维生素D缺乏与老年高血压合并心房颤动的相关性

Relationship between vitamin D deficiency and atrial fibrillation in elderly hypertensive patients

目的 探讨维生素D缺乏与老年高血压合并心房颤动的关系及其预测价值。方法 选取2019年1月—2021年12月,于中国人民解放军第三〇五医院就诊的老年高血压患者192例,根据有无房颤分为研究组(n=102)和对照组(n=90)。记录受试者的一般资料和实验室指标,测定心脏超声参数。采用Pearson相关分析探讨25-羟维生素D[25(OH)D]与超敏C反应蛋白(hs-CRP)和左房内径(LAD)的相关性;以logistic回归预测高血压合并房颤的影响因素;通过受试者操作特征曲线分析血清25(OH)D水平对房颤的预测作用。结果 与对照组比较,研究组hs-CRP水平升高,25(OH)D水平降低,LAD增大,LVEF降低,差异均有统计学意义(P<0.05)。25(OH)D与LAD呈显著负相关(r=-0.180,P=0.013)。多因素logistic回归分析发现,hs-CRP水平升高(OR=1.474, 95%CI:1.150~1.888,P=0.002)、 25(OH)D水平降低(OR=1.281, 95%CI:1.141~1.440,P<0.001)以及LAD增大(OR=1.450, 95%CI:1.234~1.703,P<0.001)是老年高血压合并房颤的危险因素。以25(OH)D 16.68 ng/mL作为预测房颤的临界值,曲线下面积为0.717,灵敏度为65.70%,特异度为74.44%。结论 维生素D缺乏有望成为预测老年高血压患者房颤的潜在指标。

Objective To investigate the relationship between vitamin D deficiency and atrial fibrillation in elderly hy⁃pertensive patients and its predictive value.Methods A total of 192 elderly hypertension patients admitted to Hospital 305 of People􀆳s Liberation Army from January 2019 to December 2021 were selected and divided into study group(n=102)and con⁃trol group(n=90)according to the presence or absence of atrial fibrillation.Their general data and laboratory indicators were recorded and cardiac ultrasound parameters were determined.Pearson correlation analysis was used to investigate the correlation between 25⁃hydroxyvitamin D[25(OH)D]and hypersensitive C⁃reactive protein(hs⁃CRP)and left atrial diameter(LAD).Logistic regression was used to predict the influencing factors of hypertension complicated with atrial fibrillation.The predictive effect of serum 25(OH)D level on atrial fibrillation was analyzed by receiver operating characteristic curve.Results Com⁃pared with the control group,the levels of hs⁃CRP and LAD in the study group increased and 25(OH)D and LVEF decreased,with significant differences(P<0.05).25(OH)D was negatively correlated with LAD(r=-0.180,P=0.013).Multivari⁃ate logistic regression analysis showed that elevated hs⁃CRP level(OR=1.474,95%CI:1.150⁃1.888,P=0.002),decreased 25(OH)D level(OR=1.281,95%CI:1.141⁃1.440,P<0.001)and increased LAD(OR=1.450,95%CI:1.234⁃1􀆰703,P<0.001)were risk factors for hypertension complicated with atrial fibrillation in the elderly.Using 25(OH)D 16.68 ng/mL as the critical value to predict atrial fibrillation,the area under the curve was 0.717,the sensitivity was 65.70%,and the speci⁃ficity was 74.44%.Conclusion Vitamin D deficiency may be a potential predictor of atrial fibrillation in elderly patients with hypertension.