitoring the changes of the myocardial fiber indexes of patients can provide a reference in preventing the occurrence of MVA.