冠状动脉慢血流现象合并心房颤动的相关因素分析

王宗方; 柏战; 张林叶; 胡保奎; 刘冉

doi:10.12125/j.chj.202105093

冠状动脉慢血流现象合并心房颤动的相关因素分析

Analysis of related factors of coronary slow flow phenomenon accompanied by atrial fibrillation

摘要

摘要:
目的探讨冠状动脉慢血流现象（coronary slow flow phenomenon，CSFP）合并心房颤动（atrial fibrillation，AF）患者的临床特征，分析CSFP合并AF的相关预测因素。
方法选取芜湖市第二人民医院2015年1月～2021年2月行冠脉造影术检查存在CSFP不伴AF患者作为对照组（n=196），选取同期CSFP伴AF患者作为观察组(n=61)。比较两组患者的一般临床资料、有关实验室指标及冠脉造影结果，采用多因素Logistic回归分析CSFP合并AF的危险因素，绘制受试者工作特征曲线（receiver operating characteristic curve, ROC 曲线），分析相关有统计学意义的危险因素预测CSFP合并AF的价值。
结果与对照组比较，观察组年龄、吸烟、脑卒中/TIA、心力衰竭、CHA₂DS₂-VASc评分、尿酸、肌酐、左心房内径（LAD）较高；BPC、TG 、HDL、eGFR及LVEF较低，差异有统计学意义(P<0.05 或 P<0.01)，其余指标无统计学差异。冠状动脉造影结果显示，观察组左前降支和右冠状动脉同时发生CSFP的比例较对照组增加，差异有统计学意义（P<0.05）。多因素Logistic回归分析显示尿酸和CHA₂DS₂-VASc评分为CSFP合并AF的独立危险因素。ROC曲线分析显示，尿酸曲线下面积（area under the curve，AUC）为0.757（95% CI：0.675~0.838），对CSFP合并AF最佳诊断界值为433.5 μmol/L，灵敏度为58.6%，特异度为90.0%。CHA₂DS₂-VASc评分的AUC为0.728（95%CI：0.646~0.810），最佳诊断界值为3，灵敏度为54.1%，特异度为82.7%。
结论尿酸水平和CHA₂DS₂-VASc评分具有CSFP合并AF的预测价值，可能成为CSFP合并AF的预测指标。

Abstract:
AIM To investigate the clinical characteristics of patients with coronary slow flow phenomenon (CSFP) accompanied by atrial fibrillation (AF) and analyze related predictive factors.
METHODS One hundred and ninety-six CSFP patients without AF who underwent coronary angiography in our hospital from January 2015 to February 2021 were selected as the control group and 61 CSFP patients accompanied by AF in the same period were selected as the observation group. General clinical data, relevant laboratory indicators and coronary angiography results of the two groups were compared. The risk factors of CSFP accompanied by AF were screened and analyzed by multivariate logistic regression analysis. The receiver operating characteristic curve (ROC curve) was used to analyze the value of risk factors with statistical significance in predicting CSFP accompanied by AF.
RESULTS Compared with those in the control group, there was significant difference in age, smoking rate, stroke/TIA heart failure,CHA₂DS₂-VASc score, uric acid, creatinine, left atrial diameter (LAD), blood platelet count (BPC), triglycerides (TG), high-density lipoprotein (HDL), estimated glomerular filtration rate (eGFR) and left ventricular ejection fraction (LVEF) in the observation group (P<0.05). Coronary angiography results showed that the incidence of CSFP in both left anterior descending artery and right coronary artery in the observation group was significantly higher than that in the control group (P<0.05). Multivariate logistic regression analysis showed that uric acid and CHA₂DS₂-VASc score were independent risk factors for CSFP accompanied by AF. ROC curve analysis showed that the area under the curve (AUC) of uric acid was 0.757 (95% CI: 0.675-0.838) and the best diagnostic cut-off value for CSFP accompanied by AF was 433.5 μmol/L, the sensitivity was 58.6% and the specificity was 90.0%. The AUC of the CHA₂DS₂-VASc score was 0.728 (95% CI: 0.646-0.810) and the best diagnostic cut-off value was 3, the sensitivity was 54.1% and the specificity was 82.7%.
CONCLUSION Uric acid level and the CHA₂DS₂-VASc score have predictive value for CSFP accompanied by AF and may be used as effective predictors.

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