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

zehuiwang

医生/ 护师

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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2020-08-22 lhlxtx

#致心律失常性#

64 0
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2020-12-01 lovetcm

#睾酮#与#心律失常#相关，#二甲双胍#能否减轻其风险？

256 0
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2020-08-10 柳叶一刀

#致心律失常性右室心肌病#

83 0
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2020-06-11 quxin068

#恶性心律失常#

69 0
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2020-06-11 爆笑小医

#肌病#

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