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

doi:10.3969/j.issn.1006-5725.2023.20.014

Abstract

Abstract:

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.

Key words: heart failure with preserved ejection fraction, atrial fibrillation, structural remodeling of atrial fibrillation, uric acid, brain natriuretic peptide

CLC Number:

R541.61

Bin WANG,Dan HU,Fangfang. WANG. 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[J]. The Journal of Practical Medicine, 2023, 39(20): 2633-2637.

Figures/Tables 6

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References 26

1	王小红，王丽.不同射血分数心力衰竭患者黄嘌呤氧化酶与尿酸的表达及意义［J］.实用医学杂志，2022，38（10）：1231-1235.
2	杜美玲，王晓元，张爱爱，等.抗凝治疗与房颤患者血浆神经源性外泌体中T-tau蛋白和Aβ1-42含量变化的关系［J］.实用医学杂志，2022，38（4）：459-463.
3	REDDY Y N V， OBOKATA M， VERBRUGGE F H， et al. Atrial dysfunction in patients with heart failure with preserved ejection fraction and atrial fibrillation［J］. J Am Coll Cardiol， 2020，76（9）：1051-1064.
4	DEIS T， ROSSING K， ERSBØLL M K， et al. Uric acid in advanced heart failure： relation to central haemodynamics and outcome［J］. Open Heart， 2022，9（2）：e002092.
5	杨东，骆昌云，刘川，等. 急性心力衰竭合并房颤患者sST2、BNP、AngⅡ的表达及意义［J］. 解放军医药杂志，2022，34（2）：79-82.
6	PIESKE B， TSCHÖPE C， DE BOER R A， et al. How to diagnose heart failure with preserved ejection fraction： the HFA-PEFF diagnostic algorithm： a consensus recommendation from the Heart Failure Association （HFA） of the European Society of Cardiology （ESC）［J］. Eur Heart J， 2019，40（40）：3297-3317.
7	HINDRICKS G， POTPARA T， DAGRES N， et al. 2020 ESC Guidelines for the diagnosis and management of atrial fibrillation developed in collaboration with the European Association for Cardio-Thoracic Surgery （EACTS）： The Task Force for the diagnosis and management of atrial fibrillation of the European Society of Cardiology （ESC） Developed with the special contribution of the European Heart Rhythm Association （EHRA） of the ESC［J］. Eur Heart J， 2021，42（5）：373-498.
8	张智文，雷志博，李牧蔚，等. 左心房容积指数预测老年不明原因栓塞性卒中患者新发心房颤动和脑卒中复发的临床意义［J］. 中华老年心脑血管病杂志，2021，23（3）：251-255.
9	罗先道，张朝新，王欢，等. 射血分数保留心力衰竭患者胆汁酸代谢谱的变化及意义［J］. 中国分子心脏病学杂志，2023，23（1）：5156-5161.
10	CHEN J， ARONOWITZ P. Congestive heart failure［J］. Med Clin North Am， 2022，106（3）：447-458.
11	黄江伟，江鑫，蒋长荣，等. 心房肌细胞外泌体miR-130在房颤发病中的作用机制［J］. 实用医学杂志，2022，38（14）：1766-1772.
12	SAGRIS M， VARDAS E P， THEOFILIS P， et al. Atrial fibrillation： pathogenesis， predisposing factors， and genetics［J］. Int J Mol Sci， 2021，23（1）：6.
13	孙瑞雪，刘宇，王恒和. 心力衰竭患者心室重构研究技术及现状［J］. 医学综述，2021，27（10）：2009-2014.
14	BRUNDEL B J J M， AI X， HILLS M T， et al. Atrial fibrillation［J］. Nat Rev Dis Primers， 2022，8（1）：21.
15	DENG Y， LIU F， YANG X， et al. The key role of uric acid in oxidative stress， inflammation， fibrosis， apoptosis， and immunity in the pathogenesis of atrial fibrillation［J］. Front Cardiovasc Med， 2021，8：641136.
16	KOBAYASHI T， KOKUBO Y， HIGASHIYAMA A， et al. Uric acid and incident atrial fibrillation of 14 years population-based cohort study： The Suita Study［J］. J Arrhythm， 2021，37（5）：1215-1219.
17	DOEHNER W， ANKER S D， BUTLER J， et al. Uric acid and sodium-glucose cotransporter-2 inhibition with empagliflozin in heart failure with reduced ejection fraction： the EMPEROR-reduced trial［J］. Eur Heart J， 2022，43（36）：3435-3446.
18	SELVARAJ S， CLAGGETT B L， PFEFFER M A， et al. Serum uric acid， influence of sacubitril-valsartan， and cardiovascular outcomes in heart failure with preserved ejection fraction： PARAGON-HF［J］. Eur J Heart Fail， 2020，22（11）：2093-2101.
19	COIRO S， CARLUCCIO E， BIAGIOLI P， et al. Elevated serum uric acid concentration at discharge confers additive prognostic value in elderly patients with acute heart failure［J］. Nutr Metab Cardiovasc Dis， 2018，28（4）：361-368.
20	陈方圆，焦长青，黎冉，等. BNP水平联合心脏结构指标对高血压伴HFREF的临床预测价值［J］. 安徽医科大学学报，2021，56（3）：471-475.
21	康路，忽德运，王攀. 冠心病患者经胸超声心动图定量参数和心室重塑相关血清指标关系及对预后预测价值［J］. 临床误诊误治，2023，36（4）：57-62.
22	RØRTH R， JHUND P S， YILMAZ M B， et al. Comparison of BNP and NT-proBNP in patients with heart failure and reduced ejection fraction［J］. Circ Heart Fail， 2020，13（2）：e006541.
23	彭麟越，韩薇. 心房颤动中心房纤维化机制的研究进展［J］. 中国循证心血管医学杂志，2022，14（2）：244-246.
24	XU M， ZHENG X， WANG D， et al. Blockage of C-X-C motif chemokine receptor 2 （CXCR2） suppressed uric acid （UA）-induced cardiac remodeling［J］. Front Physiol， 2021，12：700338.
25	胡丐锋. 尿酸在心力衰竭和心肌纤维化中的作用及其机制研究［D］. 北京：中国医学科学院北京协和医学院，2020.
26	安冬梅，曹丽，刘洁，等. 心电图aVR导联联合前体脑钠肽水平对急性前壁心肌梗死后心力衰竭的预测价值［J］. 中国医药导报，2022，19（23）：49-5261，

组别	例数	性别（男/女）	年龄（岁）	体质量指数（kg/m²）	收缩压（mmHg）	舒张压（mmHg）	左室射血分数（%）
对照组	100	52/48	64.38 ± 5.36	23.64 ± 3.72	124.16 ± 5.58	82.74 ± 5.61	56.96 ± 5.38
阵发性AF组	46	26/20	63.32 ± 6.64	23.72 ± 3.85	124.73 ± 7.18	83.16 ± 6.17	56.62 ± 3.38
持续性AF组	54	30/24	64.12 ± 5.21	24.02 ± 3.69	123.96 ± 6.64	83.33 ± 5.76	55.84 ± 4.15
χ² /F值		0.331	0.560	0.184	0.203	0.207	1.012
P值		0.845	0.572	0.832	0.817	0.814	0.366

组别	例数	UA（μmol/L）	BNP（pg/mL）
对照组	100	208.86 ± 22.36	113.97 ± 32.56
阵发性AF组	46	361.25 ± 40.24^a	662.54 ± 72.47^a
持续性AF组	54	435.25 ± 45.67^ab	975.58 ± 110.48^ab
F值		564.47	1 254.56
P值		< 0.001	< 0.001

组别	例数	LAD（mm）	LAVI（mL/m²）
对照组	100	32.95 ± 3.36	31.39 ± 3.32
阵发性AF组	46	36.29 ± 4.02^a	35.48 ± 4.11^a
持续性AF组	54	41.68 ± 4.37^ab	40.92 ± 4.15^ab
F值		92.230	114.190
P值		< 0.001	< 0.001

指标	LAD		LAVI
指标	r值	P值	r值	P值
UA	0.436	0.031	0.451	0.036
BNP	0.449	0.028	0.453	0.033

影响因素	B	95%CI	P值
血清UA	1.871	1.105 ~ 2.256	< 0.001
血清BNP	1.635	1.022 ~ 2.139	< 0.001

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

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