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目的探讨血浆大内皮素-1(Big ET-1)水平与肥厚型梗阻性心肌病(HOCM)患者伴发心房颤动的相关性。方法入选北京阜外医院2014年9月至2016年5月收治的HOCM患者189例,测定血浆Big ET-1水平等化验指标,完善心电图、动态心电图、超声心动图(UCG)及心脏磁共振(CMR)检查。根据心电图结果将患者分为心房颤动组(房颤组)33例及窦性心律组(窦律组)156例,进行相关统计学分析。结果房颤组与窦律组相比,血浆Big ET-1显著升高,UCG测量的左房前后径、CMR测量的左房前后径及左室舒张末期横径偏大(均P<0.05)。相关性分析及多元线性回归显示,Ln Big ET-1与HOCM患者的左房前后径(房颤组:r=0.365,P=0.037;窦律组:r=0.184,P=0.021)及Ln N末端B型利钠肽原(NT-pro BNP,房颤组:r=0.381,P=0.029;窦律组:r=0.346,P<0.001)呈正相关。多因素Logistic回归显示Ln Big ET-1(OR 3.209,95%CI 1.545~6.665)、CMR测量的左房前后径(OR 1.126,95%CI 1.054~1.203)及心悸(OR 3.597,95%CI 1.434~9.027)为HOCM患者伴发房颤的独立预测指标(均P<0.05)。以Big ET-1水平诊断HOCM伴发房颤的ROC曲线下面积为0.752(95%CI 0.66~0.85,P<0.001),当Big ET-1的诊断界值为0.285 pmol/L时,灵敏度为75.8%,特异度为73.1%。结论 HOCM合并心房颤动患者的血浆Big ET-1水平明显升高。Ln Big ET-1、左房内径及心悸均为HOCM伴发房颤的独立预测指标。血浆Big ET-1水平可能在HOCM伴发心房颤动的诊断及预测中具有一定价值。
Objective To investigate the correlation between plasma ET-1 level and patients with hypertrophic obstructive cardiomyopathy (HOCM) associated with atrial fibrillation. Methods 189 patients with HOCM admitted to Fu Wai Hospital in Beijing from September 2014 to May 2016 were enrolled in this study. Plasma ET-1 levels and other laboratory parameters were measured. The electrocardiogram, ambulatory electrocardiogram, echocardiogram (UCG) and cardiac magnetic resonance CMR) examination. The patients were divided into atrial fibrillation group (AF group) 33 cases and sinus rhythm group (sinus rhythm group) 156 cases according to the results of electrocardiogram. Statistical analysis was performed. Results Compared with sinus rhythm group, Big ET-1 in atrial fibrillation group was significantly higher than that in sinus rhythm group. Left anterior chamber diameter measured by UCG, left anterior chamber diameter measured by CMR, and diastolic dimension of left ventricular end diastole were both larger (all P <0.05) . Correlation analysis and multivariate linear regression showed that left anterior chamber diameter (AF group: r = 0.365, P = 0.037; sinus rhythm group: r = 0.184, P = 0.021) and Ln N There was a positive correlation between terminal B-type natriuretic peptide (NT-pro BNP, atrial fibrillation group: r = 0.381, P = 0.029; sinus rhythm group: r = 0.346, P <0.001). Multivariate Logistic regression showed that Ln Big ET-1 (OR 3.209, 95% CI 1.545-6.665), left anterior chamber diameter (OR 1.126, 95% CI 1.054-1.203) and palpitations (OR 3.597, 95% CI 1.434 ~ 9.027) were independent predictors of AF in patients with HOCM (all P <0.05). The area under the ROC curve of Big ET-1 in diagnosing HOCM with atrial fibrillation was 0.752 (95% CI 0.66-0.85, P <0.001). When the diagnostic limit of Big ET-1 was 0.285 pmol / L, the sensitivity was 75.8%, specificity was 73.1%. Conclusion The plasma level of Big ET-1 in patients with HOCM combined with atrial fibrillation is significantly increased. Ln Big ET-1, left atrial diameter and palpitations were independent predictors of HOCM with atrial fibrillation. Plasma levels of Big ET-1 may have some value in the diagnosis and prediction of HOCM associated with atrial fibrillation.