射血分数保留心衰患者NT-proBNP与房颤的相关性研究

Association between NT-proBNP and atrial fibrillation in heart failure patients with preserved ejection fraction

目的 探讨射血分数保留心力衰竭(HFpEF)患者血清N末端B型利钠肽原(NT-proBNP)水平及其他因素与房颤(AF)的相关性。方法 回顾性分析2020年1~8月就诊于我院心血管内科的HFpEF患者419例,其中合并AF 107例,检测血清NT-proBNP水平,根据血清NT-proBNP中位数水平(351pg/ml)分为两组(Q1组≤351pg/ml,Q2组>351pg/ml)。采用Logistic回归分析NT-proBNP及其他因素与AF的关系。结果 (1)高NT-proBNP组(Q2组)AF发生率高;(2) Logistic回归分析显示:高NT-proBNP水平[(OR=1.082,95%CI1.044~1.121),P<0.05],左心房内径(LAD)增大[OR=1.201,95%CI(1.129~1.277),P<0.05],平均心率增快[OR=1.033,95%CI(1.015~1.051),P<0.05]增加合并AF的风险;使用钙通道阻滞剂[OR=0.336,95%CI(0.172~0.657),P<0.05]降低合并AF的风险;(3) NT-proBNP水平与发生AF风险的拟合曲线显示:随着NT-proBNP水平增高,发生AF风险增大;(4) ROC曲线显示:NT-proBNP预测HFpEF患者合并AF的截断值为421pg/ml,曲线下面积为0.862,敏感度为83.8%,特异性为74.5%。结论 在HFpEF患者中,NTproBNP、LAD、心率、使用钙通道阻滞剂与AF相关,NT-proBNP预测HFpEF合并AF具有较高临床价值。

Objective To analyse the association between NT-proBNP level and atrial fibrillation(AF) in heart failure patients with preserved ejection fraction(HFpEF). Methods Selected 419 patients with HFpEF in our hospital from Jan to Aug, 2020, including 107 patients with AF. Patients were divided into two groups according to median NT-proBNP level, patients with NT-proBNP≤351pg/ml were in Q1 group, patients with NT-proBNP>351pg/ml were in Q2 group. Analysed the relationship between NT-proBNP and AF by Logistic regression, drew the fitting curve and ROC curve. Results(1) The incidence of AF in high NT-proBNP group(Q2 group) was high.(2) Logistic regression analysis showed that higher NT-proBNP level [OR=1.082, 95%CI(1.044~1.121), P<0.05], larger left atrial diameter [OR=1.201, 95%CI(1.129~1.277), P<0.05] and faster average heart rate [OR=1.033, 95%CI(1.015~1.051), P<0.05]increased the risk of AF, the use of calcium channel blockers [OR=0.336, 95%CI(0.172~0.657), P<0.05] reduced the risk of AF.(3)The fitting curve between NT-proBNP level and the risk of AF showed that the risk of AF increased with the increase of NT-proBNP level.(4) ROC curve showed that the cut-off value of NT-proBNP for predicting AF in HFpEF patients was 421pg/ml, the area under the ROC curve was 0.862,the sensitivity was 83.8%, and the specificity was 74.5%. Conclusion In HFpEF patients, NT-proBNP, LAD, heart rate and the use of calcium channel blockers are associated with AF. NT-proBNP has great clinical value in predicting HFpEF with AF.