冠心病心房颤动血瘀证患者心房颤动负荷与炎症趋化因子等客观指标的相关性研究

Correlation between atrial fibrillation load and inflammatory chemokines and other objective indexes in patients with blood stasis syndrome of coronary heart disease-atrial fibrillation

目的通过观察不同心房颤动(房颤)负荷的冠状动脉粥样硬化性心脏病(冠心病)房颤血瘀证患者,分析其血清炎症趋化因子水平、血栓指标、心脏超声指标之间的相关性。方法选取2021年4月至2021年12月于中国中医科学院广安门医院就诊患者,根据房颤发生时间/总记录时间的比值划分入组患者不同负荷量分组:低负荷组≤20%(n=19)、中负荷组20%<负荷量≤50%(n=27)、高负荷组>50%(n=14)。收集并记录入组患者年龄、性别、体重、身高、吸烟史、饮酒史、高血压、糖尿病、脑卒中史、动态心电图房颤持续时间、心脏彩超指标等。炎症趋化因子血清样本检测均采用液相悬浮芯片技术。结果中、高负荷组纤维蛋白原(FIB)水平、CHA2DS2-VASc评分高于低负荷组,差异具有统计学意义(P<0.05);高负荷组D-二聚体表达明显高于中、低负荷组,差异具有统计学意义(P<0.01);中、高负荷组左心房内径(LAD)值明显高于低负荷组,差异具有统计学意义(P<0.01);左室射血分数(LVEF)水平低负荷组明显高于中、高负荷组,差异具有统计学意义(P<0.01)。中、高负荷组血清趋化因子(CXCL8/IL-8、CXCL12、TNF-α、IL-4、IL-10、IL-16)表达水平明显高于低负荷组,差异具有统计学意义(P<0.01)。双变量相关分析表明:CXCL8/IL-8、CXCL16、IL-4、IL-10与D-二聚体之间存在正相关(分别为r_(1)=0.308,P_(1)<0.05;r_(2)=0.316,P_(2)<0.05;r_(3)=0.368,P_(3)<0.05;r_(4)=0.276,P_(4)<0.05)。IL-1β、IL-10与FIB之间存在正相关(分别为r_(1)=0.270,P_(1)<0.05;r_(2)=0.280,P_(2)<0.05)。CXCL16与CHA2DS2-VASc分值之间存在正相关(r=0.298,P<0.05);CXCL8/IL-8、IL-16、CXCL16、TNF-α与LAD之间存在正相关性(分别为r_(1)=0.470,P_(1)<0.01;r_(2)=0.380,P_(2)<0.05;r_(3)=0.373,P_(3)<0.01;r_(4)=0.484,P_(4)<0.01);CXCL8/IL-8与LVEF值之间存在负相关性(r=-0.331,P<0.05)。结论冠心病房颤血瘀证患者房颤负荷与炎症趋化因子具有相关性,房颤负荷越高,其血清炎症趋化因子水平(CXCL8/IL-8、CXCL12、TNF-α、IL-4、IL-10、IL-16)越高。

Objective To analyze the correlation among the levels of inflammatory chemokines,thrombosis indexes and indexes of color Doppler echocardiogram through observing the patients with blood stasis syndrome of CHD-AF with different AF loads.Methods The patients were chosen from Guang’anmen Hospital of China Academy of Chinese Medical Sciences from Apr.2021 to Dec.2021.All patients were divided,according to ratio of AF onset time to the total recording time,into low-load group(load≤20%,n=19),mid-load group(20%<load≤≤50%,n=27)and high-load group(load>50%,n=14).The indexes of age,gender,body weight,smoking history,drinking history,hypertension,diabetes,stroke history,AF duration on ambulatory electrocardiogram and color Doppler echocardiogram were collected and recorded in all groups.The serum samples of inflammatory chemokines were detected by using liquid suspension microarray technology.Results The level of fibrinogen(FIB)and scores of CHA2DS2-VASc were higher in mid-load group and high-load group than those in low-load group(P<0.05).The expression of D-dimer(D-D)was significantly higher in high-load group than that in mid-load group and lowload group(P<0.01),and left atrial diameter(LAD)was lower in in mid-load group and high-load group than that in low-load group(P<0.01).The level of LVEF was significantly higher in low-load group than that in mid-load group and high-load group(P<0.01).The expressions of CXCL8/IL-8,CXCL12,TNF-α,IL-4,IL-10 and IL-16 were significantly higher in mid-load group and high-load group than those in low-load group(P<0.01).The results of bivariate correlation analysis showed that CXCL8/IL-8,CXCL16,IL-4 and IL-10 were positively correlated to D-D(r_(1)=0.308,P_(1)<0.05;r_(2)=0.316,P_(2)<0.05;r_(3)=0.368,P_(3)<0.05;r_(4)=0.276,P_(4)<0.05),IL-1βand IL-10 were positively correlated to FIB(r_(1)=0.270,P_(1)<0.05;r_(2)=0.280,P_(2)<0.05),CXCL16 was positively correlated to scores of CHA2DS2-VASc(r=0.298,P<0.05),CXCL8/IL-8,IL-16,CXCL16 and TNF-αwas positively correlated to LAD(r_(1)=0.470,P_(1)<0.01;r_(2)=0.380,P_(2)<0.05;r_(3)=0.373,P_(3)<0.01;r_(4)=0.484,P_(4)<0.01),and CXCL8/IL-8 was negatively correlated to LVEF(r=-0.331,P<0.05).Conclusion There is a correlation between inflammatory chemokines and AF load in patients with blood stasis syndrome of CHD-AF,and the higher the AF load,the higher the levels of inflammatory chemokines(CXCL8/IL-8,CXCL12,TNF-α,IL-4,IL-10,IL-16).