南方医科大学学报

南方医科大学学报 ›› 2020, Vol. 40 ›› Issue (05): 752-758.doi: 10.12122/j.issn.1673-4254.2020.05.23

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痛风患者超声心动图参数的相关性分析

孙广瀚，刘 健，万 磊，龙 琰，鲍丙溪，张 颖   

  • 出版日期:2020-05-20 发布日期:2020-05-20
  • 基金资助:

Correlations of echocardiographic parameters in Gout patients: a retrospective analysis

  

  • Online:2020-05-20 Published:2020-05-20

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摘要： 目的 基于回顾性分析探究痛风患者超声心动图参数的相关性分析。方法 通过安徽省中医院数据库中检索到2012年1月~2019年6月的住院数据和医疗记录，研究其超声心动图参数和临床实验室指标：超敏C-反应蛋白（hs-CRP）、血沉（ESR）、同型半胱氨酸（Hcy）、免疫球蛋白A（IgA）、免疫球蛋白G（IgG）、免疫球蛋白M（IgM）、补体C3、补体C4、甘油三脂（TG）、总胆固醇（TC）、尿酸（UA）、低密度脂蛋白胆固醇（LDL-C）、高密度脂蛋白胆固醇（HDL-C）；室间隔厚度（IVST）、左室后壁厚度（LVPWd）、左室舒张末期内径（LVDd）、左室收缩末期内径（LVDs）、左房内径（LAD）、最大P波时限（Pmax）、射血分数（EF）、每搏输出量（SV）。运用 SPSS 22.0、SPSS Clementine 11.1 Aprior 等统计学软件对指标进行关联规则、相关性分析、热图分析、多因素Logistics回归分析。结果 （1）热图分析显示：EF、SV表达最为显著，其次是AODd、LADs、LVDd、FS。根据聚类分析可以将AODd、EF、FS、LADs、LVDd、SV为聚1类，IVSTd、LVPWTd、MPAD、Pmax、RVDd为聚2类；（2）相关性分析显示，383例患者的EF与LVDd成负相关（P<0.05），与FS、SV成正相关（P<0.05）；AODd与IVSTd、LADs、LVDd、LVPWTd、RVDd、SV、ESR成正相关（P<0.05）；FS与EF、SV成正相关（P<0.05），与LVDd成负相关（P<0.05）；IVSTd与AODd、LADs、LVPWTd、补体C4、成正相关（P<0.05）；LADs与AODd、IVSTd、MPAD、RVDd、SV成正相关（P<0.05）；LVDd与AODd、IVSTd成正相关（P<0.05），与LVDd、补体C3成负相关（P<0.05）；MPAD与LADs、HDLC、TC成正相关（P<0.05），与Pmax成负相关（P<0.05）；Pmax与LVDd、RVDd、SV成正相关（P<0.05），与FS、MPAD成负相关（P<0.05）；RVDd与AODd、LADs、LVDd、Pmax、SV成正相关（P<0.05）；SV与AODd、EF、LADs、LVDd、Pmax、RVDd成正相关（P<0.05）；补体C3与补体C4、CRP成正相关（P<0.05），与LVPWTd成负相关（P<0.05）；补体C4与IVSTd、补体C3、CRP、ESR成正相关（P<0.05），CRP与补体C3、补体C4、IgA、IgG成正相关（P<0.05），与TC、HDLC、TG 成负相关（P<0.05）；TG 与 HDLC、IgM、TC 成正相关（P<0.05），与 CRP 成负相关（P<0.05）；HDLC 与 MPAD、HDLC、TC成正相关（P<0.05），与CRP成负相关（P<0.05）；IgA与CRP、IgG、IgM成正相关（P<0.05）；IgG与CRP、IgA、IgM成正相关（P<0.05）；IgM与TG、IgA、IgG、UA成正相关（P<0.05），与CRP成负相关（P<0.05）；UA与IgM成正相关（P<0.05）；ESR与AODd、补体C4成正相关（P<0.05）；HCY与RVDd成负相关（P<0.05）；TC与MPAD、TG成正相关（P<0.05），与CRP成负相关（P<0.05）；（3）经关联性分析，Pmax升高与LDL-C、UA、补体C4、TG、HCY、HDL-C、IgG、ESR、CRP、补体C3升高有明显关联性；SV升高与UA、LDL-C、补体C4、HDL-C、CRP、IgG、HCY、TC、ESR、TG、补体C3升高有明显关联性；（4）多因素Logistics回归分析分析结果提示：FS与LDL-c呈正相关（P<0.05），Pmax与IgM呈负相关（P<0.05），SV与ESR呈负相关（P<0.05），其余与其他指标不相关（P>0.05）。结论 痛风患者的超声心动图参数的变化与炎症、免疫、代谢指标的升高具有相关性，具有吸烟史和饮酒史患者并不对心功能变化产生影响，代谢指标的变化是超声心动图参数变化的危险因素。

Abstract: Objective To explore the correlations of echocardiographic parameters in patients with gout. Methods The hospitalization data and medical records of patients with gout between January, 2012 and June, 2019 were retrieved from the database of Anhui Provincial Hospital of Traditional Chinese Medicine, and the echocardiographic parameters and clinical laboratory test results of the inflammatory, immunological and metabolic indicators were analyzed. SPSS 22.0, SPSS Clementine 11.1 Aprior and other statistical software were used to determine the association rules and carry out correlation analysis, heat map analysis and multi-factor logistic regression analysis of the indicators. Results Heat map analysis showed that the expressions of EF and SV were the most significant, followed by AODd, LADs, LVDd and FS. Cluster analysis showed that AODd, EF, FS, LADs, LVDd, and SV were all in cluster 1, and IVSTd, LVPWTd, MPAD, Pmax, and RVDd were in cluster 2. Correlation analysis showed that in the 383 patients, EF was negatively correlated with LVDd (P<0.05) and positively correlated with FS and SV (P<0.05); AODd was positively correlated with IVSTd, LADs, LVDd, LVPWTd, RVDd, SV, and ESR (P<0.05); FS was positively correlated with EF and SV (P<0.05) and negatively correlated with LVDd (P<0.05)；IVSTd was positively correlated with AODd, LADs, LVPWTd, and complement C4 (P<0.05); LADs were positively correlated with AODd, IVSTd, MPAD, RVDd, and SV (P<0.05); LVDd was positively correlated with AODd, IVSTd (P<0.05), and negatively correlated with LVDd and complement C3 (P<0.05); MPAD and LADs, HDLC and TC were positively correlated (P<0.05)and negatively correlated with Pmax (P<0.05); Pmax was positively correlated with LVDd, RVDd and SV (P<0.05)and negatively correlated with FS and MPAD (P<0.05); RVDd was positively correlated with AODd, LADs, LVDd, Pmax, SV (P<0.05); SV was positively correlated with AODd, EF, LADs, LVDd, Pmax, and RVDd (P<0.05); complement C3 was positively correlated with complement C4 and CRP (P<0.05), and negatively correlated with LVPWTd (P<0.05); complement C4 was positively correlated with IVSTd, complement C3, CRP, and ESR (P<0.05); CRP was positively correlated with complement C3, complement C4, IgA, IgG (P<0.05), and negatively correlated with TC, HDLC, and TG (P<0.05); TG was positively correlated with HDLC, IgM, and TC (P<0.05), and negatively correlated with CRP (P<0.05); HDLC was positively correlated with MPAD , HDLC and TC (P<0.05) and negatively correlated with CRP (P<0.05); IgA was positively correlated with CRP, IgG and IgM (P<0.05); IgG was positively correlated with CRP, IgA and IgM (P<0.05); IgM is positively correlated with TG, IgA, IgG, UA (P<0.05) and negatively correlated with CRP (P<0.05); UA was positively correlated with IgM (P<0.05); ESR was positively correlated with AODd and complement C4 (P<0.05); HCY was negatively correlated with RVDd (P<0.05); TC was positively correlated with MPAD and TG (P<0.05), and negatively correlated with CRP (P<0.05). The increase of Pmax was significantly associated with the increase of LDL-C, UA, complement C4, TG, HCY, HDL-C, IgG, ESR, CRP, and complement C3; the increase of SV was associated with the elevations of UA, LDL-C, complement C4, HDL-C, CRP, IgG, HCY, TC, ESR, TG, and complement C3. Multivariate logistic regression analysis indicated that FS was positively correlated with LDL-C (P<0.05), Pmax was negatively correlated with IgM (P<0.05), and SV was negatively correlated with ESR (P<0.05). Conclusion The changes of echocardiographic parameters in patients with gout are correlated with the increase in inflammation, immunity, and metabolic indexes. Patients with a history of smoking and drinking do not show obvious changes in cardiac function. The changes in metabolic indexes are risk factors for changes in echocardiographic parameters.