CAJ | 학술논문

目的：分析血浆脑钠肽（BNP）对冠状动脉粥样硬化性心脏病（冠心病，CHD）合并心房纤颤（AF）患者发生心房血栓事件的预测价值。方法入选98例的CHD合并AF患者，依据有无左心房血栓分为：对照组（52例，未发生心房血栓）、研究组（46例，发生心房血栓）。检测并比较两组患者的血浆BNP、糖化血红蛋白（HbA1c）、总胆固醇（TC）、氧化低密度脂蛋白（ox-LDL）、高密度脂蛋白胆固醇（HDL-C）、高敏C反应蛋白（hs-CRP）水平以及心脏超声指标左心室射血分数（LVEF）、左心室舒张末期内径（LVEDd）及左房直径（LAD）的差异。应用多元Logistic回归分析上述指标与患者心房血栓发生的相关性。结果与对照组相比，研究组患者BNP、hs-CRP、ox-LDL、LVEDd、LAD水平显著升高，分别为：[（358.6±77.8）pg/ml vs.（1102.9±315.7）pg/ml，P=0.001]；[（5.8±1.0）mg/L vs.（7.4±1.3）mg/L，P=0.027]、[（3.4±0.8）mmol/L vs.（4.0±0.9）mmol/L，P=0.038]、[（58.1±5.5） mm vs.（74.3±6.8）mm，P=0.030]、[（32.5±3.8）mm vs.（39.6±4.3）mm，P=0.021]，LVEF、HDL-C则明显降低，分别为：[（57.3±3.8）%vs.（48.2±3.1）%，P=0.015]、[（1.08±0.27）mmol/L vs.（0.72±0.16）mmol/L，P=0.029]，差异均有统计学意义；而HbA1C、TC水平无统计学差异（P＞0.05）。多元Logistic回归分析显示，BNP（OR=1.986，P=0.009）与LAD（OR=0.863，P=0.028）为心房血栓发生的独立预测因子。结论BNP能独立预测CHD合并AF患者心房血栓的发生。
목적：분석혈장뇌납태（BNP）대관상동맥죽양경화성심장병（관심병，CHD）합병심방섬전（AF）환자발생심방혈전사건적예측개치。방법입선98례적CHD합병AF환자，의거유무좌심방혈전분위：대조조（52례，미발생심방혈전）、연구조（46례，발생심방혈전）。검측병비교량조환자적혈장BNP、당화혈홍단백（HbA1c）、총담고순（TC）、양화저밀도지단백（ox-LDL）、고밀도지단백담고순（HDL-C）、고민C반응단백（hs-CRP）수평이급심장초성지표좌심실사혈분수（LVEF）、좌심실서장말기내경（LVEDd）급좌방직경（LAD）적차이。응용다원Logistic회귀분석상술지표여환자심방혈전발생적상관성。결과여대조조상비，연구조환자BNP、hs-CRP、ox-LDL、LVEDd、LAD수평현저승고，분별위：[（358.6±77.8）pg/ml vs.（1102.9±315.7）pg/ml，P=0.001]；[（5.8±1.0）mg/L vs.（7.4±1.3）mg/L，P=0.027]、[（3.4±0.8）mmol/L vs.（4.0±0.9）mmol/L，P=0.038]、[（58.1±5.5） mm vs.（74.3±6.8）mm，P=0.030]、[（32.5±3.8）mm vs.（39.6±4.3）mm，P=0.021]，LVEF、HDL-C칙명현강저，분별위：[（57.3±3.8）%vs.（48.2±3.1）%，P=0.015]、[（1.08±0.27）mmol/L vs.（0.72±0.16）mmol/L，P=0.029]，차이균유통계학의의；이HbA1C、TC수평무통계학차이（P＞0.05）。다원Logistic회귀분석현시，BNP（OR=1.986，P=0.009）여LAD（OR=0.863，P=0.028）위심방혈전발생적독립예측인자。결론BNP능독립예측CHD합병AF환자심방혈전적발생。
Objective To analyze the predictive value of plasma B-type natriuretic peptide (BNP) to atrial thrombosis in patients with coronary heart disease (CHD) complicating atrial fibrillation (AF). Methods The patients (n=98) were divided, according to the occurrence of left atrial thrombus, into control group (n=52, without atrial thrombosis) and research group (n=46, with atrial thrombosis). The levels of BNP, glycated hemoglobin (HbAlc), total cholesterol (TC), oxidized low-density lipoprotein (ox-LDL), high-density lipoprotein-cholesterol (HDL-C), high-sensitivity C-reactive protein (hs-CRP), left ventricular ejection fraction (LVEF), left ventricular end diastolic diameter (LVEDd) and left atrial diameter (LAD) were detected and compared in 2 groups. The correlation between above indexes and left atrial thrombosis was analyzed by using multiple Logistic regression analysis. Results Compared with control group, in research group the levels of BNP [(358.6±77.8) pg/ml vs. (1102.9 ±315.7) pg/ml, P=0.001], hs-CRP [(5.8±1.0) mg/L vs. (7.4±1.3) mg/L, P=0.027], ox-LDL [(3.4±0.8) mmol/L vs. (4.0±0.9) mmol/L, P=0.038], LVEDd [(58.1±5.5) mm vs. (74.3±6.8) mm, P=0.030] and LAD [(32.5±3.8) mm vs. (39.6±4.3) mm, P=0.021] increased significantly, and LVEF [(57.3±3.8)%vs. (48.2±3.1)%, P=0.015] and HDL-C [(1.08±0.27) mmol/L vs. (0.72±0.16) mmol/L, P=0.029] decreased significantly. The levels of HbA1C and TC had no statistical difference between 2 groups (P>0.05). The multiple Logistic regression analysis showed that BNP (OR=1.986, P=0.009) and LAD (OR=0.863, P=0.028) were independent predictive factors of atrial thrombosis. Conclusion BNP can independently predict atrial thrombosis in patients with CHD complicating AF.