心房肌葡萄糖转运体-3的水平对冠心病患者冠脉旁路移植术后新发房颤风险的影响

Impaired myocardium GLUT3 levels associated with the risk of new-onset atrial fibrillation after isolated coronary artery bypass grafting surgery

目的分析心房组织葡萄糖转运体-3(GLUT3)水平与冠心病患者接受冠状动脉旁路移植(CABG)术后新发房颤(POAF)的相关性,并评估影响GLUT3水平的风险因素。方法前瞻性人选79例窦性心律且接受冠脉搭桥的冠心病患者,其中22例患者出现术后新发房颤。收集患者术前、术中和术后的资料,在术中获取右心耳组织保存备分析。POAF由心电图评定,而且必须有抗心律失常治疗。GLUT3的在心肌组织中的浓度用ELISA方法测定。对可能与GLUT3有关的诸因素进行卡方检验和logistic多因素回归分析,以分析GLUT3与POAF的相关性和影响GLUT3水平的风险因素。结果CLUT3水平在发生术后房颤的患者组中明显较低,与POAF明显相关(P<0.05)。在多元线性回归模型中,低GLUT3水平与糖尿病明显相关(95%CI,8171.804-12402.757;P<0.05)。结论心房肌组织GLUT3水平低的患者存在更多术后新发房颤的风险。心房肌组织能量代谢障碍是导致CABG术后新发房颤的可能机制。

Objective The goal of this study was to analyze the relationship between glucose transporters 3 and new-onset atrial fibrillation （AF） after isolated CABG surgery. Methods Right atrial appendages were obtained from 79 patients who were in normal sinus rhythm and undergoing isolated coronary artery bypass grafting, those who exhibited new-onset POAF （ n = 22 ） or remained in sinus rhythm （ SR ） （ n = 57 ） were prospectively matched based on preoperative, intraoperative, and postoperative characteristics. Postoperative atrial fibrillation was assessed by electrocardiogram and must have required initiation of antiarrhythmic therapy or anticoagulation. Local GLUT3 concentration was quantified by enzyme-linked immunosorbent assay （ELISA） in tissue homogenates. Results GLUT3 levels was significant reduced in POAF patients compared with controls （ P 〈 0.05 ）. This selective reduction in GLUT5 was associated with presence of metabolism syndrome （MS） and diabetes mellitus （ DM ） （ P 〈 0.05 ）. Conclusions Patients who have low GLUT3 levels are in more risk of new-onset postoperative atrial fibrillation. The myofibrillar energetic impairment may be important in the pathogenesis of AF.