肌腱蛋白-C与内皮细胞特异性分子-1及血管生成素样蛋白4与心房颤动射频消融术后复发的关系

Relationship between tenascin-C,endothelial cell specific molecule-1,angiopoietin like protein 4 and recurrence after radiofrequency ablation of atrial fibrillation

目的:探讨血清肌腱蛋白-C(tenascin-C,TNC)、内皮细胞特异性分子-1(endothelial cell specific molecule-1,ESM-1)、血管生成素样蛋白4(angiopoietin like protein 4,ANGPTL4)与阵发性心房颤动(paroxysmal atrial fibrillation,PAF)患者射频消融术后复发的关系。方法:选择2016年6月至2018年12月,我院行射频消融术治疗的PAF患者134例,随访3年,根据随访结果分为复发组(n=42)和未复发组(n=92),比较两组血清TNC、ESM-1、ANGPTL4水平,应用多因素Logistic回归分析射频消融术后复发的关联影响因素,并建立联合应用的风险预测模型。应用受试者工作特征(receiver operating characteristic,ROC)曲线分析血清TNC、ESM-1、ANGPTL对PAF患者射频消融术后复发的预测价值。结果:复发组血清TNC、ESM-1水平显著高于未复发组,ANGPTL4水平显著低于未复发组(P<0.05)。Logistic回归分析显示,PAF病程≥3年、CHA2DS2-VASc评分≥2分、术中出现心房扑动/房性心动过速、TNC升高、ESM-1升高、ANGPTL4降低是PAF患者射频消融术后复发的危险因素(P<0.05)。ROC曲线分析显示,血清TNC、ESM-1、ANGPTL4联合检验对PAF患者射频消融术后复发预测的效能最高。结论:PAF射频消融术后复发患者血清TNC、ESM-1水平升高,ANGPTL4水平降低,检测血清TNC、ESM-1、ANGPTL对PAF患者射频消融术后复发具有一定预测价值。

Objective:To investigate the relationship between serum tenascin-C(TNC),endothelial cell specific molecule-1(ESM-1),angiopoietin like protein 4(ANGPTL4)and recurrence after radiofrequency ablation in patients with paroxysmal atrial fibrillation(PAF).Methods:134 patients with PAF who were treated by radiofrequency ablation in our hospital from June 2016 to December 2018 were selected,and followed up for 3 years.All the patients were divided into recurrence group(n=42)and non recurrence group(n=92)according to the follow-up results.The levels of serum TNC,ESM-1 and ANGPTL4 were compared between the two groups.Multivariate Logistic regression was used to analyze the associated influencing factors of recurrence after radiofrequency ablation,and a risk prediction model of combined application was established.The receiver operating characteristic(ROC)curve was used to analyze the predictive value of serum TNC,ESM-1 and ANGPTL for recurrence after radiofrequency ablation in patients with PAF.Results:The levels of serum TNC and ESM-1 in the recurrence group were significantly higher than those in the non-recurrence group,and the level of ANGPTL4 was significantly lower than that in the non-recurrence group(P<0.05).Logistic regression analysis showed that PAF duration≥3 years,CHA2DS2-VASc score≥2 scores,intraoperative atrial flutter/atrial tachycardia,increased TNC,increased ESM-1 and decreased ANGPTL4 were risk factors for recurrence after radiofrency ablation in patients with PAF(P<0.05).ROC curve analysis showed that serum TNC,ESM-1 and ANGPTL4 combined test had the highest efficacy in predicting recurrence in patients with PAF after radiofrequency ablation.Conclusions:The levels of serum TNC and ESM-1 are increased,and ANGPTL4 levels are decreased in recurrence after radiofrequency ablation of patients with PAF.Detection of serum TNC,ESM-1 and ANGPTL has certain predictive value for recurrence after radiofrequency ablation of patients with PAF.