Clinical characteristics and risk factors of atrial fibrillation in patients with chronic high altitude heart disease
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摘要: 目的 分析高原地区慢性高原性心脏病患者非瓣膜性心房颤动(房颤)的临床特征和危险因素。方法 连续纳入2021年8月-2022年6月入住西藏山南市人民医院心内科的慢性高原性心脏病患者共303例, 分为房颤组(83例)和非房颤组(220例)。比较基线资料, 采用相关分析和logistic回归分析房颤的相关因素和危险因素。结果 房颤与年龄、血尿酸、N末端B型利钠肽原(NT-proBNP)、左房内径、右室内径均呈正相关(r=0.3114、0.1415、0.2452、0.1214、0.5925, 均P < 0.05), 与低密度脂蛋白胆固醇、血红蛋白、左室射血分数均呈负相关(r=-0.1271、-0.1347、-0.1827, 均P < 0.05)。多因素回归分析显示, 年龄(OR=1.074, 95%CI: 1.039~1.109, P < 0.05)、血尿酸(OR=1.003, 95%CI: 1.000~1.005, P=0.032)及左房增大(OR=1.312, 95%CI: 1.219~1.413, P < 0.05)是房颤的独立危险因素。结论 年龄、血尿酸及左房增大为慢性高原性心脏病患者房颤发生的危险因素。Abstract: Objective To analyze the clinical characteristics and risk factors of atrial fibrillation (AF) in patients with chronic high altitude heart disease.Methods The present study enrolled 303 consecutive patients with chronic high altitude heart disease who received hospitalization in our center.The patients were divided into AF group (83 cases) and non-AF group (220 cases).Data of clinical characteristics and related laboratory tests were collected and analyzed.We conducted Lasso-Logistic regression for dimension reduction and feature selection, and then identified risk factors for AF in chronic high altitude heart diseases.Results The AF was positively correlated with age, serum uric acid, NT-proBNP, left atrial dimension, right ventricle dimension (r=0.3114, 0.1415, 0.2452, 0.1214, 0.5925, all P < 0.05), and AF was negatively correlated with low density lipoprotein, hemoglobin, left ventricular ejection fraction (r=-0.1271, -0.1347, -0.1827, all P < 0.05) in patients.The Logistic regression revealed that age (OR=1.074, 95%CI: 1.039-1.109), serum uric acid (OR=1.003, 95%CI: 1.000-1.005) and enlarged left atrial dimension (OR=1.312, 95%CI: 1.219-1.413) were the risk factors of AF in patients with chronic high altitude heart diseases (all P < 0.05).Conclusion Age, serum uric acid and enlarged left atrial dimension are risk factors of AF in Chronic high altitude heart diseases.
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表 1 两组患者的临床基线特征及实验室指标比较
Table 1. General data between the two groups
X±S 参数 房颤组(83例) 非房颤组(220例) t/χ2 P 男性/例(%) 41(49.4) 128(58.2) 1.885 0.170 年龄/岁 70.4±9.9 60.4±14.8 5.691 < 0.001 RBC/(×1012·L-1) 5.0±0.9 5.4±1.0 2.630 0.009 HGB/(g·L-1) 147.1±28.2 156.1±30.2 -2.358 0.019 TC/(mmol·L-1) 3.5±1.0 3.8±1.0 -1.937 0.054 LDL-C/(mmol·L-1) 2.2±0.8 2.5±0.8 -2.223 0.027 TG/(mmol·L-1) 1.2±0.7 1.2±0.6 0.160 0.873 CR/(μmol·L-1) 79.8±23.4 73.5±27.4 1.869 0.063 UA/(μmol·L-1) 472.4±157.3 424.9±145.0 2.479 0.014 LVEF/% 56.7±7.3 59.8±7.5 -3.224 0.001 LV/mm 53.8±4.7 52.7±5.2 1.761 0.079 LA/mm 43.4±5.5 35.1±4.9 12.762 < 0.001 RV/mm 32.9±4.4 31.8±3.7 2.122 0.035 PASP/mmHg 61.2±16.0 57.4±14.6 1.960 0.051 NT-proBNP/(ng·L-1) 7702.9± 8708.7 3584.5±6675.7 4.388 < 0.001 收缩压/mmHg 131.9±17.3 134.3±14.1 -1.281 0.201 舒张压/mmHg 88.0±12.2 87.5±9.9 0.405 0.686 高血压病/例(%) 36(43.4) 92(41.8) 0.060 0.807 糖尿病/例(%) 5(6.0) 5(2.3) 1.612 0.204 冠心病/例(%) 17(20.5) 44(20.0) 0.009 0.926 吸烟史/例(%) 2(2.4) 15(6.8) 1.458 0.227 饮酒史/例(%) 30(36.1) 91(41.6) 0.733 0.392 注：RBC：红细胞；CR：血肌酐；LV：左室。1mmHg=0.133 kPa。 
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表 2 房颤与相关变量的相关性分析
Table 2. Correlation analysis of AF and related variables
统计值 年龄 HGB LDL-C UA NT-proBNP LA RV LVEF P < 0.001 0.0190 0.0270 0.0137 < 0.001 < 0.001 0.0346 0.0014 r 0.3117 -0.1347 -0.1271 0.1415 0.2452 0.5925 0.1214 -0.1827
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表 3 房颤危险因素的Logistic回归分析
Table 3. Logistic regression analysis of risk factors of AF
变量 单因素 多因素 OR(95%CI) P OR(95%CI) P 年龄 1.064(1.039~1.089) < 0.001 1.074(1.040~1.109) < 0.001 HGB 0.990(0.981~0.998) 0.020 0.996(0.983~1.009) 0.514 LDL-C 0.685(0.488~0.960) 0.028 0.846(0.534~1.341) 0.477 UA 1.002(1.000~1.004) 0.015 1.003(1.000~1.005) 0.032 LA 1.328(1.241~1.422) < 0.001 1.313(1.221~1.413) < 0.001 RV 1.068(1.004~1.136) 0.037 0.961(0.876~1.054) 0.401 LVEF 0.944(0.911~0.979) 0.002 0.987(0.939~1.038) 0.617
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