采用自体动静脉内瘘维持性血液透析患者新发心房颤动危险因素分析

Risk factors of new atrial fibrillation in patients undergoing maintenance hemodialysis with autoarteriovenous fistula

目的 探讨采用自体动静脉内瘘维持性血液透析患者新发心房颤动(AF)的危险因素。方法 选取自2017年1月至2022年11月收治的采用自体动静脉内瘘维持性血液透析患者134例为研究对象。其中,新发AF的67例患者纳入AF组,并将AF组按AF类型分为阵发性心房颤动(PAF)亚组(n=26)和非阵发性心房颤动(NPAF)亚组(n=41)。将同期住院且未发生AF的67例患者纳入非AF组。比较AF组与非AF组患者的临床指标,采用单因素和多因素Logistic回归分析法探究可能发生AF的危险因素,比较阵发性AF亚组与非阵发性AF亚组患者的临床指标,采用单因素和多因素Logistic回归分析法探究新发AF呈持续性发展的危险因素。采用受试者工作特征(ROC)曲线评估危险因素对维持性血液透析患者新发AF的预测价值。结果 多因素Logistic回归分析结果显示,左心房内径增大、N端B型钠尿肽原>35 000 pg/ml是维持性血液透析患者新发AF的独立危险因素。多因素Logistic回归分析结果显示,室间隔厚度增加是维持性血液透析患者新发AF呈持续性发展的危险因素。ROC曲线结果显示,左心房内径曲线下面积为0.772,95%可信区间为0.693~0.851,最佳临界值为40.5 mm,敏感度为53.7%,特异度为91.0%。结论 左心房内径增大、N端B型钠尿肽原>35 000 pg/ml是维持性血液透析患者新发AF的独立危险因素。室间隔厚度增加是维持性血液透析患者新发AF呈持续性发展的危险因素。左心房内径对AF的发生具有较好的预测价值,当左心房内径≥40.5 mm时的预测效能较高。

Objective To investigate the risk factors of new atrial fibrillation(AF)in patients undergoing maintenance hemodialysis with autoarteriovenous fistula.Methods A total of 134 patients undergoing maintenance hemodialysis with autoarteriovenous fistula from January 2017 to November 2022 were selected as the study objects.Among them,67 patients with new AF were included in the AF group,and the AF group was divided into paroxysmal atrial fibrillation(PAF)subgroup(n=26)and non-paroxysmal atrial fibrillation(NPAF)subgroup(n=41)according to AF type.A total of 67 patients who were hospitalized during the same period and did not develop AF were included in the non-AF group.The clinical indicators of patients in AF group and non-AF group were compared,univariate and multivariate Logistic regression analysis was used to explore the possible risk factors for AF,and the clinical indicators of patients in paroxysmal AF subgroup and non-paroxysmal AF subgroup were compared.Univariate and multivariate Logistic regression analysis were used to explore the risk factors for the persistent development of new AF.The predictive value of risk factors for new AF in maintenance hemodialysis patients was evaluated using receiver operating characteristic(ROC)curves.Results Multivariate Logistic regression analysis showed that left atrial diameter enlargement and N-terminal pro-B-type natriuretic peptide>35000 pg/ml were independent risk factors for new AF in maintenance hemodialysis patients.Multivariate Logistic regression analysis showed that increased interventricular septal thickness was a risk factor for the continuous development of new AF in maintenance hemodialysis patients.ROC curve results showed that the area under the curve of the left atrial diameter was 0.772,95%confidence interval was 0.693-0.851,the optimal critical value was 40.5 mm,the sensitivity was 53.7%,and the specificity was 91.0%.Conclusion Left atrial diameter enlargement and N-terminal B-type natriuretic peptide>35000 pg/ml were independent risk factors for new AF in maintenance hemodialysis patients.Increased interventricular septal thickness is a risk factor for the persistent development of new AF in maintenance hemodialysis patients.The left atrial diameter has a good predictive value for AF occurrence,and when the left atrial diameter is not less than 40.5 mm,the prediction effect is higher.