外周血白细胞端粒长度与急性心肌梗死后新发房性心律失常的相关性

The Association Between Telomere Length in Peripheral Blood and New-onset Atrial Arrhythmia After Acute Myocardial Infarction

目的:急性心肌梗死后的房性心律失常并不少见,其与缺血性脑卒中的发生以及不良预后密切相关。老龄是心房颤动等房性心律失常发生的重要危险因素,而端粒长度缩短是生物学衰老的重要标志。本研究旨在探讨外周血白细胞端粒长度对急性心肌梗死后新发房性心律失常的影响。方法:连续入选300例急性心肌梗死患者,通过连续心电监测记录患者心肌梗死发作后1周内新发的房性心律失常事件,发生房性心律失常的患者设为房性心律失常组,未发生房性及室性心律失常者作为对照组。通过实时定量PCR测定患者的白细胞端粒相对长度(以t/s比值表示,即外周血白细胞基因组DNA的端粒末端重复序列拷贝数与血红蛋白编码基因拷贝数的比值)。采用多因素Logistic回归分析来探讨t/s比值与急性心肌梗死后新发房性心律失常的相关性。结果:最终纳入211例急性心肌梗死患者,其中27例(12.8%)在心肌梗死发作后1周内新发房性心律失常。与对照组(n=184)相比,房性心律失常组(n=27)患者的年龄较大[(58.56±9.12)岁vs(.66.30±8.69)岁],白细胞端粒相对长度明显缩短(t/s比值:1.32±1.17 vs.0.75±0.58),差异均有统计学意义(P均<0.05)。多因素Logistic回归分析提示,t/s比值为心肌梗死后房性心律失常的独立危险因素(OR=2.804,95%CI:1.149~6.842,P=0.024)。结论:外周血白细胞端粒相对长度缩短与急性心肌梗死后房性心律失常的发生显著相关,其对急性心肌梗死后房性心律失常有潜在的预测价值。

Objectives:Post-acute myocardial infarction(AMI)atrial arrhythmia is common in clinical practice.It correlates with ischemic stroke and worse outcome.Aging is a major risk factor for atrial arrhythmia including atrial fibrillation,while telomere length shortening serves as the hallmark of biological aging.The present study aims to investigate the relationship between circulating leukocytes telomere length and post-AMI atrial arrhythmia.Methods:A total of 300 consecutive patients with acute myocardial infarction were recruited.Newly onset of atrial arrhythmia was detected by continuous ECG monitoring within one week post AMI.Patients with atrial arrhythmias were designated as atrial arrhythmia group,while patients without atrial or ventricular arrhythmias served as control group.The relative length of telomere was quantified by real time PCR(shown as t/s ratio,namely the copy number of terminal repeat sequence in circulating leukocytes versus the copy number of hemoglobin).Multivariable logistic regression was carried out to determine the relationship between telomere length and post-AMI atrial arrhythmia.Results:The telomere length was measured in 211 out of the 300 AMI patients.27(12.8%)patients developed atrial arrhythmia during the first week after AMI.Compared with the control group(n=184),patients were older([58.56±9.12]year-old vs.[66.30±8.69]year-old,P<0.001)and telomere length was shorter(t/s ratio:1.32±1.17 vs.0.75±0.58,P=0.013)in the atrial arrhythmia group.Multivariable logistic regression analysis showed that t/s ratio was an independent risk factor for the occurrence of post-AMI atrial arrhythmia(OR=2.804,95%CI:1.149-6.842,P=0.024).Conclusions:Shorter telomere length in circulating leukocytes is found to be significantly associated with post-AMI atrial arrhythmia,and it could be used as a potential biomarker for predicting post-AMI atrial arrhythmia.