血清趋化素和半乳糖凝集素3水平对心房颤动并发左心房纤维化有预测价值

Serum chemerin and Gal-3 expression levels are valuable for predicting patients with atrial fibrillation complicated with left atrial fibrosis

目的:探讨血清趋化素(chemerin)、半乳糖凝集素3 (gal-3)水平对心房颤动并发左心房纤维化的预测价值。方法:收集138例首次进行导管射频消融手术治疗的心房颤动患者,根据低电压区(LVAS)占左心房总面积范围,将患者分为LVAS<10%组73例和LVAS≥10%组65例。采用酶联免疫吸附试验(ELISA)检测并比较2组血清chemerin、gal-3水平,分析其水平变化与心房颤动并发左心房纤维化的关系,绘制受试者工作特征(ROC)曲线分析其对心房颤动并发左心房纤维化的预测价值。结果:持续性心房颤动、吸烟、饮酒、甘油三酯(TG)、左房内径(LAD)、左室射血分数(LVEF)、舒张早期峰值流速(E)/舒张晚期峰值流速(A)、E/二尖瓣环舒张早期运动速度峰值(e’)、血清chemerin、Gal-3水平与心房颤动并发左心房纤维化有关(P均<0.05)。Pearson相关性分析显示,血清chemerin、Gal-3水平与心房颤动患者左心房纤维化呈正相关(P<0.01)。多因素Lgistic回归分析结果显示,合并持续性心房颤动、LAD降低、血清chemerin水平升高、血清Gal-3水平升高是心房颤动患者左心房纤维化的独立危险因素(OR>1,P<0.05)。血清chemerin水平截断值为147.26 ng/mL时,预测心房颤动并发左心房纤维化的ROC曲线下面积(AUC)为0.73,此时灵敏度和特异性分别为76.25%、69.33%;血清Gal-3水平截断值为56.39 pg/mL时,AUC为0.71,此时灵敏度和特异性分别为74.46%、68.29%,二者联合检测的AUC为0.77,此时灵敏度和特异性分别为79.37%、69.28%。结论:心房颤动并发左心房纤维化患者血清chemerin、Gal-3水平与左心房纤维化呈正相关关系,其水平对预测心房颤动并发左心房纤维化具有较好预测价值。

Objective:To explore the predictive value of serum chemerin and Galectin-3(Gal-3) expression levels in atrial fibrillation(AF) complicated with left atrial fibrosis.Methods:A total of 138 patients with AF who underwent radiofrequency catheter ablation for the first time in our hospital from February 2020 to June 2021 were enrolled.According to the total area of left atrium occupied by low-voltage areas(LVAS),patients were divided into LVAS < 10% group(73 cases) and LVAS ≥ 10% group(65 cases).Serum chemerin and Gal-3 levels were detected by enzyme-linked immunosorbent assay(ELISA),and their relationship with AF complicated with left atrial fibrosis was analyzed.The ROC curve was drawn to analyze their predictive value for AF complicated with left atrial fibrosis.Results:Persistent AF,smoking,drinking,TG,LAD,LVEF,E/A,E/e',serum chemerin,serum Gal-3 were associated with AF complicated with left atrial fibrosis(P< 0.05).Pearson correlation analysis showed that serum chemerin and Gal-3 levels were positively correlated with left atrial fibrosis in patients with AF(P< 0.01).The results of multivariate Lgistic regression analysis showed that persistent AF,decreased LAD,increased serum chemerin level and serum Gal-3 level were independent risk factors for left atrial fibrosis in patients with AF(OR > 1,P< 0.05).When the cut-off value of serum chemerin level was 147.26 ng/mL,the area under the ROC curve of predicting AF complicated with left atrial fibrosis was 0.73,and the sensitivity and specificity were 76.25% and 69.33%,respectively.When the cut-off value of serum Gal-3 level was 56.39 pg/mL,the area under the ROC curve for predicting AF complicated with left atrial fibrosis was 0.71,and the sensitivity and specificity were 74.46% and 68.29%,respectively.The area under the ROC curve for predicting AF complicated with left atrial fibrosis was 0.77.The sensitivity and specificity were 79.37% and 69.28%,respectively.Conclusion:Serum chemerin and Gal-3 levels are positively correlated with left atrial fibrosis in patients with AF complicated with left atrial fibrosis,and their levels have a good predictive value for predicting left atrial fibrosis in patients with AF complicated with left atrial fibrosis.