代谢综合征对冠心病患者心房纤颤的影响

目的:探讨代谢综合征(MS)与冠心病患者心房纤颤(AF)发生的关系。方法:入选住院拟行选择性冠状动脉造影(CAG),并确诊为冠心病(CHD)的患者1 805例,分为非MS组(n=1 150)及MS组(n=655),比较两组的相关临床资料,超声心动图及AF的情况。结果:MS组患者AF发生率明显高于非MS组(14.2%vs.8.1%,P0.01),MS组左房内经(LAD),左室舒张末期内径(LVEDD)、左室壁厚度(LVPW),左室质量(LVM),左室质量指数(LVMI)均高于非MS组(P0.05),左室射血分数(LVEF)明显低于非MS组(P0.01)。Logistic回归分析显示冠心病患者发生AF的危险与年龄,左房增大、左室扩大及并发MS明显相关(OR分别为1.666、4.446、1.950、1.636,均P0.05)。AF(n=188)与无AF患者(n=1 617)相关指标、单因素分析发现AF组MS发生率明显高于无AF组(49.3%vs.4.5%,P0.01),体质量指数(BMI)、空腹血糖(FPG)水平明显升高(均P0.05)。进一步Logistic回归分析显示MS组中肥胖与AF的发生关系最密切(OR:1.911,P0.01)。结论:MS与冠心病患者发生AF的危险关系密切。

Relationship between metabolic syndrome and increased risk of atrial fibrillation in patients with coronary heart disease

AIM: To explore the effect of metabolic syndrome (MetS) on atrial fibrillation (AF) in coronary heart disease (CHD) patients. METHODS: A cross-sectional study was conducted in a cohort of 1805 hospitalized CHD patients who were divided into CHD+non-MetS group (n=1 150) and CHD+MetS group (n=655) according to MetS criteria. RESULTS: Incidence of AF in CHD+MetS group was higher than that in CHD+non-MetS group (14.2% vs. 8.1%, P<0.01). Left atrial diameter (LAD), left ventricular end-diastolic diameter (LVEDD), interventricular septum thickness (IVS), left ventricular posterior wall thickness (LVPW), left ventricular mass (LVM) and left ventricular mass index (LVMI) were higher in CHD+MetS group than those in CHD+non-MetS group (P<0.05), whereas left ventricular ejection fraction (LVEF) was lower (P<0.01). After adjustment for age, LAD and LVEDD, logistic regression analysis showed that MetS predicted the incidence of AF in CHD patients (OR: 1.631, P<0.05). AF patients (n=188) were more likely to be complicated with MetS than non-AF patients (n=1 617, 49.3% vs. 34.5%, P<0.01) with higher body mass index (BMI) and fasting plasma glucose (FPG)(P<0.05). Further logistic regression analysis suggested that obesity was the most closely related independent predisposing risk factor for AF (OR: 1.911, P<0.01). CONCLUSION: MetS is closely associated with the incidence of AF in CHD patients. Obesity is the most closely related predisposing factor for AF among all MetS factors.