2023 年第 2 期 第 18 卷

血尿酸水平和稳态模型胰岛素抵抗指数对代谢综合征患者新发心房颤动的影响及预测价值

Effect and predictive value of serum uric acid level and homeostasis model assessment of insulin resistance index on new-onset atrial fibrillation in patients with metabolic syndrome

作者：郭东浩1韩宇博2张美君1田苗1唐玥1刘莉2

英文作者：Guo Donghao1 Han Yubo2 Zhang Meijun1 Tian Miao1 Tang Yue1 Liu Li2

单位：1黑龙江中医药大学，哈尔滨150040；2黑龙江中医药大学附属第一医院心血管病一科，哈尔滨150040

英文单位：1Heilongjiang University of Chinese Medicine Harbin 150040 China; 2First Department of Cardiovascular Disease First Affiliated Hospital of Heilongjiang University of Chinese Medicine Harbin 150040 China

关键词：代谢综合征；心房颤动；血尿酸；稳态模型胰岛素抵抗指数；巢式病例对照研究

英文关键词：Metabolicsyndrome;Atrialfibrillation;Serumuricacid;Homeostasismodelassessmentofinsulinresistanceindex;Nestedcase-controlstudy

• 摘要：

• 目的 探讨血尿酸水平和稳态模型胰岛素抵抗指数（HOMA-IR）对代谢综合征（MS）患者新发心房颤动的影响及预测价值。方法 本研究采用巢式病例对照研究设计，基于回顾性MS队列。收集2015年1月至2016年12月于黑龙江中医药大学附属第一医院就诊的MS患者，筛选基线调查起5年内新发心房颤动的病例285例为心房颤动组；匹配未发生心房颤动的病例570例为对照组。收集2组患者基线资料，分析基线资料的组间差异；通过构建Logistic回归模型并校正混杂因素，分析血尿酸水平和HOMA-IR与MS患者新发心房颤动的关系；通过受试者工作特征（ROC）曲线进行预测价值分析。结果 心房颤动组的血尿酸水平和HOMA-IR均高于对照组，差异均有统计学意义（均P＜0.05）；血尿酸和HOMA-IR为MS患者新发心房颤动的独立影响因子（均P<0.05）。将血尿酸和HOMA-IR分别按照四分位数（Q1、Q2、Q3、Q4）分层，构建Logistic回归模型。校正全部混杂因素后，血尿酸Q2、Q3、Q4分层新发心房颤动的风险分别为Q1分层的1.752、3.040、4.281倍，HOMA-IR Q3、Q4分层新发心房颤动的风险分别为Q1分层的1.922、2.403倍。血尿酸、HOMA-IR及二者联合预测MS患者新发心房颤动的ROC曲线下面积（AUC）分别为0.757、0.714、0.828；二者联合预测新发心房颤动的AUC高于单一指标（均P＜0.05）。结论 在MS人群中，血尿酸水平和HOMA-IR是新发心房颤动的独立影响因子，且新发心房颤动的风险与血尿酸水平和HOMA-IR呈正相关；血尿酸水平和HOMA-IR对新发心房颤动均有良好的预测价值，且二者联合对新发心房颤动的预测价值更高。

• Objective To investigate the effect and predictive value of serum uric acid(SUA) level and homeostasis model assessment of insulin resistance index (HOMA-IR) on new-onset atrial fibrillation in patients with metabolic syndrome(MS). Methods  This was a nested case-control study based on a retrospective MS cohort. Patients with MS were enrolled in First Affiliated Hospital of Heilongjiang University of Chinese Medicine from January 2015 to December 2016. Screening 285 cases of new-onset atrial fibrillation within 5 years from the baseline survey were selected as the atrial fibrillation group, and 570 cases without atrial fibrillation were matched as the control group. Baseline data of two groups were collected, and the differences between groups were analyzed. Then, the correlation of SUA level and HOMA-IR to new-onset atrial fibrillation in patients with MS were analyzed by constructing a Logistic regression model and adjusting for confounding factors. Predictive value analysis was performed by receiver operating characteristic (ROC) curve. Results  The SUA level and HOMA-IR in the atrial fibrillation group were higher than those in the control group (both P<0.05). SUA and HOMA-IR were independent influencing factors for new-onset atrial fibrillation in patients with MS (both P<0.05). The SUA and HOMA-IR were stratified respectively according to the quartile(Q1, Q2, Q3 and Q4) to build a Logistic regression model. After adjusting for all confounding factors, the risk of new-onset atrial fibrillation in the Q2, Q3 and Q4 stratification of SUA was 1.752, 3.040, and 4.281 times of the Q1 stratification, respectively. Meanwhile, the risk in the Q3 and Q4 stratification of HOMA-IR was 1.922 and 2.403 times of the Q1 stratification, respectively. The area under the ROC curve(AUC) of SUA, HOMA-IR and their combination for predicting new-onset atrial fibrillation in patients with MS were 0.757, 0.714, and 0.828. AUC of the combination was higher than that of any single indicator (both P<0.05). Conclusions  In MS population, SUA level and HOMA-IR are independent influencing factors of new-onset atrial fibrillation, and the risk of new-onset atrial fibrillation is positively correlated with SUA level and HOMA-IR. Both indicators have good predictive value, and the combination of the two has a higher predictive value.