内脂素与ST段抬高型心肌梗死患者PPCI术后新发心房颤动的关系

Relationship between visfatin and new-onset atrial fibrillation after PPCI in patients with ST elevation myocardial infarction

目的循环内脂素（visfatin）水平高低与急性ST段抬高型心肌梗死（STEMI）患者的全因死亡发生具有相关性。据此推测,较高的内脂素可能与主要不良心血管事件（MACE）的发生有关,并增加急诊经皮冠状动脉介入治疗（PPCI）STEMI患者心房颤动（AF）的发生率。方法 604例接受PPCI治疗的STEMI患者纳入研究。使用ELISA法测量术前血浆内脂素浓度。随访1年,记录术后AF及MACE发生率,并分析血浆内脂素水平与MACE、新发AF之间的关系。结果在604例患者中,新发AF 42例（6.95%）。与术后无AF患者相比,新发AF患者1年MACE发生率升高（45.24%比19.57%,P〈0.05）。此外,与血浆低水平内脂素（≤14.5μg/L）患者相比,血浆高水平内脂素（〉14.5μg/L）患者拥有更高的MACE发生率（31.02%比9.56%,P〈0.001）和新发AF率（10.24%比2.94%,P〈0.001）。多因素Cox风险回归模型分析显示,血浆内脂素水平为PPCI术后1年新发AF的独立预测因素（HR 1.51,95%CI 1.03~2.23,P=0.021）。结论在行PPCI的STEMI患者中,血浆内脂素水平高低与MACE的发生有关,并且与新发AF率呈正相关。

Aim Circulating visfatin levels has reflected the long-term survival in patients with ST-elevation myocardial infarction（ STEMI）. It postulated that higher visfatin would be linked to increased risk for atrial fibrillation（ AF）and major adverse cardiovascular events（ MACE） in patients with STEMI treated with primary percutaneous coronary intervention（ PPCI）. Methods 604 patients with acute STEMI underwent the PPCI were enrolled in the study. ELISA was used to measure plasma visfatin concentrations. One-year MACE and adverse events were compared between patients with and without new-onset AF after PPCI,and statistical analysis was used to respectively analyze the relationship between plasma visfatin level and MACE,plasma visfatin level and new-onset AF. Results From statistical data we learned that 42 of these patients had the new-onset AF（ 6.95%）. The incidence rate of MACE in patients with new-onset AF was higher than patients without AF after PPCI within one year（ 45.24% vs 19.57%,P〈0.05）. Moreover,compared with patients with low plasma visfatin levels（ ≤14.5 μg/L）,the patients with higher plasma visfatin levels（ 〉14.5 μg/L） had high rates of MACE（ 31.02% vs 9.56%,P〈0.001） and new-onset AF（ 10.24% vs 2.94%,P〈0.001）. The multivariate Cox hazard regression model revealed that the plasma visfatin level was an independent predictor for occurrence of new-onset AF after PPCI one year（ hazard ratio（ HR） was 1.51,and 95% confidence interval（ CI） was 1.03 to 2.23,P = 0.021）.Conclusion Plasma visfatin levels have a positive correlation with the incidence rate of new-onset AF and connection with MACE in patients with acute STEMI treated with PPCI.