Correlation between left atrial diameter and renal function in patients with atrial fibrillation
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摘要:目的
探讨心房颤动患者左心房内径(LAD)与肾功能的相关性。
方法选取364例心房颤动患者作为研究对象, 收集患者的临床资料, 包括性别、年龄、身高、体质量、吸烟史、饮酒史、心房颤动类型、高血压病史、冠心病病史、糖尿病病史、心力衰竭病史、用药史、高敏肌钙蛋白I、脑钠肽、C反应蛋白、肌酐、尿素氮、LAD、左室射血分数(LVEF)、左室舒张末期内径(LVDd)、左室后壁厚度(LVPWTd)和室间隔厚度(IVSTd); 计算估算肾小球滤过率(eGFR)和体质量指数。采用Spearman相关分析法探讨LAD与肌酐、尿素氮、eGFR的相关性; 将eGFR < 60 mL/(min·1.73 m2)设定为肾功能不全, 采用单因素Logistic回归分析探讨心房颤动患者肾功能不全的影响因素; 采用二元Logistic回归分析探讨房颤患者LAD与肾功能不全的关系。
结果Spearman相关分析结果显示, 心房颤动患者中LAD与肌酐(r=0.279, P < 0.001)、尿素氮(r=0.190, P < 0.001)呈正相关, 与eGFR(r=-0.263, P < 0.001)呈负相关。单因素Logistic回归分析结果显示, 性别、糖尿病病史、高血压病史、冠心病病史、心力衰竭病史、房颤类型、钠-葡萄糖共转运蛋白2抑制剂用药史、利尿剂用药史、LAD、LVEF、LVDd、IVSTd均为房颤患者肾功能不全的影响因素(P < 0.05)。二元Logistic回归分析结果显示, 与LAD第1四分位(LAD ≤ 38 mm)相比, LAD第4四分位(LAD>47 mm)心房颤动患者发生肾功能不全的风险升高5.199倍(OR=5.199, 95 %CI: 1.210~22.337, P=0.027)。
结论心房颤动患者的LAD与肾功能显著相关, 且LAD是心房颤动患者肾功能不全的影响因素。
Abstract:ObjectiveTo explore the correlation between left atrial diameter (LAD) and renal function in patients with atrial fibrillation.
MethodsA total of 364 patients with atrial fibrillation were selected as study subjects. Clinical data of the patients were collected, including gender, age, height, body weight, smoking history, drinking history, atrial fibrillation type, history of hypertension, coronary heart disease, diabetes, heart failure, medication history, high-sensitivity troponin I, brain natriuretic peptide, C-reactive protein, creatinine, urea nitrogen, LAD, left ventricular ejection fraction (LVEF), left ventricular end-diastolic diameter (LVDd), left ventricular posterior wall thickness (LVPWTd), and interventricular septal thickness (IVSTd). Estimated glomerular filtration rate (eGFR) and body mass index were calculated. Spearman correlation analysis was used to explore the correlations of LAD with creatinine, urea nitrogen, and eGFR. With eGFR < 60 mL/(min·1.73 m2) setting as renal insufficiency, univariate Logistic regression analysis was used to explore the influencing factors of renal insufficiency in patients with atrial fibrillation. Binary Logistic regression analysis was used to explore the relationship between LAD and renal insufficiency in patients with atrial fibrillation.
ResultsSpearman correlation analysis showed that LAD was positively correlated with creatinine (r=0.279, P < 0.001) and urea nitrogen (r=0.190, P < 0.001) in patients with atrial fibrillation, and negatively correlated with eGFR (r=-0.263, P < 0.001). Univariate Logistic regression analysis showed that gender, history of diabetes, hypertension, coronary heart disease, heart failure, atrial fibrillation type, sodium-glucose cotransporter 2 inhibitor medication history, diuretic medication history, LAD, LVEF, LVDd, and IVSTd were all influencing factors of renal insufficiency in patients with atrial fibrillation (P < 0.05). Binary Logistic regression analysis showed that compared with the first quartile of LAD (LAD ≤ 38 mm), the risk of renal insufficiency in patients with atrial fibrillation in the fourth quartile of LAD (LAD>47 mm) increased by 5.199 times(OR=5.199; 95 %CI, 1.210 to 22.337; P=0.027).
ConclusionLAD of patients with atrial fibrillation is significantly related to renal function, and LAD is an influencing factor of renal insufficiency in patients with atrial fibrillation.
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表 1 4组房颤患者一般资料比较[n(%)][M(P25, P75)]
指标 分类 第1组(n=95) 第2组(n=99) 第3组(n=90) 第4组(n=80) χ2/H P 性别 男 42(44.21) 56(56.57) 55(61.11) 50(62.50) 7.681 0.053 女 53(55.79) 43(43.43) 35(38.89) 30(37.50) 年龄/岁 68.00(58.00, 77.00) 69.00(61.00, 77.00) 70.00(61.75, 77.25) 73.50(63.00, 81.00) 5.837 0.120 体质量指数/(kg/m2) 24.98(23.03, 26.67) 26.37(24.61, 28.55) 27.11(24.27, 28.75) 26.75(24.73, 29.90) 18.124 < 0.001 吸烟史 14(14.74) 25(25.25) 23(25.56) 20(25.00) 4.478 0.214 饮酒史 10(10.53) 20(20.20) 21(23.33) 14(17.50) 5.699 0.127 病史 糖尿病 17(17.89) 28(28.28) 30(33.33) 27(33.75) 7.394 0.060 高血压 48(50.53) 56(56.57) 58(64.44) 52(65.00) 5.341 0.148 冠心病 35(36.84) 46(46.46) 45(50.00) 43(53.75) 5.696 0.127 心力衰竭 6(6.32) 14(14.14) 18(20.00) 22(27.50) 15.390 0.002 用药史 胰岛素 5(5.26) 3(3.03) 5(5.56) 6(7.50) 1.821 0.610 SGLT2i 5(5.26) 4(4.04) 7(7.78) 4(5.00) 1.354 0.716 β受体阻滞剂 22(23.16) 23(23.23) 26(28.89) 25(31.25) 2.828 0.516 钙通道阻滞剂 21(22.11) 21(21.21) 28(31.11) 19(23.75) 3.028 0.387 ACEI/ARB/ARNI 32(33.68) 26(26.26) 30(33.33) 30(37.50) 2.759 0.430 利尿剂 9(9.47) 11(11.11) 9(10.00) 18(22.50) 8.503 0.037 房颤类型 持续性 16(16.84) 49(49.49) 51(56.67) 63(78.75) 69.759 < 0.001 阵发性 79(83.16) 50(50.51) 39(43.33) 17(21.25) hs-cTnI/(ng/mL) 0.001(0.001, 0.006) 0.003(0.001, 0.190) 0.008(0.001, 0.029) 0.010(0.001, 0.035) 23.481 < 0.001 脑钠肽/(ng/mL) 70.39(26.10, 155.97) 201.30(81.48, 396.30) 248.78(112.00, 571.78) 423.98(179.94, 1 118.80) 62.210 < 0.001 C反应蛋白/(mg/L) 0.50(0.50, 1.29) 0.95(0.50, 2.98) 0.63(0.50, 3.15) 1.17(0.50, 4.63) 9.440 0.024 eGFR/[mL/(min·1.73 m2)] 89.90(76.68, 98.84) 86.33(73.65, 7.31) 81.97(69.51, 93.46) 75.26(56.24, 92.61) 21.651 < 0.001 SCr/(μmol/L) 68.02(55.17, 78.44) 72.80(60.91, 85.53) 74.45(65.31, 86.98) 80.35(70.34, 99.75) 29.490 < 0.001 BUN/(mmol/L) 5.83(4.59, 7.11) 6.59(5.07, 7.88) 6.31(5.02, 7.65) 6.95(5.46, 8.91) 13.747 0.003 LVEF/% 60.00(58.00, 60.00) 58.00(55.00, 60.00) 58.00(55.00, 60.00) 55.50(43.50, 58.00) 83.370 < 0.001 LVDd/mm 45.00(43.00, 48.00) 47.00(44.00, 50.00) 48.00(46.00, 53.00) 50.00(48.00, 57.75) 72.768 < 0.001 左室后壁厚度/mm 8.60(8.00, 9.20) 9.00(8.50, 9.60) 9.30(8.70, 10.00) 9.75(9.00, 10.30) 39.431 < 0.001 室间隔厚度/mm 9.00(8.10, 10.00) 9.30(8.80, 10.00) 9.95(9.00, 11.00) 10.00(9.00, 11.00) 25.637 < 0.001 SGLT2i: 钠-葡萄糖协同转运蛋白2抑制剂; ACEI: 血管紧张素转化酶抑制剂; ARB: 血管紧张素Ⅱ受体阻断剂; ARNI: 血管紧张素受体-脑啡肽酶抑制剂; hs-cTnI: 高敏肌钙蛋白I; eGFR: 估算肾小球滤过率; SCr: 肌酐; BUN: 尿素氮; LVEF: 左室射血分数; LVDd: 左室舒张末期内径。 
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表 2 房颤患者肾功能不全的单因素Logistic回归分析
变量 β SE OR 95%CI P 性别 -0.645 0.288 0.525 0.298~0.922 0.025 体质量指数 -0.061 0.041 0.941 0.869~1.019 0.135 吸烟史 -0.559 0.386 0.572 0.268~1.219 0.148 饮酒史 -0.751 0.454 0.472 0.194~1.150 0.099 高敏肌钙蛋白I -0.558 0.788 0.572 0.122~2.680 0.479 C反应蛋白 -0.001 0.002 0.999 0.995~1.004 0.761 房颤类型 0.658 0.293 1.931 1.088~3.426 0.025 糖尿病病史 1.037 0.293 2.820 1.588~5.006 < 0.001 高血压病史 0.846 0.320 2.329 1.243~4.365 0.008 冠心病病史 0.965 0.298 2.625 1.463~4.711 0.001 心力衰竭病史 0.678 0.340 1.970 1.012~3.834 0.046 SGLT2i用药史 1.343 0.481 3.830 1.492~9.832 0.005 ACEI/ARB/ARNI用药史 0.345 0.294 1.412 0.793~2.514 0.241 β受体阻滞剂用药史 0.435 0.305 1.545 0.850~2.811 0.154 利尿剂用药史 0.812 0.363 2.253 1.106~4.588 0.025 左心房内径 0.090 0.019 1.094 1.053~1.136 < 0.001 左室射血分数 -0.042 0.013 0.959 0.934~0.984 0.002 左室舒张末期内径 0.043 0.021 1.044 1.001~1.088 0.042 左室后壁厚度 0.211 0.136 1.234 0.946~1.611 0.121 室间隔厚度 0.202 0.091 1.224 1.024~1.463 0.027
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表 3 房颤患者LAD与肾功能不全的二元Logistic回归分析
LAD分组 模型1 模型2 模型3 β SE OR(95%CI) P β SE OR(95%CI) P β SE OR(95%CI) P 第1四分位 — — — — — — — — — — — — 第2四分位 0.716 0.522 2.046(0.735~5.694) 0.170 1.019 0.587 2.771(0.876~8.759) 0.083 0.695 0.678 2.004(0.531~7.563) 0.305 第3四分位 1.005 0.512 2.732(1.001~7.459) 0.050 1.385 0.568 3.994(1.313~12.148) 0.015 1.038 0.641 2.822(0.803~9.921) 0.106 第4四分位 2.022 0.484 7.557(2.929~19.495) < 0.001 2.303 0.547 10.008(3.428~29.221) < 0.001 1.648 0.744 5.199(1.210~22.337) 0.027 第1四分位数: LAD≤38 mm; 第2四分位数: LAD>38~42 mm; 第3四分位数: LAD>42~47 mm; 第4四分位数: LAD>47 mm; 模型1: 不包含协变量; 模型2: 根据模型1，加入性别、BMI、糖尿病病史、高血压病史、冠心病病史、心力衰竭病史协变量进行调整; 模型3: 根据模型2，加入CRP、LVEF、LVDd、IVSTd、房颤类型协变量进行调整。
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