2021 年第 7 期 第 16 卷

维持性血液透析患者新发心房颤动的危险因素分析

Risk factors of new-onset atrial fibrillation in patients undergoing maintenance hemodialysis

作者：黄微1蒙迪2倪向荣1徐伟1姚专1邓湘玲1杨中1

英文作者：Huang Wei1 Meng Di2 Ni Xiangrong1 Xu Wei1 Yao Zhuan1 Deng Xiangling1 Yang Zhong1

单位：1湖南中医药高等专科学校附属第一医院肾内二科，湖南省株洲市412000；2湖南中医药高等专科学校附属第一医院神经内科，湖南省株洲市412000

英文单位：1The Second Department of Nephrology the First Affiliated Hospital of Hunan Traditional Chinese Medicine College Hunan Province Zhuzhou 412000 China; 2Department of Neurology the First Affiliated Hospital of Hunan Traditional Chinese Medicine College Hunan Province Zhuzhou 412000 China

关键词：维持性血液透析；心房颤动；危险因素；预后

英文关键词：Maintenancehemodialysis;Atrialfibrillation;Riskfactors;Prognosis

• 摘要：

• 目的 探讨维持性血液透析（MHD）患者新发心房颤动的危险因素。方法 回顾性分析2016年 1月至2019年1月于湖南中医药高等专科学校附属第一医院接受MHD治疗的276例患者的临床资料，根据患者是否合并新发心房颤动分为心房颤动组（32例）和非心房颤动组（244例）。比较2组的基线资料、实验室指标及超声心动图指标。分析MHD患者新发心房颤动的危险因素。结果 心房颤动组年龄、心力衰竭比例、冠心病（冠状动脉粥样硬化性心脏病）比例、C反应蛋白（CRP）、B型脑钠肽、室间隔厚度、透析血流量均高于非心房颤动组，透析时间长于非心房颤动组，差异均有统计学意义（均P＜0.05）。多因素Logistic回归分析结果显示，年龄（比值比=2.748，95%置信区间：1.647~3.927）、心力衰竭（比值比=1.793，95%置信区间：1.353~2.475）、CRP（比值比=2.180，95%置信区间：1.458~2.974）、室间隔厚度（比值比=1.864，95%置信区间：1.227~2.683）为MHD患者新发心房颤动的独立危险因素（均P＜0.05）。受试者工作特征曲线分析结果显示，室间隔厚度预测维持性血液透析患者发生心房颤动曲线下面积最大（0.819），最佳临界值为12.20 mm，敏感度为87.50%，特异度为51.79%。结论 年龄、心力衰竭、CRP、室间隔厚度为MHD患者新发心房颤动的独立危险因素，其中室间隔厚度的预测价值最高。

• Objective To explore the risk factors of new-onset atrial fibrillation(AF) in patients undergoing maintenance hemodialysis(MHD). Methods From January 2016 to January 2019, the clinical data of 276 patients undergoing MHD therapy in the First Affiliated Hospital of Hunan Traditional Chinese Medicine College were collected. According to whether patients complicated with new-onset AF, they were divided into AF group(32 cases) and non-AF group(244 cases). The baseline data, laboratory and echocardiographic indexes were compared between the two groups. The risk factors of new-onset AF in patients undergoing MHD were analyzed. Results The age, heart failure rate, coronary atherosclerotic heart disease rate, C-reactive protein(CRP), brain natriuretic peptide, ventricular septal thickness, and dialysis blood flow in AF group were higher than those in non-AF group(all P<0.05). Multivariate Logistic regression analysis showed that age［odds ratio(OR)=2.748， 95% confidence interval(CI): 1.647-3.927］, heart failure(OR=1.793, 95% CI: 1.353-2.475), CRP(OR=2.180, 95% CI: 1.458-2.974), and ventricular septal thickness(OR=1.864, 95% CI: 1.227-2.683) were independent risk factors of new-onset AF in patients undergoing MHD(all P<0.05). The receiver operating characteristic curve showed that ventricular septal thickness had the largest area under the curve(0.819) in predicting new-onset AF in patients undergoing MHD, the optimal cut-off value was 12.20 mm, the sensitivity was 87.50%, and the specificity was 51.79%. Conclusion Age, heart failure, CRP, and ventricular septal thickness are independent risk factors of new-onset AF in patients undergoing MHD and the predicted value of ventricular septal thickness is the highest.