血清促肾上腺皮质激素与老年高血压合并射血分数保留型心力衰竭患者发生心房颤动的关系

Relationship between Serum Adrenocorticotropic Hormone and Atrial Fibrillation in Elderly Hypertensive Patients Combined with Heart Failure with Preserved Ejection Fraction

目的 探讨血清促肾上腺皮质激素(ACTH)与老年高血压合并射血分数保留型心力衰竭(HFpEF)患者发生心房颤动(以下简称房颤)的关系。方法 前瞻性选取2020年5月至2021年10月于青海省心脑血管病专科医院就诊的老年高血压合并HFpEF患者150例。收集所有患者一般资料、实验室检查指标及房颤发生情况。采用多因素Logistic回归分析探讨血清ACTH与高血压合并HFpEF患者发生房颤的关系。结果 150例患者中,6例随访期间失访、2例随访期间病死,最终纳入142例患者。142例患者中60例发生房颤,房颤发生率为42.2%,将其作为房颤组,其余82例患者作为非房颤组。房颤组入院时收缩压、舒张压及血清N末端脑钠肽前体(NT-proBNP)、心肌肌钙蛋白I(cTnI)、ACTH高于非房颤组(P<0.05)。多因素Logistic回归分析结果显示,血清NT-proBNP[OR=1.348,95%CI(1.123,1.618)]、ACTH[OR=1.262,95%CI(1.026,1.552)]升高是老年高血压合并HFpEF患者发生房颤的独立危险因素(P<0.05)。结论 血清ACTH升高是老年高血压合并HFpEF患者发生房颤的危险因素,即血清ACTH越高,患者房颤发生风险越高。

Objective To investigate the relationship between serum adrenocorticotropin(ACTH)and atrial fibrillation in elderly hypertensive patients combined with heart failure with preserved ejection fraction(HFpEF).Methods A total of 150 elderly hypertension patients combined with HFpEF were prospectively selected from May 2020 to October 2021 in Qinghai Province Cardiovascular and Cerebrovascular Disease Specialist Hospital.General data,laboratory examination indicators and the occurrence of atrial fibrillation were collected.Multivariate Logistic regression analysis was used to investigate the relationship between serum ACTH and atrial fibrillation in elderly hypertension patients combined with HFpEF.Results Among 150 patients,6 cases were lost to follow-up and 2 cases died during follow-up.Finally,142 patients were included.Among 142 patients,60 had atrial fibrillation,with an incidence of 42.2%,they were included in the atrial fibrillation group,and the rest 82 patients were included in the non-atrial fibrillation group.The levels of systolic blood pressure and diastolic blood pressure at admission and serum N-terminal pro-brain natriuretic peptide(NT-proBNP),cardiac troponin I(cTnI)and ACTH in the atrial fibrillation group were higher than those in the non-atrial fibrillation group(P<0.05).Multivariate Logistic regression analysis showed that increased serum NT-proBNP[OR=1.348,95%CI(1.123,1.618)]and ACTH[OR=1.262,95%CI(1.026,1.552)]were independent risk factors for atrial fibrillation in elderly hypertensive patients combined with HFpEF(P<0.05).Conclusion Increased serum ACTH is a risk factor for atrial fibrillation in elderly hypertension patients combined with HFpEF,that is,the higher the serum ACTH level,the higher the risk of atrial fibrillation.