半乳糖凝集素3表达水平变化与非瓣膜心房颤动的类型及卒中风险的相关性研究

Correlation studies of serum galectin-3 expressions with nonvalvular atrial fibrillation

目的 探索非瓣膜性心房颤动(房颤)中半乳糖凝集素3(galectin-3,Gal-3)中表达水平的变化与非瓣膜心房颤动的相关性,为病程的预测提供参考。方法 选取2020年12月至2022年4月期间在北京大学首钢医院收治的80例非瓣膜性房颤患者纳入观察组,并将患者,根据症状不同分为阵发性房颤组42例、持续性房颤组38例;同期选取窦性心律患者40例作为对照组。在对比全部患者一般资料和生化常规等检查的基础上,使用酶联免疫吸附剂测定测定患者静脉血Gal-3水平,采用组间对比和回归分析的方法探索Gal-3表达水平变化与非瓣膜心房颤动的相关性。结果 阵发性房颤组、持续性房颤组和对照组Gal-3、左心房内径(LAD)、血浆N末端B型利钠肽原(NT-proBNP)和CHA2DS2-VASc评分比较,差异有统计学意义(t=7.152、6.884、7.273、10.057,P=0.001、0.001、0.001、0.004)。80例非瓣膜性房颤患者,CHA2DS2-VASc评分≥4分(n=11)、2~3分(n=34)、0~1分(n=35)血清Gal-3水平比较,差异有统计学意义(F=12.308,P=0.000);LAD≥50 mm(n=22)血清Gal-3水平(175.43±21.57)ng/ml较LAD<50 mm(n=58)的(159.11±21.02)ng/ml明显升高(t=3.079,P=0.003);Pearson相关性分析显示,Gal-3与NT-proBNP、LAD、CHA2DS2-VASc评分均呈正相关(P<0.05);Logistic回归分析则显示血清Gal-3水平与房颤的易患性有关(OR=1.551,95%CI 1.038~2.318);LAD值与房颤的易患性有关(OR=1.268,95%CI 1.039~1.549)。多因素Cox回归分析显示,Gal-3水平与房颤的生存风险有关(OR=1.280,95%CI 1.072~1.529);LAD值与房颤的生存风险存在一定的相关性(OR=1.098,95%CI1.012~1.192)。结论 血清中Gal-3表达水平变化与非瓣膜心房颤动的类型及房颤发生发展密切相关,提示Gal-3水平升高可以一定程度上对持续性房颤和房颤卒中风险进行早期预测和评估。

Objective To explore the correlation between the expression level of Galectin-3(Gal-3)and non-valvular atrial fibrillation(NVAF),and to provide reference for the prediction of the course of NVAF.Methods Eighty patients with non-valvular atrial fibrillation admitted to Peking University Shougang Hospital from December 2020 to April 2022 were selected as the observation group,and the patients were divided into paroxysmal atrial fibrillation group(n=42)and persistent atrial fibrillation group(n=38)according to different symptoms.They were divided into paroxysmal atrial fibrillation(PaAF)group and persistentatrial fibrillation(PeAF)group.Meanwhile,40 patients with sinus rhythm(SR)were selected as the control group.On the basis of comparison of general data and biochemical routine tests of all patients,the level of Gal-3 in venous blood was measured by enzyme-linked immunosorbent assay(ELISA).The correlation between the change of Gal-3 expression level and non-valvular atrial fibrillation was explored by comparison and regression analysis between groups.Results There were significant differences in the levels of Gal-3,left atrial diameter(LAD),plasma N-terminal pro-B-type natriuretic peptide(NT-proBNP)and CHA_(2)DS_(2)-VASc among the three groups(t=7.152,6.884,7.273,10.057,P<0.05,P=0.001,0.001,0.001,0.004).In 80 patients with non-valvular atrial fibrillation,CHA_(2)DS_(2)-VASc score≥4(n=11),2-3(n=34),0-1(n=35),the difference of serum Gal-3 levels was statistically significant(F=12.308,P=0.000).The serum level of Gal-3 in LAD≥50 mm group(175.43±21.57)ng/ml was significantly higher than that in LAD<50 mm group(159.11±21.02)ng/ml(t=3.079,P=0.003).Pearson correlation analysis showed that Gal-3 was positively correlated with NT-pro BNP,LAD and CHA_(2)DS_(2)-VASc scores(P<0.05).There was no significant difference in general clinical data among the three groups(P>0.05).The levels of Gal-3,left atrial diameter(LAD)and N-terminal pro-brain natriuretic peptide(N-terminal pro-brain natriuretic peptide)in the PaAF group and the PeAF group in the observation group were significantly higher than those in the control group(P<0.05).NT-proBNP)were higher than those in the control group,and Gal-3,LAD and NTproBNP in the PeAF group were significantly higher than those in the PaAF group.In addition,serum Gal-3 levels in patients with LAD≥50 mm were significantly higher than those in patients with LAD<50 mm(P=0.003),and there were significant differences in serum Gal-3 levels among patients with CHA2DS2-VASc score≥4,2-3 and 0-1(P=0.000).However,there was no significant difference in NT-pro BNP and LVEF among the three subgroups(P>0.05).Pearson correlation analysis showed that Gal-3 was positively correlated with NT-pro BNP,LAD and CHA2DS2-VASc scores(P<0.05),but not with LVEF(P>0.05).Logistic regression analysis showed that serum Gal-3 level was associated with the susceptibility to atrial fibrillation(OR=1.551,95%CI 1.038-2.318).LAD was associated with the susceptibility to atrial fibrillation(OR=1.268,95%CI 1.039-1.549).Multivariate Cox regression analysis showed that Gal-3 level was associated with the survival risk of AF(OR=1.280,95%CI 1.072-1.529).There was a certain correlation between LAD and the survival risk of atrial fibrillation(OR=1.098,95%CI 1.012-1.192).Conclusion The change of serum Gal-3 expression level is closely related to the type of NVAF and the occurrence and development of AF,suggesting that the increase of serum Gal-3 level can predict and evaluate the risk of persistent AF and stroke in AF to a certain extent.