持续性房颤合并肺部感染患者血清炎症因子水平与左心房重构的相关性研究

Changes of serum inflammatory factors in patients with persistent atrial fibrillation complicated with pulmonary infections and their correlation with left atrial remodeling

目的分析持续性房颤合并肺部感染患者血清炎症因子水平与左心房重构的相关性。方法选取2016年1月-2017年1月医院收治的持续性心房颤动患者510例为病例组,根据是否合并肺部感染分为感染组243例和非感染组267例,选取100名健康志愿者作为对照组。对研究对象的血清超敏C-反应蛋白(hs-CRP)、白细胞介素-6(IL-6)、肿瘤坏死因子-α(TNF-α)水平及左心房内径(LAD)、后壁背向散射积分(IBS)、背向散射积分周期变化值(CVIB)等左心房重构指标进行检测和比较。结果病例组患者的血清hs-CRP、IL-6、TNF-α水平及LAD、IBS分别为(6.89±1.27)mg/L、(148.81±41.97)ng/L、(116.64±39.96)ng/L及(45.04±2.26)mm、(44.12±6.52)%均高于对照组(P<0.001),CVIB为(6.42±1.83)低于对照组(P<0.001)。感染组患者的血清hs-CRP、IL-6、TNF-α分别为(7.48±1.32)mg/L、(168.83±44.75)ng/L、(137.79±42.03)ng/L高于非感染组(P<0.001),两组患者LAD、IBS、CVIB水平差异无统计学意义。以病例组患者的LAD均值为分界值,其中LAD>45 mm258例,LAD≤45mm 252例,LAD>45 mm患者血清hs-CRP、IL-6、TNF-α水平高于LAD≤45 mm患者(P<0.001);较高的LAD与肺部感染和血清hs-CRP、TNF-α水平具有相关性(P<0.001)。结论持续性房颤合并肺部感染患者的血清炎症因子水平高,而肺部感染和血清炎症因子过表达与患者的左心房重构具有相关性,临床医生应给予及时、有效地干预,以改善患者的预后。

OBJECTIVE To analyze the changes of serum inflammatory factors in patients with persistent atrial fibrillation complicated with pulmonary infections and their correlation with left atrial remodeling,so as to provide an objective basis for clinical diagnosis and treatment.METHODS 510 patients with persistent atrial fibrillation treated in the hospital from Jan.2016 to Jan.2017 were selected as subjects.According to whether the patients were complicated with pulmonary infections,the patients were divided into the infected group（243 cases）and the uninfected group（267 cases）.100 healthy volunteers were selected as the control group.The serum high sensitivity C reactive protein（hs-CRP）,interleukin-6（IL-6）,tumor necrosis factor alpha（TNF-α）levels and the left atrial remodeling indicators such as the left atrial diameter（LAD）,the integrated backscatter（IBS）,cyclic variation of integrated backscatter（CVIB）were detected and compared for the patients in the two groups.RESULTS The serum hs-CRP,IL-6,TNF-αlevels and the LAD,IBS levels of the patients in the case group were（6.89±1.27）mg/L,（148.81±41.97）ng/L,（116.64±39.96）ng/L and（45.04±2.26）mm,（44.12±6.52）%,which were significantly higher than those in the control group（P〈0.001）.CVIB was（6.42±1.83）,significantly lower than that in the control group（P〈0.001）.The serum hs-CRP,IL-6,TNF-αlevels of the patients in the infected group were（7.48±1.32）mg/L,（168.83±44.75）ng/L,（137.79±42.03）ng/L,which were significantly higher than those in the uninfected group（P〈0.001）.The differences of LAD,IBS and CVIB between the patients in the two groups were not significant.Taking the average value of LAD level in the patients of the case group as the dividing value,the patients were divided into group A（LAD〉 45 mm,258 cases）and group B（LAD≤45 mm,252 cases）.The serum hs-CRP,IL-6,TNF-αlevels of the patients in group A were significantly higher than those in group B（P〈0.001）.The results of multivariate logistic regression analysis showed that the higher LAD was correlated with the incidence of pulmonary infection and the serum hs-CRP,TNF-αlevels（P 〈0.001）.CONCLUSIONThe inflammatory factors levels of the patients complicated with pulmonary infection were higher.The overexpression of the serum inflammatory factors and the incidence of the pulmonary infection were related to left atrial remodeling,the clinicians should give timely and effective intervention to improve the prognosis of the patients.