房颤患者发生重度二尖瓣反流的影响因素分析

Analysis of Influencing Factors for Severe Mitral Regurgitation in Patients with Atrial Fibrillation

【目的】探讨房颤患者发生重度二尖瓣反流(MR)的影响因素。【方法】回顾性分析2018年8月至2020年3月本院心内科收治的98例房颤合并MR患者的临床资料,根据MR严重程度将其分为重度MR组(n=19)、中度MR组(n=46)、轻度MR组(n=33)。比较三组患者心脏超声指标及临床资料的差异,采用多因素Logistic回归分析相关指标与房颤患者发生重度MR的相关性,采用受试者工作特征(ROC)曲线分析相关指标评估房颤患者发生重度MR的临床价值。【结果】重度MR组患者房颤病程长于及B型脑钠肽(BNP)水平显著高于中度MR组、轻度MR组,差异有统计学意义(P<0.05)。重度MR组左心房内径(LAD)、二尖瓣流速(MV)及右心房容积(RAV)显著大于中度MR组、轻度MR组,左心室射血分数(LVEF)显著低于中度MR组、轻度MR组,差异有统计学意义(P<0.05)。多因素Logistic回归分析结果显示,LAD、房颤病程及BNP是房颤患者发生重度MR的影响因素(P<0.05)。ROC曲线分析显示,LAD评估房颤患者发生重度MR的曲线下面积(AUC)显著高于房颤病程及BNP(P<0.05),同时房颤病程及BNP价值相当(P>0.05)。【结论】LAD、BNP及房颤病程是AF患者发生重度MR的影响因素,也是识别重度MR的潜在指标。

【Objective】To explore the influencing factors of severe mitral regurgitation(MR)in patients with atrial fibrillation.【Methods】A retrospective analysis was conducted on the clinical data of 98 patients with atrial fibrillation complicated with MR admitted to the cardiology department of our hospital from August 2018 to March 2020.They were divided into severe MR group(n=19),moderate MR group(n=46),and mild MR group(n=33)based on the severity of MR.We compared the differences in cardiac ultrasound indicators and clinical data among three groups of patients,and used multivariate logistic regression analysis to investigate the correlation between related indicators and the occurrence of severe MR in patients with atrial fibrillation.The clinical value of the occurrence of severe MR in patients with atrial fibrillation was evaluated using receiver operating characteristic curve(ROC)analysis of related indicators.【Results】The duration of atrial fibrillation and B-type brain natriuretic peptide(BNP)levels in the severe MR group were significantly higher than those in the moderate and mild MR groups,with statistically significant differences(P<0.05).The left atrial diameter(LAD),mitral valve velocity(MV)and right atrial volume(RAV)in the severe MR group were significantly higher than those in the moderate MR group and the mild MR group,and the left ventricular Ejection fraction(LVEF)was significantly lower than those in the moderate MR group and the mild MR group(P<0.05).Multivariate logistic regression analysis showed that LAD,duration of atrial fibrillation,and BNP were the influencing factors for the occurrence of severe MR in patients with atrial fibrillation(P<0.05).The Receiver operating characteristic analysis showed that the area under the curve(AUC)of LAD in evaluating severe MR in patients with atrial fibrillation was significantly higher than the duration and BNP of atrial fibrillation(P<0.05),and the duration and BNP of atrial fibrillation were equivalent(P>0.05).【Conclusion】LAD,BNP,and duration of atrial fibrillation are influencing factors for the occurrence of severe MR in AF patients,and are also potential indicators for identifying severe MR.