心房颤动首次导管射频消融术患者趋化素与半乳糖凝集素-3和内脂素水平与术后复发的关联性及临床意义评价

Evaluation of the correlation and clinical significance of Chemerin,galectin-3 and visfatin levels with postoperative recurrence in patients undergoing first radiofrequency catheter ablation of atrial fibrillation

目的探讨心房颤动(房颤)首次导管射频消融术患者趋化素(chemerin)、半乳糖凝集素-3(Gal-3)、内脂素(visfatin)水平与术后复发的关联性及临床意义。方法选取四川绵阳四○四医院2021年9月至2023年8月首次行导管射频消融术的105例房颤患者进行前瞻性队列研究,随访3个月根据有无复发分为复发组和未复发组。比较两组基线资料、术前Chemerin、Gal-3及visfatin水平,logistic回归分析复发的预警因素,以方差膨胀因子和容忍度评价logistic回归分析是否存在多重共线性问题,以受试者工作特征曲线(ROC)分析各相关因素对复发的预测价值,以精准-召回(PR)曲线评价联合预测方案的召回率和精准率。结果复发组OSAS患者占比(27.59%)高于未复发组(3.95%),行神经节丛消融患者占比(37.93%)低于未复发组(61.84%)(P<0.05);复发组Chemerin、Gal-3、visfatin水平高于未复发组[(170.54±36.83)ng/ml比(122.69±31.50)ng/ml、(6.13±2.00)μg/L比(3.99±1.25)μg/L、(34.17±10.22)g/ml比(21.58±6.97)g/ml,均P<0.05]。Logistic回归显示,OSAS、Chemerin、Gal-3、visfatin均是复发的相关危险因素,行神经节丛消融是复发的相关保护因素(P<0.05),多重共线性检验显示,各相关因素的方差膨胀因子介于1.045~2.007,容忍度介于0.544~0.901,多重共线性可能性低。将OSAS、行神经节丛消融、Chemerin、Gal-3、visfatin原始数据按照20%、20%、60%随机划分为测试集、验证集、训练集,得到OSAS、行神经节丛消融、Chemerin、Gal-3联合visfatin的ROC曲线显示,各相关因素联合的AUC为0.911,高于OSAS(0.842)、行神经节丛消融(0.501)、Chemerin(0.780)、Gal-3(0.841)、visfatin(0.727)(P<0.05)。PR曲线显示,各相关因素联合方案的AUC为0.858,具有较高的召回率和精准率。结论房颤首次导管射频消融术患者术前Chemerin、Gal-3、visfatin水平与术后复发密切相关,三者联合OSAS、行神经节丛消融预测复发呈现出较高的预测性能,可为临床识别房颤复发高风险人群提供客观数据参考,有助于制定预防策略,从而减少术后的复发。

Objective To investigate the correlation and clinical significance of Chemerin,galectin-3(Gal-3)and visfatin levels with postoperative recurrence in patients undergoing first radiofrequency catheter ablation for atrial fibrillation(AF).Methods A total of 105 patients with atrial fibrillation who underwent radiofrequency catheter ablation for the first time in Forty Four Hospital of Mianyang,Sichuan Province from September 2021 to August 2023 were selected for prospective cohort study,and were divided into relapse group and non-recurrence group according to whether there was recurrence or not.Baseline data,preoperative Chemerin,Gal-3 and visfatin levels were compared between the two groups.Logistic regression was used to analyze the early warning factors for recurrence,and variance inflation factor and tolerance were used to evaluate whether there was multicollinearity in logistic regression analysis.Receiver operating characteristic curve(ROC)was used to analyze the predictive value of each related factor to recurrence,and the recall rate and accuracy of the combined prediction scheme were evaluated with the precision recall(PR)curve.Results The proportion of OSAS patients in the relapsed group(27.59%)was higher than that in the non-relapsed group(3.95%),and the proportion of ganglion plexus ablation patients(37.93%)was lower than that in the non-relapsed group(61.84%)(P<0.05).The levels of Chemerin,Gal-3 and visfatin in relapsed group were higher than those in non-relapsed group[(170.54±36.83)ng/ml vs.(122.69±31.50)ng/ml、(6.13±2.00)μg/L vs.(3.99±1.25)μg/L、(34.17±10.22)g/ml vs.(21.58±6.97)g/ml,all P<0.05];Logistic regression showed that OSAS,Chemerin,Gal-3 and visfatin were all related risk factors for recurrence,and ganglion plexus ablation was related protective factor for recurrence(P<0.05).Multicollinearity test showed that the variance inflation factor of all related factors ranged from 1.045 to 2.007.The tolerance ranges from 0.544 to 0.901,and the possibility of multicollinearity is low.The original data of OSAS,radial ganglion plexus ablation,Chemerin,Gal-3 and visfatin were randomly divided into test set,verification set and training set according to 20%,20%and 60%,and the ROC curve of OSAS,radial ganglion plexus ablation,Chemerin and Gal-3 combined with visfatin was obtained.The combined AUC of all related factors was 0.911,which was higher than that of OSAS(0.842),ganglion us ablation(0.501),Chemerin(0.780),Gal-3(0.841)and visfatin(0.727)(P<0.05).The PR curve shows that the AUC of the combined scheme of all related factors is 0.858,which has a high recall rate and accuracy rate.Conclusion Preoperative Chemerin,Gal-3 and visfatin levels are closely related to postoperative recurrence in patients with first catheter radiofrency ablation of atrial fibrillation.The combination of the three levels with OSAS and ganglion us ablation shows high predictive performance in predicting recurrence,which can provide objective data reference for clinical identification of high-risk patients with atrial fibrillation recurrence and help develop preventive strategies,reduce postoperative recurrence.