Correlation between blood lipid level and left atrial function in patients with hypertension
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摘要:
目的 探索高血压患者血脂水平与心房颤动发生之前左心房功能受损的相关性。 方法 连续收集2018年8月～2020年7月期间在北京安贞医院心内科就诊的原发性高血压患者，按照左心房SR-LAs，SR-LAe或SR-LAa是否低于参考值划分为左房应变正常组（n=124）和左房应变受损组(n=62）。收集一般情况和血脂等临床资料，并进行二维斑点追踪成像技术（two-dimension speckle tracking imaging, 2D-STI）联合经胸超声心动图检查来评估患者左心房功能受损情况。多变量Logistic回归分析左心房应变受损与血脂水平和其他临床指标的相关性。对血脂综合指数和左心房应变参数进行Pearson线性相关分析。 结果 左心房应变受损的患者与左心房应变正常的患者相比，其BMI（P<0.05）、总胆固醇水平（P<0.01）、LDL-C水平（P<0.01）和血脂综合指数（P<0.01）均较低；超声数值方面，左心房应变受损的患者具有较低的左心室射血分数（P<0.05）、较厚的室间隔（P<0.01）和较大左心房内径（P<0.01）。左心房应变受损的患者三个应变指标均降低（均P<0.01）。多变量Logistic回归分析显示LDL-C、血脂综合指数、BMI和LVEF与左心房应变受损独立相关，Pearson线性相关分析分析显示血脂综合指数与左心房应变率参数呈正相关。 结论 在高血压患者中，血脂水平中总胆固醇和LDL-C与左心房机械功能受损呈独立相关。 -
关键词:
- 血脂 /
- 左心房功能 /
- 二维斑点追踪成像技术
Abstract:AIM To explore the correlation between blood lipid levels and the mechanical function of left atrial in patients with hypertension. METHODS Patients diagnosed with hypertension in Beijing Anzhen Hospital from August 2018 to July 2020 were continuously selected. General clinical data were collected and blood lipids levels were tested. Two-dimension speckle tracking imaging (2D-STI) combined with transthoracic echocardiography was used to assess the patients’ left atrial mechanical function. The patients were divided into two groups: a normal left atrial strain group (n=124) and an impaired left atrial strain group (n=62). The correlation of left atrial strain damage with blood lipid levels and other clinical indicators were analyzed by multivariate Logistic regression analysis and the correlation of blood lipid index and left atrial strain parameters was analyzed by Pearson correlation analysis. RESULTS Compared with patients with normal left atrial strain, patients with impaired left atrial strain had lower BMI (P<0.05), total cholesterol level (P<0.01), LDL-C level (P<0.01) and blood lipid comprehensive index (P<0.01). In terms of ultrasound value, patients with impaired left atrial strain had lower left ventricular ejection fraction (P<0.05), thicker ventricular septum (P<0.01) and larger left atrial diameter (P<0.01). The three strain indexes decreased in patients with left atrial strain injury (all P<0.01). Multivariate Logistic regression analysis showed that LDL-C, blood lipid comprehensive index, BMI and LVEF were independently correlated with left atrial strain damage. Pearson linear correlation analysis showed that blood lipid comprehensive index was positively correlated with left atrial strain rate parameters. CONCLUSION In hypertensive patients, low total cholesterol and LDL-C levels are independently related to the mechanical impairment of the left atrium. -
表 1 研究人群的人口学特征和实验室参数
项目 左房应变正常组
（n=124）左房应变受损组
(n=62）年龄（岁） 55±7 57±7 男性 53（43） 31（50） BMI（kg/m2） 28±5 24±4 a 合并冠心病 28（23） 17（27） 使用他汀药物 38（31） 27（44） 收缩压(mmHg) 150±12 148±13 舒张压(mmHg) 86±8 85±10 空腹血糖（mmol/L） 5.4±1.2 5.4±1.3 总胆固醇（mmol/L） 5.5±1.6 5.2±1.2b HDL-C（mmol/L） 1.4±0.4 1.4±0.5 甘油三酯（mmol/L） 1.3±0.5 1.2±0.6 LDL-C（mmol/L） 3.7±0.9 2.9±0.7 b 血脂综合指数 18±4 13±3 b 表中计数资料均为[例数（%）]，与左房应变正常组相比，aP<0.05，bP<0.01 
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表 2 两组常规超声数值的比较
（ $\bar x $ ±s）项目 左房应变正常组
（n=124）左房应变受损组
(n=62）LVEF（%） 60 ± 6 58 ± 6 a LVEDD（mm） 46 ± 5 50 ± 5 LVESD（mm） 27 ± 4 29 ± 4 IVSD（mm） 11.0 ± 1.9 11.9 ± 1.6b PWD（mm） 10.5 ± 1.7 11.1 ± 1.6 LAD（mm） 35.1 ± 0.5 39.9 ± 0.4b E/A 0.8 ± 0.3 0.7 ± 0.4 SR-LAs（s−1） 1.8 ± 0.3 1.4 ± 0.3b SR-LAe（s−1） 1.6 ± 0.6 1.3 ± 0.4b SR-LAa（s−1） 2.9 ± 0.4 2.2 ± 0.5b 与左房应变正常组相比，aP<0.05，bP<0.01
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表 3 左房应变受损的多变量logistic回归
项目 OR 95%CI LDL-C 0.986 0.973-0.998 血脂综合指数 0.904 0.885-0.913 BMI 0.935 0.908-0.966 LVEF 0.925 0.876-0.976
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表 4 血脂综合指数与左心房应变率参数的相关性
变量 血脂综合指数 R值 P值 SR-LAs（s−1） 0.266 <0.01 SR-LAe（s−1） 0.271 <0.01 SR-LAa（s−1） 0.221 <0.01
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