作者：桑明敏，祝存奎，马生龙

单位：

810001青海省西宁市，青海省心脑血管病专科医院心律失常二科

Units：

Department of ArrhythmiaⅡ, Qinghai Province Cardiovascular and Cerebrovascular Disease Specialist Hospital, Xining810001, China

关键词：

心力衰竭；高血压；心房颤动；促肾上腺皮质激素

Keywords：

Heart failure; Hypertension; Atrial fibrillation; Adrenocorticotropic hormone

CLC：

R 541.62 R 544.1 R 541.75

DOI：

10.12114/j.issn.1008-5971.2023.00.138

Funds：

青海省心脑血管病专科医院院内科研课题（2021-qxyn-30）

摘要：

目的　探讨血清促肾上腺皮质激素（ACTH）与老年高血压合并射血分数保留型心力衰竭（HFpEF）患者发生心房颤动（以下简称房颤）的关系。方法　前瞻性选取2020年5月至2021年10月于青海省心脑血管病专科医院就诊的老年高血压合并HFpEF患者150例。收集所有患者一般资料、实验室检查指标及房颤发生情况。采用多因素Logistic回归分析探讨血清ACTH与高血压合并HFpEF患者发生房颤的关系。结果　150例患者中，6例随访期间失访、2例随访期间病死，最终纳入142例患者。142例患者中60例发生房颤，房颤发生率为42.2%，将其作为房颤组，其余82例患者作为非房颤组。房颤组入院时收缩压、舒张压及血清N末端脑钠肽前体（NT-proBNP）、心肌肌钙蛋白I（cTnI）、ACTH高于非房颤组（P＜0.05）。多因素Logistic回归分析结果显示，血清NT-proBNP〔OR=1.348，95%CI（1.123，1.618）〕、ACTH〔OR=1.262，95%CI（1.026，1.552）〕升高是老年高血压合并HFpEF患者发生房颤的独立危险因素（P＜0.05）。结论　血清ACTH升高是老年高血压合并HFpEF患者发生房颤的危险因素，即血清ACTH越高，患者房颤发生风险越高。

Abstract：

　Objective To investigate the relationship between serum adrenocorticotropin (ACTH) and atrialfibrillation in elderly hypertensive patients combined with heart failure with preserved ejection fraction (HFpEF) . Methods Atotal of 150 elderly hypertension patients combined with HFpEF were prospectively selected from May 2020 to October 2021 inQinghai Province Cardiovascular and Cerebrovascular Disease Specialist Hospital. General data, laboratory examination indicatorsand the occurrence of atrial fibrillation were collected. Multivariate Logistic regression analysis was used to investigate therelationship between serum ACTH and atrial fibrillation in elderly hypertension patients combined with HFpEF. Results Among150 patients, 6 cases were lost to follow-up and 2 cases died during follow-up. Finally, 142 patients were included. Among 142patients, 60 had atrial fibrillation, with an incidence of 42.2%, they were included in the atrial fibrillation group, and the rest 82patients were included in the non-atrial fibrillation group. The levels of systolic blood pressure and diastolic blood pressure atadmission and serum N-terminal pro-brain natriuretic peptide (NT-proBNP) , cardiac troponin I (cTnI) and ACTH in the atrialfibrillation group were higher than those in the non-atrial fibrillation group (P < 0.05) . Multivariate Logistic regression analysisshowed that increased serum NT-proBNP [OR=1.348, 95%CI (1.123, 1.618) ] and ACTH [OR=1.262, 95%CI (1.026, 1.552) ]were independent risk factors for atrial fibrillation in elderly hypertensive patients combined with HFpEF (P < 0.05) . ConclusionIncreased serum ACTH is a risk factor for atrial fibrillation in elderly hypertension patients combined with HFpEF, that is, thehigher the serum ACTH level, the higher the risk of atrial fibrillation.

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