术前血浆磷脂转运蛋白水平与冠状动脉旁路移植术后新发心房颤动的相关性

Correlation of preoperative phospholipid transfer protein in plasma and new-onset atrial fibrillation after coronary artery bypass grafting

目的探讨术前血浆磷脂转运蛋白(PLTP)水平与冠状动脉旁路移植术(CABG)后新发房颤(POAF)的相关性及其诊断价值。方法自2015年1月至2016年6月,在中国医学科学院北京协和医学院泰达国际心血管病医院就诊并接受单独CABG手术的所有病人中,选取40例发生POAF的病人为AF组,未发生POAF的病人40例,为SR组。测量两组病人术前血浆中PLTP水平,评价其与POAF的相关性与其对POAF的诊断价值。结果 AF组PLTP水平(1.5±1.5) mg/mL显著低于SR组(2.6±1.6) mg/mL(P=0.004);在矫正POAF发生的相关变量后,PLTP仍与POAF独立相关;ROC分析显示PLTP诊断POAF的曲线下面积(AUC)为0.74(P<0.001),其临界值为0.43 mg/mL。结论发生CABG术后POAF的病人血浆中PLTP水平较未发生病人为低;术前血浆中PLTP水平与CABG术后POAF的发生独立相关,且可能为POAF发生的可靠预测指标。

Objective To investigate the correlation between preoperative plasma phospholipid transfer protein(PLTP)and the onset of postoperative atrial fibrillation(POAF)after coronary artery bypass grafting(CABG).Methods Eighty patients who were treated in Chinese Academy of Medical Sciences&Peking Union Medical College and TEDA International Cardiovascular Hospital and underwent isolated CABG from January 2015 to June 2016 were enrolled in the study,among whom 40 patients who developed POAF were as assigned into AF group,and another 40 patients without POAF in SR group.The plasma PLTP concentrations were measured and compared between the two groups,and a multivariable logistic regression was performed to investigate the correlation of PLTP with the onset of POAF,and an ROC analysis was performed to investigate the diagnostic value of PLTP concentration for POAF.Results The plasma level of PLTP in AF group was significantly lower than that in SR group[(1.5±1.5)mg/mL vs.(2.6±1.6)mg/mL,P=0.004].After adjustment of related variables for POAF,the PLTP concentration was still independently correlated with the onset of POAF,and the ROC analysis indicated that the area under the curve(AUC)of PLTP for the onset of POAF was 0.74(P<0.001),and the optimal cutoff value of PLTP concentration was 0.43 mg/mL.Conclusions The plasma concentration of PLTP in patients with POAF who received isolated CABG was lower than that in patients without POAF,and the PLTP concentration was independently correlated with the onset of POAF,and it may become a useful predictive indicator of POAF.