血清尿酸及脑钠肽水平与射血分数保留心衰房颤患者房颤结构重构关系

Relationships of serum uric acid and brain natriuretic peptide levels with structural remodeling of atrial fibrillation in patients with heart failure with preserved ejection fraction

目的探讨血清尿酸(UA)、脑钠肽(BNP)水平与射血分数保留的心衰(HFpEF)合并房颤(AF)患者房颤结构重构的关系。方法选取保定市第一医院2020年5月至2022年5月收治的100例HFpEF合并AF患者为研究对象,其中阵发性AF患者46例(阵发性AF组),持续性AF患者54例(持续性AF组),选取同时期100例单纯HFpEF患者作为对照组。比较三组血清UA、BNP水平及左心房内径(LAD)、左心房容积指数(LAVI),并进行相关性分析。绘制受试者工作特征曲线(ROC)分析血清UA、BNP水平对HFpEF合并AF患者房颤结构重构的诊断价值。结果与对照组比较,阵发性AF组、持续性AF组血清UA、BNP水平更高,LAD、LAVI更大(P<0.05);与阵发性AF组比较,持续性AF组血清UA、BNP水平更高,LAD、LAVI更大(P<0.05)。HFpEF合并AF患者血清UA、BNP水平均与LAD、LAVI呈正相关(均P<0.05)。血清UA、BNP水平升高均是HFpEF合并AF患者房颤结构重构的危险因素(P<0.05)。血清UA、BNP联合诊断HFpEF合并AF患者房颤结构重构的AUC为0.853,敏感度和特异度分别为85.00%、70.00%。结论血清UA、BNP在HFpEF合并AF患者中呈现高表达,且均与房颤结构重构指标LAD、LAVI呈正相关,可在一定程度上作为诊断房颤结构重构的重要指标。

Objective To investigate the relationshipsof serum uric acid(UA)and brain natriuretic peptide(BNP)levels with structural remodeling of atrial fibrillation in patients with heart failure with preserved ejection fraction(HFpEF)complicated with atrial fibrillation(AF).Methods A total of 100 patients with HFpEF and AF admitted to Baoding No.1 Hospital from May 2020 to May 2022 were selected as the research objects.According to the medical history and dynamic electrocardiogram results,they were divided into paroxysmal AF group(n=46)and persistent AF group(n=54).Another 100 patients only with HFpEF during the same period were selected as control group.Serum UA and BNP levels and left atrial internal diameter(LAD)and left atrial volume index(LAVI)were compared between the three groups and correlation analysis was performed.The diagnostic value of serum UA and BNP levels for structural remodelling of AF in those patients with HFpEF and AF was analysed by plotting subject operating characteristic curves(ROC).Results The serum UA and BNP levels were higher and LAD and LAVI were significantly higher in the paroxysmal AF and persistent AF groups compared with the control group(P<0.05).The serum UA and BNP levels were higher and LAD and LAVI were greater in the persistent AF group compared with the paroxysmal AF group(P<0.05).The serum UA and BNP levels in the patients with HFpEF and AF were both positively correlated with LAD and LAVI(both P<0.05).Elevated serum UA and BNP levels were both risk factors for the structural remodeling of AF in the patients with HFpEF and AF(P<0.05).The AUC of the combined serum UA and BNP for the diagnosis of structural remodeling of AF in the patients with HFpEF and AF was 0.853,with the sensitivity and specificity of 85.00% and 70.00%,respectively.Conclusion Serum UA and BNP are expressed at a high level in patients with HFpEF combined with AF.Both of them are positive correlation with LAD and LAVI,indicating that then can be used as important indicators for the diagnosis of structural remodeling of AF to some extent.