不同临床因素时房颤患者炎症标志物的浓度变化及意义

Changes of concentration and significance of inflammatory markers in patients with atrial fibrillation in various clinical state

目的研究不同临床因素时心房颤动(房颤)患者炎症标志物的浓度变化,探讨不同临床因素时房颤患者与炎症的关系。方法研究对象为60例经心电图诊断为房颤患者,按能否自行复律分为阵发性房颤组及非阵发性房颤组,其中非阵发性房颤组又分别按左心房内径(小于或等于40 mm,大于40 mm)、年龄(小于70岁,大于或等于70岁)、左室射血分数(小于50%,大于或等于50%)分成亚组;采用酶联免疫吸附法(ELISA)检测各组血浆高敏C-反应蛋白(Hs-CRP)、白细胞介素6(IL-6)的浓度,对其结果进行统计分析。结果房颤患者的Hs-CRP、IL-6水平明显高于正常对照组,差异有统计学意义(P<0.05),非阵发性房颤组的Hs-CRP、IL-6水平明显高于阵发性房颤组,差异有统计学意义(P<0.05);左心房内径大于40 mm亚组Hs-CRP、IL-6水平明显高于左心房内径(LAD)小于或等于40 mm亚组,差异有统计学意义(均P<0.01),年龄大于或等于70岁亚组Hs-CRP、IL-6水平明显高于年龄小于70岁亚组,差异有统计学意义(P<0.05),经协方差校正后非阵发性房颤组中射血分数(LVEF)小于50%者Hs-CRP、IL-6水平与射血分数大于或等于50%者比较差异无统计学意义(P>0.05)。结论 (1)房颤与炎症有关,炎症参与了房颤的发生与持续。(2)房颤患者中左心房内径明显增大者、高龄者的Hs-CRP、IL-6水平明显增高,且Hs-CRP、IL-6水平与左心房内径成正相关,Hs-CRP与年龄成正相关,提示炎症通过影响心房结构重构参与了房颤的发生发展过程。

Objective To explore the correlation between in various clinical state and inflammation in patients with atrial fibrillation（Af）by investigate changes of concentration of plasm high sensitivity C-reactive protein（Hs-CRP） and interleuki-6（IL-6） in patients with Af.Methods 60 patients who were diagnosed as Af were entered and were compared with normal control group（n=20）,patients with Af were divided into two groups：paroxysmal Af（n=18）and no paroxysmal Af（n=42） group according to spontaneously termination,no paroxysmal Af group were divided into various subgroups according to left atrial diameter（LAD≤40 mm,LAD40 mm）,age70y,≥70y）.left ventricle eject fraction（LVEF50%,LVEF≥50%）,respectively.Enzynle-linked immunonsorbent assay（ELISA） methods were used to measure plasma Hs-CRP and IL-6 levels in 60 patients with Af and in normal control group,statistical evaluation was performed with SPSS 12.0 software.Results The plasma Hs-CRP and IL-6 levels of LAD﹥40 mm in patients with no paroxysmal Af were significantly higher than that in subset of LAD≤40 mm（P0.05）,The plasma Hs-CRP and IL-6 levels in subset of age≥70y in patients with no paroxysmal Af was higher than that in subset of age 70y.No significant changes of their levels were found between LVEF50% and LVEF≥50% group in patients with no paroxysmal Af after adjusted by covariance analysis.Conclusion（1）The results indicate that inflammation in Af patients may play an important role in the initiating and sustaining Af.（2）The plasma Hs-CRP and IL-6 levels in subset of LAD40 mm,age≥70y in patients without no paroxysmal Af are significantly elevated,this study indicates that the inflammatory reaction may promote the occurrence and progression of atrial fibrillation by affect atrial remodeling.