血清磷酸根水平与HFp/mrEF伴房颤患者的关系及其对预后评价的意义

目的：探讨合并房颤（atrial fibrillation, AF）的射血分数保留/射血分数中间值的心衰（HFp/mrEF）患者血清磷酸根水平与B型利钠肽（brain natriuretic peptide, BNP）水平的关系及对不良心血管事件的影响。方法：选择2014年6月─2015年6月本院首次接诊的96例心衰且肌钙蛋白Ⅰ不超过0.012 pg/mL的患者，根据其心电图、心超、BNP等分为仅心衰组（23例）和有AF的心衰组（73例）。有AF的心衰组又分为HFp/mrEF+AF组（43例）和射血分数降低心衰（HFrEF）+AF组（30例）。分别检测患者入院24 h内首次血清磷酸根水平、BNP水平以及1年内不良心血管事件的发生情况。结果：HFp/mrEF+AF组患者的血清磷酸根水平与BNP浓度呈正相关（R2=0.33，P＜0.01）。且在1年内不良心血管事件发生中，较高血清磷酸根浓度的HFp/mrEF+AF组患者不良心血管事件发生率明显高于较低血清磷酸根浓度组。结论：血清磷酸根浓度与HFp/mrEF+AF患者有关，并能评估其预后。

Serum phosphorus concentration predicts adverse events in heart failure patients with preserved ejection fraction/mid-ranged ejection fraction and atrial fibrillation

Objective: To explore whether serum phosphorus concentration relates to brain natriuretic peptide level or predicts adverse events in heart failure (HF) patients with preserved ejection fraction/mid-ranged ejection fraction and atrial fibrillation (AF). Methods: From January 2014 to June 2015, sixty-nine HF patients who had a cardiac troponin I level less than 0.012pg/ml were enrolled. All these patients underwent electrocardiogram, echocardiography and serum BNP examinations. We divided them into two groups: (i) HF without AF (n = 23) and (ii) HF with AF (n = 73), who were then separated to two subgroups: AF with preserved ejection fraction (HFp/mrEF, n=43) and AF with reduced ejection fraction (HFrEF, n= 30). Serum phosphorus concentration, BNP and other biomarkers were measured within 24 hours after admission. All patients were followed-up for adverse cardiovascular events during the next 12 months. Results: In patients with HFp/mrEF and AF, serum phosphorus concentration was positively correlated with BNP level (r2=0.21, p<0.05). Also, the incidence of adverse cardiovascular events was increased in patients with higher serum phosphorus concentration, compared with those with lower serum phosphorus level. Conclusion: Serum phosphorus concentration significantly relates to brain natriuretic peptide level and predicts adverse events in heart failure patients with preserved ejection fraction/mid-ranged ejection fraction and atrial fibrillation