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目的研究高龄糖尿病合并心房颤动(房颤)患者血清高敏C反应蛋白(hs-CRP)、同型半胱氨酸(Hcy)水平的变化及与颈动脉粥样硬化程度的相关性,探讨炎症、氧化应激在糖尿病合并房颤的发生、发展中的变化及意义。方法选择高龄糖尿病合并房颤患者(房颤组)115例,糖尿病窦性心律患者(窦律组)103例及窦性心律除外糖尿病者(对照组)98例。房颤组中阵发性房颤42例、持续性房颤37例及永久性房颤36例。检测各组hs-CRP和Hcy水平;颈动脉超声检测颈动脉内膜中层厚度(IMT)及斑块Crouse积分,评价颈动脉粥样硬化情况。结果与对照组比较,房颤组和窦律组hs-CRP、Hcy、IMT和斑块Crouse积分明显升高(P<0.05);与窦律组比较,房颤组上述指标明显升高(P<0.05)。房颤组患者hs-CRP、Hcy与房颤持续时间呈正相关(r=0.64、r=0.53,P<0.05),与IMT和斑块Crouse积分呈正相关(r=0.59、r=0.66,P<0.05)。结论炎症和氧化应激在高龄糖尿病合并房颤时颈动脉粥样硬化的发生、发展可能起重要作用,而且随着房颤的持续而加重,hs-CRP、Hcy水平与糖尿病合并房颤的发生、发展及颈动脉粥样硬化的严重程度密切相关。
Objective To study the relationship between the changes of serum high-sensitivity C-reactive protein (hs-CRP), homocysteine (Hcy) and carotid atherosclerosis in elderly patients with diabetes mellitus complicated with atrial fibrillation (AF) Changes and Significance of Stress in Occurrence and Development of Diabetes Mellitus with Atrial Fibrillation. Methods One hundred and fifteen elderly diabetic patients with atrial fibrillation (AF), 103 patients with sinus rhythm (sinus rhythm) and 98 patients with sinus arrhythmia (control group) were enrolled in this study. Atrial fibrillation group in 42 cases of paroxysmal atrial fibrillation, 37 cases of persistent atrial fibrillation and permanent atrial fibrillation in 36 cases. The levels of hs-CRP and Hcy in each group were detected. Carotid artery IMT and plaque Crouse scores were detected by ultrasound to evaluate the carotid atherosclerosis. Results Compared with the control group, the scores of hs-CRP, Hcy, IMT and plaque Crouse in atrial fibrillation group and sinus rhythm group were significantly increased (P <0.05). Compared with sinus rhythm group, the above parameters were significantly increased in atrial fibrillation group (P <0.05). The hs-CRP and Hcy were positively correlated with the duration of atrial fibrillation (r = 0.64, r = 0.53, P <0.05), and positively correlated with IMT and plaque Crouse score (r = 0.59, r = 0.05). Conclusion Inflammation and oxidative stress may play an important role in the occurrence and development of carotid atherosclerosis in elderly patients with diabetes mellitus and atrial fibrillation. Moreover, the severity of carotid atherosclerosis may play an important role in the progression of atrial fibrillation. In addition, the levels of hs-CRP and Hcy and the occurrence of atrial fibrillation , Development and the severity of carotid atherosclerosis are closely related.