血浆抵抗素水平与心房颤动关系的临床研究

Clinical study on the relationship between plasma resistin level and atrial fibrillation

目的通过测定血浆抵抗素的水平,研究其在孤立性心房颤动(房颤)的发生与维持中的作用;同时分析影响其水平的相关因素及房颤的风险因素。方法研究对象为2014年6月至12月因心悸等不适就诊我院心内科的患者140例,其中试验组为房颤人群,分为孤立性房颤(60例)和房颤合并高血压(55例);根据发病时间不同,孤立性房颤又分为阵发性与持续性房颤,各30例。正常对照组为正常人群,共25例。使用单因素方差分析比较房颤人群与正常人群血浆抵抗素水平的差异。用Pearson及多重线性回归法分析影响房颤患者抵抗素水平的相关因素。用Logistic回归分析影响房颤的风险因素。结果 1超敏C反应蛋白(hs-CRP)及血浆抵抗素水平:所有房颤组的水平均高于对照组,其中孤立性房颤组低于房颤合并高血压组;阵发性房颤组低于持续性房颤组。2 Pearson相关分析:血浆抵抗素水平与hs-CRP水平、左房内径大小及收缩压均呈正相关(分别为r=0.530,P=0.000;r=0.265,P=0.004;r=0.364,P=0.000)。多重线性回归分析进一步显示收缩压(SBP)、hs-CRP水平与血浆抵抗素的水平存在线性关系:Y=-2.172+0.089 SBP+1.347 hs-CRP(R2=0.307,P<0.05)。3 Logistic回归分析表明血浆抵抗素水平、hs-CRP水平均被纳入回归方程,且OR值均>1。结论 1血浆抵抗素水平孤立性房颤组明显高于对照组,其中又以持续性房颤组增高为著,表明抵抗素与房颤的发生、节律的维持相关。2血浆抵抗素水平与hs-CRP的水平呈正相关,间接表明房颤的发生可能与抵抗素具有某种炎性特质相关,提示抵抗素可引起炎症反应并和炎症介质一起参与了房颤发生、维持。3血浆抵抗素水平在房颤合并高血压患者中升高明显,且具有协同效应,提示抵抗素也许具有独立表达高血压与房颤疾病的潜质。同时本研究也证实了高血压为房颤的风险因素,可推测抵抗素通过高血压影响房颤。

Objective By measuring the level of plasma resistin,to study its roles in the occurrence and maintenance of lone atrial fibrillation（ LAF）,and analyze the related influential factors of plasma resistin level and risk factors of AF.Methods Research objects were 140 patients consulting in the department of cardiology of our hospital because of palpitation from June to December in2014.The experimental group consisted of AF patients who were classified into patients with LAF（ 60 cases） and those with AF complicating hypertension（ 55 cases）,respectively.The LAF cases were further divided into paroxysmal AF group and persistent AF group,each with 30 cases.In the control group were normal people（ 25 cases）.The difference of plasma resistin level was analyzedbetween AF patients and normal people by one-way abalysis of variance,and its related influential factors for AF patients were analyzed in methods of Pearson correlation analysis and multiple linear regression.Logistic regression was applied in analyzing risk factors of AF.Results（ i） In terms of high sensitive C reactive protein（ hs-CRP） and plasma resistin level,the levels of AF group were all higher than those of control group;among the AF patients,the levels of LAF group were lower than those of AF complicating hypertension group and the levels of paroxysmal AF group were lower than those of persistent AF group.（ ii） Pearson correlation analysis showed that plasma resistin level was positively correlated with hs-CRP level（ r = 0.530,P = 0.000）,left atrial diameter（ r = 0.265,P = 0.004） and systolic blood pressure（ SBP）（ r = 0.364,P = 0.000）.Multiple linear regression analysis further revealed that there was a linear relationship among SBP,hs-CRP and plasma vesistin levels：Y =-2.172 ＋ 0.089 SBP ＋ 1.347 hs-CRP（ R2= 0.307,P〈0.05）.（ iii） Logistic regression analysis indicated that plasma resistin and hs-CRP levels were both enrolled into the regression equation,with OR 1.Conclusion（ i） The level of plasma resistin in LAF group was significantly higher than that in control group,especially the cases in persistent AF group,which indicated that resistin participated in the occurrence and maintenance of AF.（ ii） Plasma resistin level was positively correlated with hs-CRP level.It implied that the occurrence of AF may be related with some inflammatory characteristics of resistin,which suggested that resistin could give rise to inflammatory reaction and participate in the occurrence and maintenance of AF with inflammatory mediators.（ iii） Plasma resistin level increased significantly in AF patients complicating hypertension and showed synergistic effect,which suggested possible potentiality of resistin in expressing hypertension and AF independently.Meanwhile,the study also demonstates that hypertension is a risk factor of AF.It might be suspected that resistin can impact on AF via hypertension.