目的 探讨维持性血液透析患者心房颤动的患病情况及相关因素。方法 选取2022年3月至8月首都医科大学附属北京朝阳医院规律血液透析患者,根据是否合并心房颤动将患者分为心房颤动组和非心房颤动组,采用多因素logistic回归模型及ROC曲线分析心房颤动的相关因素及其预测价值。结果 共纳入117例患者。心房颤动组患者年龄、透析龄、超滤率、红细胞分布宽度、超敏C反应蛋白（hs-CRP）、脑钠肽、左房内径明显高于非心房颤动组,而白蛋白、左室射血分数明显低于非心房颤动组（P<0.05）。多因素logistic分析显示左房内径、超滤率、透析龄、hs-CRP、高龄是血液透析患者合并心房颤动的相关因素（P<0.05）,超滤率的ROC曲线下面积为0.695,最佳截断值为11.6ml/（kg·h）。结论 血液透析患者合并无症状性心房颤动的比例高,多发生于透析过程中,左房内径、超滤率、透析龄、hs-CRP、年龄是合并心房颤动的相关因素。
Abstract
Objective To explore the prevalence and related factors of atrial fibrillation（AF）in maintenance hemodialysis （MHD）patients. Methods Patients undergoing MHD at Beijing ChaoYang Hospital Affiliated to Capital Medical University from March to August 2022 were enrolled, and were divided into AF group and non-atrial fibrillation（non-AF）group based on whether they had atrial fibrillation. Multivariate logistic regression model and receiver operator characteristic（ROC）curves were used to evaluate the related factors of AF and its predictive value. Results A total of 117 patients were enrolled. Patients in AF group had significantly higher age,hemodialysis vintage,ultrafiltration rate,red blood cell distribution width, high-sensitivity C-reactive protein（hs-CRP）,brain natriuretic peptide,and left atrial diameter than those in non-AF group,while serum albumin and left ventricular ejection fraction were significantly lower in AF group（P< 0.05）. Multivariate logistic analysis showed that left atrial diameter,ultrafiltration rate, hemodialysis vintage,hs-CRP and advanced age were related factors for AF（P< 0.05）. The area under the ROC curve of ultrafiltration rate was 0.695, and the optimal cut-off value was 11.6 ml/（kg·h）. Conclusions The proportion of asymptomatic atrial fibrillation in MHD patients is high,and it often occurs during the dialysis process. Left atrial diameter, ultrafiltration rate, hemodialysis vintage, hs-CRP and age are related factors of AF.
关键词
血液透析 /
心房颤动 /
超滤率 /
脑钠肽 /
相关因素
Key words
hemodialysis /
atrial fibrillation /
ultrafiltration rate /
brain natriuretic peptide /
related factor
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