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目的探讨代谢综合征(MS)与原发性高血压(EH)患者心房颤动(AF)发生的关系。方法入选住院EH患者1810例,分为EH+非MS组(n=1155)及EH+MS组(n=655),比较两组的相关临床资料、超声心动图及AF的发生情况。结果EH+MS组病人AF发生率明显高于EH+非MS组(14.4%比8.3%,P<0.01)。EH+MS组左房内径(LAD)、左室舒张末期内径(LVEDD)、室间隔厚度(IVS)、左室后壁厚度(LVPW)、左室质量(LVM)、左室质量指数(LVMI)均高于EH+非MS组(均P<0.05),左室射血分数(LVEF)明显低于EH+非MS组(P<0.01)。Logistic回归分析显示原发性高血压患者发生AF的危险与年龄、左房增大、左室扩大及合并MS明显相关(OR分别为1.666、4.446、1.950、1.633,均P<0.05)。AF(n=190)与无AF患者(n=1620)相关指标单因素分析发现AF组MS发生率明显高于无AF组(49.5%比34.7%,P<0.01),体质量指数(BMI)、空腹血糖(FPG)水平亦明显升高(均P<0.05)。进一步Logistic回归分析显示MS组分中肥胖与AF的发生关系最密切(OR:1.913,P<0.01)。结论MS与EH患者发生AF的危险关系密切,可能与左心结构和功能损害有关。减重是MS合并AF病人减轻AF的重要措施。
Objective To investigate the relationship between metabolic syndrome (MS) and atrial fibrillation (AF) in patients with essential hypertension (EH). Methods 1810 hospitalized patients with EH were divided into EH + non-MS group (n = 1155) and EH + MS group (n = 655). The clinical data, echocardiography and AF were compared between the two groups. Results The incidence of AF in EH + MS group was significantly higher than that in EH + non-MS group (14.4% vs 8.3%, P <0.01). Left atrium diameter (LAD), left ventricular end diastolic dimension (LVEDD), interventricular septum thickness (IVS), left ventricular posterior wall thickness (LVPW), left ventricular mass (LVM), left ventricular mass index (LVMI) (All P <0.05). The left ventricular ejection fraction (LVEF) was significantly lower than that of EH + non-MS group (P <0.01). Logistic regression analysis showed that the risk of AF in patients with essential hypertension was significantly associated with age, left atrial enlargement, left ventricular enlargement and MS (OR = 1.666, 4.446, 1.950, 1.633, all P <0.05). Univariate analysis showed that the incidence of MS in AF group was significantly higher than that in non AF group (49.5% vs. 34.7%, P <0.01), and body mass index (BMI) in AF patients (n = 190) , Fasting blood glucose (FPG) levels were also significantly increased (all P <0.05). Further Logistic regression analysis showed that obesity was most closely related to AF in MS components (OR: 1.913, P <0.01). Conclusion There is a close relationship between MS and EH in patients with AF, which may be related to left ventricular structure and functional impairment. Weight loss is an important measure for alleviating AF in MS patients with AF.