心房颤动患者左心房血清炎性因子和血管内皮损伤标志物水平变化与血栓的相关性研究

Correlation of Markers of Inflammation and Endothelial Injury with Thrombosis in Left Atrium in Patients with Atria Fibrillation

背景心房颤动(以下简称房颤)容易合并脑卒中和外周动脉栓塞。研究房颤血栓形成的具体机制并进行有效干预以降低血栓形成的风险,是目前房颤基础和临床研究的重要方向。目的探讨房颤患者左心房血清炎性因子和血管内皮损伤标志物水平变化与血栓的相关性。方法选取2017年7月至2019年12月在广西医科大学第一附属医院接受开胸心脏手术的瓣膜性心脏病患者29例和冠心病患者10例,依据心律情况分为窦性心律组15例和房颤组24例。房颤组的24例患者再依据血栓情况分为无左心耳血栓和有左心耳血栓两个亚组,分别为房颤+左心耳血栓亚组和房颤无左心耳血栓亚组,各12例。收集患者的一般资料,并检测左心房内径(LAD)、左心室射血分数(LVEF),术中抽取左心房血液标本检测蛋白激酶B(AKT)、核转录因子κB(NF-κB)、超敏C反应蛋白(hs-CRP)、白介素(IL)-6、IL-8、肿瘤坏死因子α(TNF-α)、内皮素(ET-1)、一氧化氮(NO)、血管性血友病因子(vWF)、细胞间黏附分子(ICAM-1)及血管细胞黏附因子(VCAM-1)水平,并检测房颤+左心耳血栓亚组患者血栓面积。房颤+左心耳血栓亚组患者LAD、LVEF、炎性因子水平和血管内皮损伤标志物的水平与左心耳血栓面积的关系采用Pearson相关分析。结果窦性心律组、房颤无左心耳血栓亚组与房颤+左心耳血栓亚组患者LAD、LVEF比较,差异有统计学意义(P<0.05);房颤无左心耳血栓亚组和房颤+左心耳血栓亚组患者LAD、LVEF比较,差异无统计学意义(P>0.05)。房颤无左心耳血栓亚组患者AKT、NF-κB、IL-8、ET-1、ICAM-1、VCAM-1水平高于窦性心律组,NO水平低于窦性心律组(P<0.05)。房颤+左心耳血栓亚组患者AKT、hs-CRP水平高于房颤无左心耳血栓亚组,NO水平低于房颤无左心耳血栓亚组(P<0.05);房颤无左心耳血栓亚组和房颤+左心耳血栓亚组患者NF-κB、IL-6、IL-8、TNF-α、ET-1、vWF、ICAM-1、VCAM-1水平比较,差异无统计学意义(P>0.05)。房颤+左心耳血栓亚组患者血栓面积最大为4.8 cm2,最小为1.67 cm2,平均为(3.48±0.83)cm2。Pearson相关分析结果显示,房颤合并左心耳血栓患者LAD、LVEF、AKT、NF-κB、hs-CRP、IL-6、IL-8、TNF-α、ET-1、NO、vWF、ICAM-1、VCAM-1与血栓面积无直线相关关系(P>0.05)。结论房颤患者左心房血液炎性因子和血管内皮损伤标志物水平明显升高,且合并左心房血栓时上述指标更高。检测炎性因子和血管内皮损伤标志物的水平有助于评估房颤患者的血栓状态。

Background Atrial fibrillation(AF)patients are prone to stroke and peripheral arterial embolism.Studying the pathogenesis of thrombosis formation in AF and providing effective interventions to reduce the risk is an important direction of clinical and basic research on AF.Objective To investigate the correlation of markers of inflammation and endothelial injury with thrombosis in the left atrium(LA)in AF patients.Methods Twenty-nine patients with valvular heart disease and 10 patients with coronary heart disease who underwent thoracotomy at the First Affiliated Hospital of Guangxi Medical University from July 2017 to December 2019 were selected,and divided into sinus rhythm group(15 cases)and AF group〔24 cases,including 12 with left atrial appendage thrombus(LAAT),and 12 without LAAT〕according to heart rhythm.General demographics were collected.Besides that,other data were also collected,including left atrial diameter(LAD)and left ventricular ejection fraction(LVEF),levels of protein kinase B(AKT),nuclear factor-κB(NF-κB),high-sensitivity C-reactive protein(hs-CRP),interleukin-6(IL-6),IL-8,tumor necrosis factor(TNF-α),endothelin-1(ET-1),nitric oxide(NO),von Willebrand factor(VWF),intercellular adhesion molecule(ICAM-1)and vascular cell adhesion factor(VCAM-1)in the left atrial blood sample,and calculated thrombus area in patients with AF and LAAT.The relationships of LAD,LVEF,markers of inflammation and endothelial injury with calculated area of thrombus in AF with LAAT patients were analyzed by Pearson correlation.Results There were significant differences in LAD and LVEF between sinus rhythm patients and AF patients with or without LAAT(P<0.05).AF patients with and without LAAT had no significant differences in LAD and LVEF(P>0.05).AF patients without LAAT had higher levels of AKT,NF-κB,IL-8,ET-1,ICAM-1 and VCAM-1 and lower NO level in left atrium than patients with sinus rhythm(P<0.05).AF patients with LAAT had higher levels of AKT and hs-CRP,and lower NO level in left atrium than those without(P<0.05).AF patients with and without LAAT had no significant differences in levels of NF-κB,IL-6,IL-8,TNF-α,ET-1,vWF,ICAM-1 and VCAM-1(P>0.05).The maximum area,minimum area,and average area of the left atrial appendage thrombus in AF patients with LAAT were 4.8 cm2,1.67 cm2,and(3.48±0.83)cm2,respectively.Pearson correlation analysis showed LAD,LVEF,AKT,NF-κB,hs-CRP,IL-6,IL-8,TNF-α,ET-1,NO,vWF,ICAM-1,and VCAM-1 had no linear correlation with the area of thrombus in AF patients with LAAT(P>0.05).Conclusion Increased levels of markers of inflammation and endothelial injury in left atrium were found in AF patients,which were even more higher when the patients also had LAAT.Detecting the markers of inflammation and endothelial injury in left atrium is helpful to evaluate the thrombus prevalence in AF patients.