关节置换术前老年房颤患者血清内源性孤啡肽与C反应蛋白水平变化的研究

Changes of endogenous nociceptin/orphanin FQ (N/OFQ) and C-reactive protein in elderly patients with atrial fibrillation before joint replacement

目的研究全膝关节置换术前老年房颤患者血清内源性孤啡肽(N/OFQ)、C反应蛋白(CRP)水平变化,并探讨其意义。方法将阵发性房颤(PAAF)组分为PAAFⅠ组(≤75岁)32例和PAAFⅡ组(>75岁)31例,持续性房颤(PEAF)组分为PEAFⅠ组(≤75岁)27例和PEAFⅡ组(>75岁)32例,非房颤窦性心律患者47例(对照组)。检测各组N/OFQ、CRP水平,左心房内径(LAD)、左室射血分数(LVEF),空腹三酰甘油(TG)、低密度脂蛋白胆固醇(LDL-C)、高密度脂蛋白胆固醇(HDL-C)值,并对上述指标进行分析。结果 PAAF组和PEAF组LAD值高于对照组,PEAF组LAD值高于PAAF组,PAAF组和PEAF组LVEF、TG值均低于对照组,PEAF组LVEF、TG、HDL-C、LDL-C值均低于PAAF组;PAAF组HDL-C、LDL-C值均高于对照组,PEAF组HDL-C、LDL-C值均低于对照组,PAAF组和PEAF组N/OFQ、CRP水平均高于对照组,PEAF组N/OFQ、CRP水平高于PAAF组,差异均有统计学意义(P<0.05),PAAFⅡ组N/OFQ水平高于Ⅰ组,PEAFⅡ组N/OFQ水平高于Ⅰ组,差异均有统计学意义(P<0.05),而CRP水平差异均无统计学意义(P>0.05)。Logistic回归分析结果显示N/OFQ升高(OR=2.911,95%CI:1.291~6.564)、CRP升高(OR=4.636,95%CI:1.042~20.616)、LAD增大(OR=1.369,95%CI:1.000~1.875)是房颤的危险因素;LVEF升高(OR=0.489,95%CI:0.302~0.792)是房颤的保护因素。房颤患者N/OFQ、CRP水平与LAD呈正相关,与TG、LDL-C、HDL-C呈负相关;N/OFQ与CRP水平呈正相关;房颤患者年龄与N/OFQ水平呈正相关,而与CRP水平无显著相关;房颤患者LVEF与N/OFQ水平呈负相关,而与CRP水平无显著相关。ROC曲线分析结果显示,N/OFQ预测房颤发生的曲线下面积为0.949(95%CI:0.917~0.982,P<0.01),CRP预测房颤发生的曲线下面积为0.855(95%CI:0.775~0.935,P<0.01),联合预测因子预测房颤发生的曲线下面积为0.960(95%CI:0.933~0.987,P<0.01)。结论 N/OFQ、CRP与老年房颤的发生密切相关,N/OFQ用于评估全膝关节置换术前高龄房颤患者的心功能时,更具优势。

Objective To investigate the serum changes of endogenous nociceptin/orphanin FQ(N/OFQ) and C reactive protein(CRP) before total knee arthroplasty in elderly patients with atrial fibrillation,and to explore its significance.Methods The patients with paroxysmal atrial fibrillation were divided into PAAF Ⅰ subgroup(≤75 years old,n=32) and PAAF Ⅱ subgroup(> 75 years old,n=31).At the same time,the patients with persistent atrial fibrillation were divided into PEAF Ⅰ subgroup(≤75 years old,n=27) and PEAF Ⅱ subgroup(> 75 years old,n=32).Forty-seven patients with non-AF sinus rhythm were used as control group.The levels of N/OFQ and CRP,left atrial dimension(LAD),ejection fraction of left ventricle(LVEF),fasting triglyceride(TG),low-density lipoprotein(LDL-C) and high-density lipoprotein cholesterol(HDLC) were measured,and the above-mentioned indicators were analyzed.Results The LAD value was higher in PAAF group and PEAF group than that in control group.The LAD value was higher in PEAF group than that in PAAF group,and the LVEF and TG values were lower in PAAF group and PEAF group than those in control group.The values of LVEF,TG,HDL-C and LDL-C were lower in PEAF group than those of PAAF group.The values of HDL-C and LDL-C were higher in PAAF group than those of control group,and the values of HDL-C and LDL-C were lower in PEAF group than those of control group.The levels of N/OFQ and CRP were higher in PAAF group and PEAF group than those in control group,and the levels of N/OFQ and CRP were significantly higher in PEAF group than those in PAAF group(P <0.05).The level of N/OFQ was higher in PAAFII subgroup than that in PAAFI subgroup,and the level of N/OFQ was significant higher in PEAFⅡ subgroup than that in PEAF Ⅰ subgroup(P <0.05).There was no significant difference in CRP level between groups(P>0.05).Multiple Logistic regression showed that N/OFQ elevation(OR=2.911,95 % CI:1.291-6.564) and CRP elevation(OR=4.636,95% CI:1.042-20.616) and LAD enlargement(OR=1.369,95 % CI:1.000-1.875)-were the risk factors of AF.LVEF elevation(OR=0.489,95% CI:0.302-0.792)was the protective factor of AF.The levels of N/OFQ and CRP were positively correlated with LAD and negatively correlated with TG,LDL-C and HDL-C in patients with atrial fibrillation.N/OFQ and CRP levels were positively correlated.The age of AF patients was positively correlated with N/OFQ level,but not with CRP level.LVEF was negatively correlated with N/OFQ level in patients with atrial fibrillation,but no correlation with CRP level.The result of ROC curve analysis showed that the area under the curve of N/OFQ for predicting atrial fibrillation was 0.949(95%CI:0.917-0.982,P<0.01),the area under the curve of CRP for predicting atrial fibrillation was 0.855(95%CI:0.775-0.935,P<0.01),the area under the curve of joint forecasting factor for predicting atrial fibrillation was 0.960(95%CI:0.933-0.987,P<0.01).Conclusion N/OFQ and CRP are closely related to the occurrence of atrial fibrillation in the elderly,and N/OFQ is more advantageous in assessing cardiac function before total knee replacement in elderly patients with atrial fibrillation.