血清Neu5Ac、MIP-1α与阵发性心房颤动患者左心房重构和射频消融术后复发的关系分析

Serum Neu5Ac,MIP-1αAnalysis of the relationship between left atrial remodeling and recurrence after radiofrequency ablation in patients with paroxysmal Atrial fibrillation

目的探讨血清N-乙酰神经氨酸(Neu5Ac)、巨噬细胞炎性蛋白1α(MIP-1α)与阵发性心房颤动(PAF)患者左心房重构和射频消融术后复发的关系。方法选取2021年1月-2022年1月复旦大学附属闵行医院收治的PAF患者143例作为PAF组,同期选取医院体检健康者70例为健康对照组。比较2组血清Neu5Ac、MIP-1α水平,左心房重构指标[左心房收缩末期前后径(LAD)、左心房容积指数(LAVI)];采用Pearson法分析血清Neu5Ac、MIP-1α水平与左心房重构指标的相关性。患者均行射频消融术,术后随访12个月,根据有无复发分为复发亚组与未复发亚组。采用多因素Logistic回归模型分析影响PAF患者射频消融术后复发的危险因素。结果PAF组血清Neu5Ac、MIP-1α水平高于健康对照组(t=5.743、18.710,P均<0.001)。PAF组LAD、LAVI值均大于健康对照组(t=5.177、32.473,P均<0.001)。Pearson法分析显示,血清Neu5Ac、MIP-1α水平与LAD、LAVI呈正相关(r=0.496、0.548、0.513、0.505,P均<0.001)。随访12个月,无失访人员,复发38例(26.57%)。与未复发亚组比较,复发亚组高血压例数占比高,术后使用抗心律失常药比例低(χ^(2)=5.294、4.500,P=0.021、0.034),LAD、LAVI、WBC、SCr及血清Neu5Ac、MIP-1α水平均高,差异均有统计学意义(t=3.468、13.508、3.982、5.260、4.671、3.745,P均<0.001);Logistic回归分析显示,合并高血压、LAD与LAVI增加、Neu5Ac与MIP-1α水平上升为PAF患者术后复发的危险因素,术后使用抗心律失常药为保护因素[OR(95%CI)=1.297(1.077~1.561)、1.064(1.007~1.124)、1.049(1.011~1.088)、1.034(1.007~1.061)、1.339(1.145~1.566)、0.583(0.412~0.823)]。结论血清Neu5Ac、MIP-1α水平在PAF患者中上升,可导致左心房重构,是PAF患者射频消融术后复发的影响因素。

Objective To explore the relationship between serum N-acetylneuraminic acid(Neu5Ac),macrophage inflammatory protein-1α(MIP-1α)and left atrial remodeling and recurrence after radiofrequency ablation of patients with paroxysmal atrial fibrillation(PAF).Methods 143 patients with PAF admitted to Minhang Hospital affiliated with Fudan University from January 2021 to January 2022 were selected as the PAF group,while 70 healthy individuals who underwent physical examination at the hospital were selected as the healthy control group during the same period.Compare the serum Neu5Ac and MIP-1 levels between two groupsαHorizontal,left atrial remodeling indicators[left atrial end systolic diameter(LAD),left atrial volume index(LAVI)].Analysis correlation between level of serum Neu5Ac and MIP-1 and left atrial remodeling indicators using Pearson's method.All patients underwent radiofrequency ablation and were followed up for 12 months.They were divided into recurrent subgroups and non-recurrent subgroups based on the occurrence of recurrence.Using a multivariate logistic regression model to analyze the risk factors of recurrence in patients with PAF after radiofrequency ablation.Results Serum Neu5Ac and MIP-1 in the PAF groupαThe level was higher than that of the healthy control group(t=5.743,18.710,P<0.001).The LAD and LAVI values in the PAF group were higher than those in the healthy control group(t=5.177,32.473,P<0.001).Pearson method analysis showed that serum Neu5Ac and MIP-1αwere positively correlated with LAD and LAVI(r=0.496,0.548,0.513,0.505,P<0.001).After a follow-up of 12 months,there were no lost contacts and 38 cases(26.57%)experienced recurrence.Compared with the non-recurrent subgroup,the recurrent subgroup has a high proportion of hypertension cases and a low proportion of postoperative use of Antiarrhythmic agent(χ^(2)=5.294,4.500,P=0.021,0.034),LAD,LAVI,WBC,SCr,and serum Neu5Ac,MIP-1αwere all high,and the differences were statistically significant(t=3.468,13.508,3.982,5.260,4.671,3.745,all P<0.001);Logistic regression analysis showed that concomitant hypertension,increased LAD and LAVI,Neu5Ac and MIP-1αThe increase of PAF level was the risk factor for postoperative recurrence of PAF patients,and the use of Antiarrhythmic agent was the protective factor[OR(95%CI)=1.297(1.077-1.561),1.064(1.007-1.124),1.049(1.011-1.088),1.034(1.007-1.061),1.339(1.145-1.566),0.583(0.412-0.823)].Conclusion Serum Neu5Ac,MIP-1αThe increase in levels in PAF patients can lead to left atrial remodeling,which is a influencing factor for recurrence after radiofrequency ablation in PAF patients.