右室Tei指数与血清醛固酮水平对COPD患者发生房颤的预测价值研究

摘要 目的：探讨右室Tei指数、血清醛固酮水平对慢性阻塞性肺病(COPD)患者发生房颤的预测价值。方法：根据房颤的发生情况，将200例COPD患者分为房颤发生组和无房颤发生组。比较两组的病程、COPD严重程度、血清醛固酮(ALD)水平及右室Tei指数、肺动脉压、右心室横径的差异，分析右室Tei指数和ALD预测房颤发生的ROC曲线下面积、截断值、灵敏度及特异度。结果：房颤发生组病程(8.48±1.3和7.59±1.75)、右心室横径(40.52±2.74和36.27±2.4)、血清ALD(137.64±42.77和98.61±15.39)、右室Tei指数(0.37±0.12和0.31±0.07)、COPD、肺动脉高压的严重程度与无房颤发生组比较差异都有统计学意义(P<0.05)。logistic回归分析结果显示ALD、右室Tei指数、病程、和肺动脉高压程度为影响COPD患者发生房颤的独立影响因素。右室Tei指数预测房颤发生的ROC曲线下面积AUC=0.645，截断值为0.420，灵敏度为38.0%，特异度达到93.33%；ALD预测房颤发生的ROC曲线下面积为0.792，截断值为122.72 pg/mL，灵敏度为66.0%，特异度可达到98.0%。结论：右室Tei指数和血清醛固酮水平可作为慢性阻塞性肺病患者发生房颤的预测参考指标。

Predictive Value of Right Ventricular Tei Index, Serum Aldosterone Level for the Incidence of Atrial Fibrillation in Patients with COPD

ABSTRACT Objective: To investigate the predictive value of right ventricular Tei index and serum aldosterone level for the incidence of atrial fibrillation in patients with chronic obstructive pulmonary disease (COPD). Methods: According to the incidence of atrial fibrillation, 200 patients with COPD were divided into the atrial fibrillation group and the non-atrial fibrillation group. The course of disease, severity of COPD, serum aldosterone(ALD) level, right ventricular Tei index, pulmonary artery pressure, and right ventricular transverse diameter were compared between the two groups. The area under Roc curve, cut-off point, sensitivity and specificity of right ventricular Tei index and serum ALD level in predicting atrial fibrillation were analyzed. Results: There were statistically significant differences (P<0.05) in the course of disease (8.48±1.3vs.7.59±1.75), right ventricular transverse diameter (40.52±2.74 vs. 36.27±2.4), serum ALD (137.64±42.77 vs.98.61±15.39), right ventricular Tei index (0.37±0.12vs.0.31±0.07), severity of COPD and degree of pulmonary artery pressure between the two groups. Logistic regression analysis showed that the serum ALD level, right ventricular Tei index, course of COPD, and degree of pulmonary hypertension were independent influencing factors for the occurrence of atrial fibrillation in COPD patients. The best cut-off point of Right ventricular Tei index for predicting atrial fibrillation was 0.420 and the area under the ROC curve was 0.645, with a sensitivity of 38.0% and a specificity of 93.33%. The best cut-off point of serum ALD level for predicting atrial fibrillation was 122.72 pg/mL and the area under the ROC curve was 0.792, with a sensitivity of 66.0% and a specificity of 98.0%. Conclusion: The right ventricular Tei index and serum aldosterone level can be used as reference indicators for the prediction of atrial fibrillation in patients with COPD.