慢性房颤并发心力衰竭的危险性评价系统的建立

摘要

目的：建立慢性房颤并发可能心力衰竭(心衰)的危险性评价系统，并评估其临床意义。方法回顾性分析我院心血管内科2009年1月至2013年6月收治的130例房颤或房颤并发其他并发症患者的临床诊治资料，根据患者的并发症发生情况分为三组，A组48例为心房颤动并发重度心衰者，B组44例为持续性或持久性房颤伴明显心衰前期症状者；C组38例为阵发性房颤者，同时选取同期的50例健康体检者作为对照(D组)，观察各组受试者血清纤维蛋白原(Fib)、C反应蛋白(CRP)、脑钠肽(BNP)、氨基末端B型钠尿肽前体(NT-proBNP)水平，同时A、B、C组患者及D组进行心脏彩超检测其心脏左心房的内径，并进行相关性分析。结果 A组患者CRP、Fib、BNP、NT-pro BNP和左心房内径分别为(36.58±16.08) mg/L、(43.9±16.7) g/L、(2327.9±569.3) pg/mL、(2397.2±567.9) pg/mL和(61.4±28.3) mm，B组患者分别为(24.11±12.32) mg/L、(18.3±10.1) g/L、(1107.4±201.5) pg/mL、(1007.6±176.34) pg/mL和(40.6±19.4) mm，C组患者分别为(12.07±4.71) mg/L、(7.6±3.3) g/L、(800.4±130.7) pg/mL、(678.3±121.8) pg/mL和(32.9±11.6) mm，D组健康者分别为(2.56±1.35) mg/L、(3.1±1.4) g/L、(101.6±40.3) pg/mL、(80.7±31.3) pg/mL和(23.8±8.7) mm，A、B、C三组患者CRP、Fib、BNP、NT-proBNP和左心房内径均明显高于D组，差异均有统计学意义(P<0.05)。经相关性分析发现，心房内径与患者血清CRP、Fib、BNP和NT-proBNP水平有显著相关性(P<0.05)。结论通过检测患者CRP、Fib、BNP、NT-proBNP和左心房内径，可对房颤可能并发心衰、或者并发心衰前期的患者做出判断，及时干预治疗，可以极大的减少医疗治疗的成本，同时减小房颤患者病死率。%Objective To evaluate the clinical significance of early diagnosis of chronic atrial fibrillation through the establishment of risk assessment system for chronic atrial fibrillation complicated with heart failure. Methods The clinical data of 130 cases of patients with atrial fibrillation or atrial fibrillation and other complica-tions, who admitted to our hospital from January 2009 to June 2013, were retrospectively analyzed. According to complications, these patients were divided into A group (48 cases of atrial fibrillation complicated with severe heart failure), B group (44 cases of persistent or permanent atrial fibrillation with early symptoms of heart failure) and C group (38 cases with paroxysmal atrial fibrillation). At the same time, 50 subjects undergoing healthy physical ex-amination were selected as D group. Serum fibrinogen (Fib), C reactive protein (CRP) and brain natriuretic pep-tide (BNP), amino terminal B type natriuretic peptide the precursor (NT-proBNP) of each group were observed. Meanwhile, left atrial diameter of the four groups of patients were measured by heart echocardiography, and corre-lation analysis was performed. Results CRP, Fib, BNP, NT-proBNP and left atrial diameter were respectively (36.58 ± 16.08) mg/L, (43.9 ± 16.7) g/L, (2327.9 ± 569.3) pg/mL, (2397.2 ± 567.9) pg/mL and (61.4 ± 28.3) mm in A group;(24.119±12.32) mg/L, (18.3±10.1) g/L, (1107.4±201.5) pg/mL, (1007.6±176.34) pg/mL and (40.6±19.4) mm in B group;(12.07±4.71) mg/L, (7.6±3.3) g/L, (800.4±130.7) pg/mL, (678.3±121.8) pg/mL and (32.9±11.6) mm in C group and (2.56 ± 1.35) mg/L, (3.1 ± 1.4) g/L,(101.6 ± 40.3) pg/mL, (80.7 ± 31.3) pg/mL and (23.8 ± 8.7) mm in D group. CRP, Fib, BNP, NT-proBNP and left atrial diameter in A, B and C group were significantly higher than those in D group (P<0.05). The correlation analysis showed that atrial diameter and serum CRP, Fib, BNP and NT-proBNP levels had significant correlation (P<0.05). Conclusion The measurement of CRP, Fib, BNP, NT-proBNP and left atrial diameter can be used to early identify patients complicated with heart failure, or complicated with heart failure for timely intervention, which can greatly reduce the cost of medical treatment and the death rate in patients with atrial fibrillation.