孤立性阵发性心房颤动患者高敏C反应蛋白与P波离散度的关系

摘要

目的：分析孤立性阵发性心房颤动（房颤）患者血浆高敏C反应蛋白（hs-CRP）与P波离散度（Pd）的关系，以期探讨炎症对心房重构的影响。　　方法：入选孤立性阵发性房颤患者（房颤组）及年龄和性别均匹配、无房颤病史的阵发性室上性心动过速患者（对照组）各71例。比较两组临床特点、心电图Pd及血浆hs-CRP浓度等的差别。采用线性相关及多元线性回归分析Pd与血浆hs-CRP浓度及其他临床指标的相关性。　　结果：房颤组患者的左心房内径、Pd及血浆hs-CRP浓度均高于对照组（P<0.05）。多元线性回归分析显示全部患者及房颤组患者血浆hs-CRP浓度与Pd均呈正相关（P均<0.01）。多因素Logistic回归分析显示血浆hs-CRP浓度是房颤发生的独立危险因素（HR=15.430，95%CI 6.031～39.476，P<0.001），进一步调整Pd，Logistic多因素分析发现Pd与血浆hs-CRP浓度均为房颤发生的独立危险因素（P均<0.001），但血浆hs-CRP浓度预测房颤的危险比由15.430下降至6.246。　　结论：孤立性阵发性房颤患者的血浆hs-CRP浓度和Pd均为房颤发生的重要危险因素，Pd和血浆hs-CRP浓度具有相关性，hs-CRP影响房颤发生的机制部分可能是通过Pd增加介导的。提示炎症可能在心房重构中发挥重要作用、从而促进房颤的发生。%Objective: To analyze the relationship between high-sensitivity C-reactive protein (hs-CRP) and P wave dispersion (Pd) in patients with lone atrial ifbrillation (AF), and to explore the effect of inlfammation on atrial electrophysiological remodeling. Methods: Our research included 2 groups. AF group, containing 71 consecutive paroxysmal lone AF patients, and Control group, containing 71 paroxysmal supra ventricular tachycardia patients with the matched age and gender. The clinical characteristics, electrocardiographic Pd assessment and plasma hs-CRP levels were compared between 2 groups. The relationship between hs-CRP and Pd was studied by linear and multi linear regression analysis. Results: Compared with Control group, AF group showed increased left atrial diameter, Pd and hs-CRP, all P<0.05. multilinear regression analysis indicated that hs-CRP was positively related to Pd in both groups, P<0.01. Multiple logistic regression analysis revealed that hs-CRP was an independent risk factor for AF occurrence (HR=15.430, 95%CI 6.031-39.476, P<0.001), with adjusted Pd, multiple logistic regression analysis presented that both Pd and hs-CRP were the independent risk factors for AF occurrence, both P<0.001, while the HR for hs-CRP predicting AF occurrence was attenuated from 15.430 to 6.246. Conclusion: Plasma hs-CRP level and electrocardiographic Pd were the important risk factors for paroxysmal lone AF, the interaction between hs-CRP and AF occurrence could be mediated by Pd, suggesting that inlfammation might be involved in atrial electrophysiological remodeling.