血液透析联合血液灌流患者的心房颤动与左心结构改变的关系研究

目的 探讨血液透析联合血液灌流患者的心房颤动与左心结构改变的关系。方法 选取2020年12月至2021年 12月于赣州市中医院进行血液透析联合血液灌流治疗的60例终末期肾病患者，将发生心房颤动的30例患者纳入观察组，未发生心房颤动的30例患者纳入对照组。比较两组患者的左心结构指标，分析血液透析联合血液灌流患者心房颤动与左心结构改变的关系。结果 观察组患者的左室舒张末期内径（left ventricular end diastolic diameter，LVEDD）、左室收缩末期内径（left ventricular end systolic diameter，LVESD）、左心房内径（left atrium diameter，LAD）、室间隔厚度（interventricular septal thickness，IVST）、左室后壁厚度（left ventricular posterior wall thickness，LVPWT）均显著大于对照组，左室射血分数（left ventricular ejection fraction，LVEF）显著低于对照组（P<0.05）；Logistic回归分析显示，LVEF降低及LVEDD、LVESD、LAD、IVST、LVPWT升高与血液透析联合血液灌流患者发生心房颤动有关（P<0.05）；受试者操作特征曲线结果显示，LVEDD、LVESD、LAD、LVEF、IVST、LVPWT诊断血液透析联合血液灌流患者发生心房颤动的曲线下面积分别为0.724、0.708、0.760、0.761、0.762、0.758，有一定的诊断价值。结论 血液透析联合血液灌流患者的心房颤动与左心结构改变有关，左心结构指标有助于辅助诊断心房颤动。

Relationship between atrial fibrillation and left heart structure change in patients with hemodialysis combined with hemoperfusion

Objective To investigate the relationship between atrial fibrillation and left heart structure change in patients with hemodialysis combined with hemoperfusion. Methods A total of 60 patients with end-stage renal disease who underwent hemodialysis combined with hemoperfusion treatment in Ganzhou Hospital of Traditional Chinese Medicine from December 2020 to December 2021 were selected. Thirty patients with atrial fibrillation were included in observation group, and thirty patients without atrial fibrillation were included in control group. The left heart structure indexes of two groups were compared, and the relationship between atrial fibrillation and left heart structure change in patients with hemodialysis combined with hemoperfusion was analyzed. Results Left ventricular end diastolic diameter (LVEDD), left ventricular end systolic diameter (LVESD), left atrium diameter (LAD), interventricular septal thickness (IVST), and left ventricular posterior wall thickness (LVPWT) in observation group were higher than those in control group, and left ventricular ejection fraction (LVEF) was lower than that in control group (P<0.05). Logistic regression analysis showed that the decrease of LVEF and the increase of LVEDD, LVESD, LAD, IVST and LVPWT were associated with atrial fibrillation in patients with hemodialysis combined with hemoperfusion (P<0.05). The results of receiver operating characteristic curve showed that area under the curve of LVEDD, LVESD, LAD, LVEF, IVST and LVPWT in diagnosing atrial fibrillation in patients with hemodialysis combined with hemoperfusion were 0.724, 0.708, 0.760, 0.761, 0.762 and 0.758, respectively, which had certain diagnostic value. Conclusion Atrial fibrillation in patients with hemodialysis combined with hemoperfusion is related to the change of left heart structure, and the left heart structure indexes are helpful to assist the diagnosis of atrial fibrillation.