心力衰竭患者血浆甲状旁腺素浓度与房颤发生相关性分析

Correlation Analysis between Plasma Parathyroid Hormone Concentration and Atrial Fibrillation in Patients with Heart Failure

摘要: 目的：评估心力衰竭(HF)患者血浆甲状旁腺素(PTH)浓度与房颤(AF)发生的相关性。方法：研究对象为131例HF患者，根据医院心电图将患者分为心律正常组(n = 95)和AF组(n = 36)。比较两组患者基线及临床特征。采用逻辑回归分析确定AF的影响因素。采用ROC曲线分析确定PTH预测AF的最佳临界值。结果：AF患者血浆PTH浓度高于心律正常患者(P < 0.05)。Pearson相关分析显示，PTH浓度与脑钠肽浓度、左心房内径、利尿剂使用呈正相关(所有P < 0.05)，与LVEF、血红蛋白浓度和肌酐清除率呈负相关(所有P < 0.05)。单因素逻辑分析发现PTH、肌酐清除率、血红蛋白、肌酐、年龄、左心室射血分数(LVEF)与AF相关；多因素逻辑回归分析显示，仅PTH浓度与AF独立相关(所有P < 0.05)。ROC曲线分析显示，PTH诊断AF的最佳临界值为≥68.2 pg/ml，其中灵敏度为44.2%，特异度为83.3%。结论：HF患者血浆PTH浓度与房颤AF发生存在正相关。

Abstract: Objective: To analyze the relationship between plasma parathyroid hormone (PTH) concentrations and atrial fibrillation (AF) in patients with heart failure (HF). Methods: A total of 131 patients with HF were enrolled in this study. According to the electrocardiogram, the patients were divided into normal rhythm group (n = 95) and AF group (n = 36). The baseline and clinical characteristics of the two groups were compared. Logistic regression analysis was used to determine the influencing factors of AF. ROC curve analysis was used to determine the optimal cut-off value of PTH for predicting AF. Results: The plasma PTH concentration was higher in AF patients than in normal rhythm patients (P < 0.05). Pearson correlation analysis showed that PTH concentration was positively correlated with brain natriuretic peptide concentration, left atrial diameter, and diuretic use (all P < 0.05), and negatively correlated with LVEF, hemoglobin concentration, and creatinine clearance rate (all P < 0.05). Univariate logistic analysis showed that PTH, creatinine clearance rate, hemoglobin, creatinine, age and left ventricular ejection fraction (LVEF) were related to AF. Multivariate logistic regression analysis showed that only PTH concentration was independently associated with AF (all P < 0.05). ROC curve analysis showed that the optimal cut-off value of PTH for the diagnosis of AF was ≥68.2 pg/ml, with a sensitivity of 44.2% and a specificity of 83.3%. Conclusion: There was a positive correlation between plasma PTH concentration and the occurrence of atrial fibrillation (AF) in HF patients.