阵发性房颤患者血尿酸水平与左心房时相功能及机械僵硬度的相关性研究

Correlation between serum uric acid level and left atrial phase function and mechanical stiffness in patients with paroxysmal atrial fibrillation

目的 应用二维斑点追踪技术(2D-STI)评价血尿酸(SUA)水平对阵发性房颤(PAF)患者左心房时相功能及机械僵硬度(LAMS)的影响,并讨论SUA水平对PAF患者临床诊疗的价值。方法 纳入2021年5月—2022年4月兰州大学第一医院收治的PAF患者90例,根据SUA水平分组,SUA>420μmol·L^(-1)为SUA升高组(n=41),其余为SUA正常组(n=49),同时纳入健康人群作为健康对照组(n=27)。测量左房前后径(LAD)、左房最大容积(LAVmax)、左房最小容积(LAVmin)、左房总排空分数(LAtEF)、二尖瓣血流舒张早期峰值流速E峰及二尖瓣室间隔瓣环及侧壁瓣环舒张早期速度(e′)并计算平均速度。采用2D-STI评估左心房储器应变(LASr)、管道应变(LAScd)、泵应变(LASct)、左心房储器应变率(pLASRr)、管道应变率(pLASRcd)、泵应变率(pLASRct)及LAMS。结果 与健康对照组相比,PAF患者LAD、LAVmax、LAVmin增大(P<0.05),LAtEF减小(P<0.05)。左心房应变及应变率参数比较中,与健康对照组相比,SUA正常组和SUA升高组LASr、LAScd、LASct、pLASRr、pLASRcd、pLASRct均减小,LAMS均增大(P<0.05)。与SUA正常组比较,SUA升高组LASr、LAScd、LASct、pLASRr、pLASRcd、pLASRct更小,LAMS更大(P<0.05)。在不同性别左心房二维斑点追踪超声心动图参数比较中,健康对照组、SUA正常组男女性组间差异无统计学意义(P>0.05),SUA升高组女性LASr、LAScd、pLASRr相较于男性减低(P<0.05),LASct、pLASRcd、pLASRct、LAMS差异无统计学意义(P>0.05)。相关性分析显示,SUA水平与LASr、LAScd、LASct、pLASRr、pLASRcd、pLASRct、LAtEF呈负相关(r=-0.36,P<0.001;r=-0.30,P=0.001;r=-0.31,P=0.001;r=-0.31,P=0.001;r=-0.27,P=0.004;r=-0.29,P=0.002),与LAVmax、LAVmin、LAMS呈正相关(r=0.25,P=0.009;r=0.28,P=0.003;r=0.24,P=0.013)。结论 SUA与PAF患者左房时相功能呈负相关,并且SUA对老年女性患者左心房功能的影响更为敏感。

Objective To evaluate the effect of serum uric acid(SUA)level on left atrial phase function and mechanical stiffness(LAMS)in patients with paroxysmal atrial fibrillation by 2D-STI,and discuss the value of SUA level in clinical diagnosis and treatment of patients with atrial fibrillation.Methods Ninety patients with paroxysmal atrial fibrillation were enrolled in our hospital.According to SUA levels,SUA>420μmol-1 were classified as the group with elevated SUA levels(n=41),and the rest as the group with normal SUA levels(n=49).At the same time,27 healthy controls were included.The anterior-posterior diameter of left atrium(LAD),the largest volume of left atrium(LAVmax),the smallest volume of left atrium(LAVmin),the total emptying fraction of left atrium(LAtEF),the peak velocity of mitral blood flow in early diastole,and the early diastolic velocity(e')of mitral ventricular septal annulus and lateral annulus were measured,and the average velocity was calculated.2D STI was used to evaluate left atrial reservoir strain(LASr),pipeline strain(LAScd),pump strain(LASct),left atrial reservoir strain rate(pLASRr),pipeline strain rate(pLASRcd),pump strain rate(pLASRct)and LAMS.Results Compared with the healthy control group,LAD,LAVmax and LAVmin in patients with paroxysmal atrial fibrillation increased(P<0.05),while LATEF decreased(P<0.05).Compared with the healthy group,the parameters of left atrium strain and strain rate showed that LASr,LAScd,LASct,pLASRr,pLASRcd and pLASRct in the normal SUA level group and the elevated SUA level group all decreased,and LAMS increased(P<0.05).Compared with the normal SUA group,LASr,LAScd,LASct,pLASRr,pLASRcd,pLASRct were smaller and LAMS were larger(P<0.05).Comparing the parameters of left atrial two-dimensional speckle tracking echocardiography of different genders,there was no significant difference between male and female groups in the healthy control group and SUA normal group(P>0.05),while the LASr,LAScd and pLASRr of female group with increased SUA were lower than those of male group(P<0.05),and there was no significant difference in LASct,pLASRcd,pLASRct and LAMS(P>0.05).Correlation analysis showed that SUA level was negatively correlated with LASr,LAScd,LASct,pLASRr,pLASRcd,pLASRct and LAtEF(r=0.36,P<0.001;r=0.30,P=0.001;r=0.31,P=0.001;r=0.31,P=0.001;r=0.27,P=0.004;r=0.29,P=0.002),which was positively correlated with LAmax,LAmin and LAMS(r=0.25,P=0.009;r=0.28,P=0.003;r=0.24,P=0.013).Conclusion SUA is negatively correlated with the left atrial phase function in patients with atrial fibrillation,and SUA is more sensitive to the left atrial function in elderly female patients.