郑斌,吴铮,李文铮

• 1:首都医科大学附属北京安贞医院心内科北京市心肺血管疾病研究所

摘要(Abstract)：

目的探讨肾动脉狭窄(RAS)与高血压病患者发生心房颤动(AF)的相关性。方法回顾性分析2003年11月至2014年3月在首都医科大学附属北京安贞医院首次住院且不合并AF的632例高血压病住院患者,包括551例原发性高血压病患者(非RAS组)和81例合并有RAS(RAS组,包括20例左侧RAS、35例右侧RAS以及26例双侧RAS)的高血压病患者。观察随访所有纳入患者AF发病情况、心脏形态变化以及不良心血管事件(包括非致死性心肌梗死、卒中)发生情况。结果所有患者随访中位时间为38(12,70)个月。非RAS组患者有14例(2.5%)出现新发AF,RAS组患者有7例(8.6%)出现了新发AF(P=0.011)。logistic单因素回归分析示,血浆醛固酮(OR 24.165,95%CI 1.284～454.819,P=0.033)、RAS(OR 3.628,95%CI 1.418～9.282,P=0.007)与新发AF相关;糖尿病(OR 2.507,95%CI 1.336～4.701,P=0.004)、利尿药(OR 2.023,95%CI 1.078～3.794,P=0.028)与发生不良心血管事件相关。logistic多因素回归分析示,仅RAS(OR 3.325,95%CI 1.092～10.120,P=0.034)与新发AF相关;仅糖尿病(OR 2.495,95%CI 1.232～5.050,P=0.011)与发生不良心血管事件相关;而血浆肾素、血管紧张素Ⅱ、醛固酮水平与新发AF无相关性。单位时间内左心房内径增加与血清肌酸酐(r=–0.1628,P=0.0015,y=0.0031X–0.1709)和肾小球滤过率(r=–0.1375,P=0.0080,y=–0.0047X+0.4430)显著相关。结论 RAS与新发AF相关,但仍需进一步探讨。RAS患者AF风险增加的机制可能与血浆肾素、血管紧张素Ⅱ以及醛固酮水平无关,但可能与RAS患者肾功能不全及左心房重构有关。

关键词(KeyWords)： 肾动脉狭窄;高血压病;心房颤动;动脉粥样硬化

Abstract:

Keywords:

基金项目(Foundation):

作者(Author): 郑斌,吴铮,李文铮

参考文献(References)：

• [1]Griffin WF,Salahuddin T,O'Neal WT,et al.Peripheral arterial disease is associated with an increased risk of atrial fibrillation in the elderly.Europace,2016,18(6):794-798.
• [2]Violi F,Lip GY,Basili S.Peripheral artery disease and atrial fibrillation:a potentially dangerous combination.Intern Emerg Med,2012,7(3):213-218.
• [3]Zheng B,Kang J,Tian Y,et al.Angiotensin-converting enzyme inhibitors and angiotensinⅡreceptor blockers have no beneficial effect on ablation outcome in chronic persistent atrial fibrillation.Acta Cardio,2009,64(3):335-340.
• [4]Ehrlich JR,Hohnloser SH,Nattel S.Role of angiotensin system and effects of its inhibition in atrial fibrillation:clinical and experimental evidence.Eur Heart J,2006,27(5):512-518.
• [5]Liao JN,Chao TF,Liu CJ,et al.Incidence and risk factors for new-onset atrial fibrillation among patients with end-stage renal disease undergoing renal replacement therapy.Kidney Int,2015,87(6):1209-1215.
• [6]Benjamin EJ,Levy D,Vaziri SM,et al.Independent risk factors for atrial fibrillation in a population-based cohort.The framingham heart study.JAMA,1994,271(11):840-844.
• [7]Piecha G,Wiecek A,Januszewicz A.Epidemiology and optimal management in patients with renal artery stenosis.J Nephrol,2012,25(6):872-878.
• [8]Mousa AY,AbuRahma AF,Bozzay J,et al.Update on intervention versus medical therapy for atherosclerotic renal artery stenosis.J Vasc Surg,2015,61(6):1613-1623.
• [9]郑斌,颜红兵,程姝娟,等.西罗莫司洗脱支架治疗小直径肾动脉狭窄的长期随访.中国介入心脏病学杂志,2010,18(5):262-265.
• [10]Olin JW,Piedmonte MR,Young JR,et al.The utility of duplex ultrasound scanning of the renal arteries for diagnosing significant renal artery stenosis.Ann Intern Med,1995,122(11):833-838.
• [11]January CT,Wann LS,Alpert JS,et al.2014 AHA/ACC/HRSguideline for the management of patients with atrial fibrillation:a report of the American College of Cardiology/American Heart Association task force on practice guidelines and the Heart Rhythm Society.J Am Coll Cardiol,2014,64(21):e1-e76.
• [12]Thygesen K,Alpert JS,Jaffe AS,et al.Third universal definition of myocardial infarction.Glob Heart,2012,7(4):275-295.
• [13]Matsushita K,Toneli M,Lioyd A,et al.Clinical risk implications of the CKD epidemiology collaboration(CKD-EPI)equation compared with the Modification of Diet in Renal Disease(MDRD)study equation for estimated GFR.Am J Kidney Dis,2012,60(2):241-249.
• [14]Khatib R,Joseph P,Briel M,et al.Blockade of the reninangiotensin-aldosterone system(RAAS)for primary prevention of non-valvular atrial fibrillation:a systematic review and meta analysis of randomized controlled trials.Int J Cardiol,2013,165(1):17-24.
• [15]Mayyas F,Alzoubi KH,Van Wagoner DR.Impact of aldosterone antagonists on the substrate for atrial fibrillation:aldosterone promotes oxidative stress and atrial structural/electrical remodeling.Int J Cardiol,2013,168(6):5135-5142.
• [16]Amdur RL,Mukherjee M,Go A,et al.Interleukin-6 is a risk factor for atrial fibrillation in chronic kidney disease:findings from the CRIC study.PLoS One,2016,11(2):e0148189.
• [17]Eirin A,Gloviczki ML,Tang H,et al.Inflammatory and injury signals released from the post-stenotic human kidney.Eur Heart J,2013,34(7):540a-548a.
• [18]Zheng B,Liu J,Ma Q,et al.Association of atherosclerotic renal artery stenosis with major adverse cardiovascular events after acute myocardial infarction.Chin Med J(Engl),2014,127(4):618-622.
• [19]Conlon PJ,Little MA,Pieper K,et al.Severity of renal vascular disease predicts mortality in patients undergoing coronary angiography.Kidney Int,2001,60(4):1490-1497.