HIV感染者血清白蛋白、球蛋白、白球蛋白比例与心电图异常的关联

Associations between albumin,globulin,albumin to globulin ratio and electrocardiographic abnormalities among people living with HIV

目的了解HIV感染者的血清白蛋白(albumin,ALB)、球蛋白(globulin,GLB)和白球蛋白比例(albumin to globulin ratio,AGR)与心电图(electrocardiograph,ECG)异常之间的关联性。方法采用横断面研究的方法,选自2017-2018年“HIV与衰老相关疾病前瞻性队列研究”基线数据,纳入1788例18~<75岁的HIV感染者进行分析。低ALB定义为血清ALB<38 g/L,高GLB定义为血清GLB>35 g/L,低AGR定义为AGR≤1.5,ECG异常定义为出现任何心电图结果异常。采用多因素logistic回归分析模型分析ALB、GLB和AGR与ECG异常的关联性。结果ECG异常、快心律失常、窦性心动过速、ST/T段异常和左室高电压的患病率分别为41.16%(736/1788)、9.00%(161/1788)、6.15%(110/1788)、14.88%(266/1788)和5.26%(94/1788)。3.08%(55/1788)的研究对象为低ALB,37.19%(665/1788)为高GLB,65.49%(1171/1788)为低AGR。多因素logistic回归分析模型结果显示,调整年龄、性别、ALT、AST、BMI、高血压、HIV特异性变量等之后,低ALB是窦性心动过速(aOR=4.89,95%CI:1.96~12.20,P=0.001)和快心律失常(aOR=3.24,95%CI:1.50~6.99,P=0.003)的独立影响因素。高GLB是窦性心动过速的独立影响因素(aOR=1.66,95%CI:1.00~2.74,P=0.049),而与其他ECG异常差异均无统计学意义(均P>0.05)。AGR降低与窦性心动过速差异均无统计学意义(均P>0.05)。结论HIV感染者存在较高比例的白球蛋白水平异常。低ALB和高GLB是窦性心动过速的独立危险因素,提示异常的白球蛋白水平可能侧面反映较高的炎症反应状态,可为预测该人群心血管疾病的发病风险提供新的线索和依据,但其中的因果关系和机制需要进一步研究。

Objective To investigate the associations of serum albumin(ALB),globulin(GLB),albumin to globulin ratio(AGR)with electrocardiographic(ECG)abnormalities among people living with HIV.Methods This cross-sectional investigation included 1788 between 18-<75 years old from the baseline survey of Comparative HIV and Aging Research in Taizhou(CHART)cohort China from 2017 to 2018.We defined low ALB as serum ALB<38 g/L,high GLB as serum GLB>35 g/L,low AGR as AGR≤1.5,ECG abnormalities as the presence of any ECG abnormal manifestations.Multivariable logistic regression model was used to analyze the associations of ALB,GLB,AGR with ECG abnormalities.Results The prevalence of ECG abnormalities,tachycardia,sinus tachycardia,ST/T wave abnormalities and LV hypertrophy was 41.16%(736/1788),9.00%(161/1788),6.15%(110/1788),14.88%(266/1788)and 5.26%(94/1788),respectively.About 3.08%(55/1788)of participants had low ALB,37.19%(665/1788)had high GLB and 65.49%(1171/1788)had low AGR.After adjusting for traditional risk factors including age,sex,ALT,AST,BMI,hypertension and HIV-specific factors,low ALB was independently associated with sinus tachycardia(aOR=4.89,95%CI:1.96-12.20,P=0.001)and tachycardia(aOR=3.24,95%CI:1.50-6.99,P=0.003),and high GLB was independently associated with sinus tachycardia only(aOR=1.66,95%CI:1.00-2.74,P=0.049).However,no statistically significant association was found for any other ECG abnormalities(all P>0.05).And there was no statistical significance between low AGR and sinus tachycardia(all P>0.05).Conclusions Abnormal ALB and/or GLB levels are common among PLWH.The independently positive associations of low ALB,high GLB and low AGR with sinus tachycardia suggest that abnormal albumin and globulin levels may reflect the elevated inflammatory state in PLWH and thus may provide new evidence for better predicting cardiovascular disease risk among PLWH.However,the causation and underlying mechanisms need to be further investigated.