Wang Xue-Dong, Liu Jing, Zhang Yu-Chen, Wang Yu, Wang Yan, Ma Dan
Coronary Care Unit, Beijing Hepingli Hospital, Beijing, China.
Department of Cardiology, Beijing Anzhen Hospital Affiliated to Capital Medical University, Beijing, China.
Cardiovasc Diagn Ther. 2021 Feb;11(1):50-55. doi: 10.21037/cdt-20-830.
The aim of the present study was to investigate the correlation between the elevated uric acid (UA) levels and activation of the circulating renin-angiotensin-aldosterone system (RAAS) in patients with atrial fibrillation (AF).
A total of 233 outpatients and inpatients of the Cardiology Department from January 1, 2019, to December 31, 2019, were selected and divided into the sinus rhythm group (SR) with 84 cases, the paroxysmal AF group (pAF) with 76 cases, and the persistent AF group (PAF) with 73 patients. The general clinical data and the serum levels of UA of the enrolled patients were collected, and the radioimmunoassay was adopted to detect the levels of renin (Renin), angiotensin II (Ang II), and aldosterone (Ald).
Renin, AngII, Ald, and UA in the PAF group were significantly higher than those in the pAF group, and the levels of the above indicators in the pAF group were significantly higher than those in the SR group (P<0.001). The left atrium anteroposterior diameter (LAD) and the left ventricular end-diastolic diameter (LVEDD) were significantly increased in the PAF group (P<0.001). The Pearson correlation analysis showed that the levels of the high sensitivity C-reactive protein (hsCRP), AngII Renin, Ald, LVEDD, and LAD were positively correlated with the serum levels of UA (r=0.174, 0.273, 0.34, 0.385, 0.138, respectively, P<0.05 in all). The left ventricular ejection fraction (LVEF) was negatively correlated with the UA level (r=-0.177, P<0.05). Multiple linear regression analysis showed that UA (β=0.103) and LAD (β=2.162) were independent risk factors for Renin. The independent risk factor for Ang II was UA (β=0.167). The independent risk factor for Ald was UA (β=0.283) and LAD (β=8.721) (P<0.05).
Elevated UA might cause excessive activation of the RAAS, aggravate the oxidative stress, and participate in the atrial remodeling, thereby promoting the occurrence and persistence of AF.
本研究旨在探讨心房颤动（AF）患者尿酸（UA）水平升高与循环肾素-血管紧张素-醛固酮系统（RAAS）激活之间的相关性。
选取2019年1月1日至2019年12月31日心内科的233例门诊及住院患者，分为窦性心律组（SR）84例、阵发性房颤组（pAF）76例、持续性房颤组（PAF）73例。收集入选患者的一般临床资料及血清UA水平，采用放射免疫法检测肾素（Renin）、血管紧张素II（Ang II）和醛固酮（Ald）水平。
PAF组的肾素、AngII、Ald和UA显著高于pAF组，pAF组上述指标水平显著高于SR组（P<0.001）。PAF组左心房前后径（LAD）和左心室舒张末期内径（LVEDD）显著增加（P<0.001）。Pearson相关分析显示，高敏C反应蛋白（hsCRP）、AngII、肾素、Ald、LVEDD和LAD水平与血清UA水平呈正相关（r分别为0.174、0.273、0.34、0.385、0.138，均P<0.05）。左心室射血分数（LVEF）与UA水平呈负相关（r=-0.177，P<0.05）。多元线性回归分析显示，UA（β=0.103）和LAD（β=2.162）是肾素的独立危险因素。Ang II的独立危险因素是UA（β=0.167）。Ald的独立危险因素是UA（β=0.283）和LAD（β=8.721）（P<0.05）。
UA升高可能导致RAAS过度激活，加重氧化应激，并参与心房重构，从而促进AF发生和持续。
