血清直接胆红素联合尿酸与射血保留性心力衰竭合并心房颤动病人左心房重构的关系

李季; 史斌浩; 郝艳成; 王建飞

血清直接胆红素联合尿酸与射血保留性心力衰竭合并心房颤动病人左心房重构的关系

Association of serum direct bilirubin and uric acid with left atrial remodeling in HFpEF with atrial fibrillation

摘要

摘要:
目的： 探讨血清直接胆红素（DBIL）联合尿酸（UA）与射血保留性心衰（HFpEF）合并房颤（AF）病人左心房重构的关系。
方法： 选择185例HFpEF病人的临床资料，根据是否合并AF及AF分型将病人分为持续性AF组（57例，HFpEF合并持续性AF病人）、阵发性AF组（28例，HFpEF合并阵发性AF病人）和非AF组（100 例，单纯HFpEF病人），对其临床资料进行回顾性分析。比较3组血清UA、DBIL、N末端B型利钠肽原（NT-proBNP）水平及左心房内径（LAD），并进行相关性分析。多因素分析血清UA、DBIL水平与HFpEF 合并 AF 病人左心房结构重构的关系。绘制受试者工作特征曲线分析血清 UA、DBIL水平对 HFpEF合并 AF 病人左心房重构的诊断价值。
结果： 病人血清UA水平、DBIL水平及LAD按非AF组、阵发性AF组、持续性AF组排序均呈现组间递增趋势（P ＜ 0.01）；持续性AF组病人血清NT-pro BNP水平高于阵发性AF组和非AF组（P ＜ 0.01），而阵发性AF组和非AF组病人之间的血清NT-pro BNP水平差异无统计学意义（P ＞ 0.05）；HFpEF合并AF病人DBIL、UA及NT-proBNP水平均与LAD呈正相关（r = 0.383、0.447、 0.308，P ＜ 0.01）。多因素 logistic 回归分析结果显示，UA、DBIL水平升高均是发生心房重构的危险因素（P ＜ 0.05和P ＜ 0.01），但NT-proBNP不是发生左心房重构的危险因素（P ＞ 0.05）。血清UA、DBIL联合诊断HFpEF合并AF 病人左心房重构的AUC 为0.760，敏感度和特异度分别为83.70%、58.30%。
结论： 血清UA、DBIL在 HFpEF 合并 AF 病人中呈现高表达，且均与AF左心房重构指标 LAD呈正相关，可在一定程度上作为诊断AF左心房重构的重要指标，HFpEF合并AF病人中DBIL可能通过影响HFpEF的发展，促进左心房重构，进而影响AF发生发展。

Abstract:
Objective To investigate the association between serum direct bilirubin (DBIL) combined with uric acid (UA) and left atrial remodeling in patients with heart failure with preserved ejection fraction (HFpEF) complicated by atrial fibrillation (AF).
Methods Clinical data from 185 patients with HFpEF were retrospectively analyzed. Patients were stratified into three groups based on AF status: persistent AF group (n = 57, HFpEF with persistent AF), paroxysmal AF group (n = 28, HFpEF with paroxysmal AF), and non-AF group (n = 100, HFpEF without AF). Serum levels of UA, DBIL, N-terminal pro-B-type natriuretic peptide (NT-proBNP), as well as left atrial diameter (LAD), were compared across groups. Correlation and multivariate logistic regression analyses were performed to determine the relationship between UA/DBIL levels and left atrial structural (LAD) remodeling in HFpEF-AF patients. Receiver operating characteristic (ROC) curves were generated to evaluate the diagnostic value of UA and DBIL for left atrial remodeling.
Results Serum UA, DBIL, and LAD exhibited progressively increasing trends across the non-AF, paroxysmal AF, and persistent AF groups (all P ＜ 0.01). NT-proBNP levels were significantly higher in the persistent AF group than in the paroxysmal AF and non-AF groups (P ＜ 0.01), with no significant difference between paroxysmal AF and non-AF groups (P ＞ 0.05). In HFpEF-AF patients, DBIL, UA, and NT-proBNP levels showed positive correlations with LAD (r = 0.383, 0.447, and 0.308, all P ＜ 0.01). Multivariate analysis identified elevated UA (P ＜ 0.05) and DBIL (P ＜ 0.01) as independent risk factors for atrial remodeling, whereas NT-proBNP was not (P ＞ 0.05). The combination of UA and DBIL yielded an AUC of 0.760 (sensitivity 83.70%, specificity 58.30%) for diagnosing left atrial remodeling in HFpEF-AF patients.
Conclusions Serum UA and DBIL levels are significantly elevated in HFpEF-AF patients and are positively correlated with LAD, a marker of left atrial remodeling. These biomarkers may serve as potential diagnostic indicators for left atrial remodeling in this patient population. Furthermore, DBIL may contribute to left atrial remodeling by influencing the progression of HFpEF, thereby promoting the occurrence and progression of AF.

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