睾酮水平高,有恶性心律失常风险!阜外宋江平团队致心律失常性右室心肌病研究

2020-06-09 朱朱 中国循环杂志

致心律失常性右室心肌病(ARVC)是一种遗传性心肌病,常导致危及生命的室性心律失常和严重心室功能不全,尤其是在青少年期和青年期,是年轻人和运动员心脏猝死的主要病因之一。

致心律失常性右室心肌病(ARVC)是一种遗传性心肌病,常导致危及生命的室性心律失常和严重心室功能不全,尤其是在青少年期和青年期,是年轻人和运动员心脏猝死的主要病因之一。
 
近年国外研究发现,性激素可能在ARVC的发生、发展过程中发挥重要的作用。
 
近期,阜外医院宋江平研究团队发表的一项研究提示,对于中国男性ARVC患者来说,血浆睾酮水平是未来恶性心律失常事件的强烈预测因素。
 
在该研究中,中位随访17个月期间,在男性ARVC患者中,出现恶性心律失常事件(包括心脏猝死、可存活的心脏猝死、室颤、持续性室性心动过速、ICD恰当放电)者的睾酮水平显著高于没有出现上述严重事件的患者。
 
校正多个潜在混淆因素的Cox回归分析显示,血浆总睾酮水平是男性ARVC患者出现恶性心律失常事件的独立预测因素,睾酮水平升高者出现恶性心律失常事件的风险增加32.5%。
 
ROC曲线分析显示,在男性ARVC患者中,总睾酮、有生物活性的睾酮、游离睾酮水平预测恶性心律失常事件的最佳阈值分别为6.722、4.650、0.257 ng/ml。
 
但是,在出现明显结构性进展性事件(左室射血分数下降10%、心脏移植、因终末期心衰死亡)的ARVC患者中,睾酮水平并未升高。
 
相关性分析也显示,总睾酮和有生物活性的睾酮水平均与患者的基线心功能、心室扩大以及未来明显结构性进展性事件无关。
 
研究者指出,这说明,睾酮水平不是心脏结构或功能重构的预测因素。
 
研究者发现,在男性ARVC患者中,血浆总睾酮(6.390 ng/ml vs. 3.617ng/ml)、有生物活性的睾酮(4.11 ng/ml vs. 1.32 ng/ml)、游离睾酮(0.2055 ng/ml vs. 0.0768ng/ml)水平均明显高于健康男士。
 
但女性ARVC患者的睾酮水平与健康女士无明显差异。
 
从2015年10月至2018年7月,中国ARVC队列共纳入118例ARVC患者。该研究从中国ARVC队列中随机纳入99例ARVC患者,平均年龄40岁,男士占71%;另入选99名健康志愿者作对照,平均年龄41岁,其中男士占62.5%。
 
收集血样时,44.8%的ARVC患者自发病以来已发生过恶性心律失常事件,大约1/3的患者存在左室功能不全。
 
来源:Plasma Testosterone and Arrhythmic Events in Male Patients With Arrhythmogenic Right Ventricular Cardiomyopathy. ESC Heart Fail, 2020 May 29.

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    2020-12-01 lovetcm

    #睾酮##心律失常#相关,#二甲双胍#能否减轻其风险?

    0

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