房颤患者中suPAR、MMP-2、hsCRP水平及射频消融手术预后探讨

【作者】 赵志勇；

【导师】 方全；

【作者基本信息】 北京协和医学院 ， 临床医学， 2012， 博士

【摘要】 研究背景心房纤颤是临床最常见的心律失常类型,随着人口老龄化,其患病率逐年增高。心房纤颤引起患者卒中风险增加,增加总死亡率,并严重降低生活质量。近年来,射频消融手术逐渐成为治疗房颤的重要手段,由于其费用相对较高,且存在一定的风险,寻找术后复发的预测因素具有重要意义。炎症因子在房颤以及射频消融手术预后的意义也成为临床研究的热点之一。近期有研究发现高敏C反应蛋白(hsCRP)、基质金属蛋白酶-2(MMP-2)在预测术后复发方面可能具有一定意义,但也存在不一致的结果。可溶型纤维酶原激活物受体(suPAR)是近年来发现的另一种炎症因子,为纤维酶原激活物受体(uPAR)的剪切形式,有研究显示发现suPAR水平与心血管病的发病风险相关,但目前尚无研究证明其在房颤中的水平及与预后的关系。研究目的1.研究房颤患者与对照组之间基线水平suPAR、MMP-2、hsCRP的差异及相关因素。2.探讨射频消融手术后炎症因子水平的变化及其意义。3.研究房颤患者射频消融术后的复发状况及其临床因素,并探讨房颤患者中suPAR、MMP-2、hsCRP水平及其与房颤射频消融术后预后的关系。研究方法1.收集2011年7月至2012年2月间,于北京协和医院心内科行射频消融手术治疗的房颤患者的血液样本及临床资料,并对术后复发情况进行随访。2.收集2012年5月间至北京协和医院体检中心体检的无心律失常人群的血样及体检资料,并在性别、年龄、高血压、糖尿病、冠心病等患病情况与房颤组相匹配。3.酶联免疫吸附法(ELISA)测定基线血浆MMP-2及suPAR水平,放射免疫透射比浊法检测基线hsCRP水平,并研究其与房颤的相关性及影响因素。4.研究射频消融治疗后炎症因子水平的变化。5.探讨炎症因子与房颤射频消融治疗后复发的相关性与意义.结果1.持续性房颤患者中基线血浆MMP-2水平显著高于对照组,阵发性房颤患者中基线血浆suPAR水平显著低于对照组。2.房颤患者中基线血浆suPAR水平与年龄、血清肌酐水平、基线hsCRP水平以及MMP-2水平正相关。3. hsCRP在射频消融手术后1-4天出现显著上升,射频消融手术一周内出现早期发作的患者,其hsCRP增加程度显著高于无发作的患者,但早期发作与手术3个月之后的复发无明显相关性。4.射频消融术后复发患者与非复发患者其基线血浆MMP-2及suPAR水平、基线血清hsCRP水平无显著差别。5.复发患者与非复发患者比较,左房前后径、左房体积无显著差异,而左心房体积指数显著高于非复发患者。结论1.在本研究中,基线水平MMP-2、suPAR及hsCRP水平不能预测房颤射频消融手术治疗后的复发。2.射频消融手术一周内出现的早期发作与炎症水平升高相关。3.与左房前后径以及左房体积相比,左房体积指数增加与房颤复发的相关性更加密切。更多还原

【Abstract】 BackgroundAtrial fibrillation (AF) is the most common arrhythmia in clinical work. And its prevalence is increasing as the population ages. AF confers higher risk of stroke, increases the total mortality, and decreases the quality of life significantly. In recent years, radiofrequency ablation procedure has become an important means for the treatment of AF. Because of the relative higher expense and risk of the procedure, it is important to find the predictors of recurrence after the procedure. The impact of inflammation factors in AF and its value in the prediction of recurrence after RFCA have become the focus of recent clinical research. Recently it is reported that high sensitivity C-reactive protein (hsCRP) and matrix metalloproteinases are valuable in the recurrence prediction, but controversy still exists. Soluble urokinase-type plasminogen activator receptor (suPAR) is another inflammation factor that is the cleavage form of the urokinase-type plasminogen activator receptor (uPAR). Recent research shows that suPAR is related to the risk of cardiovascular disease, but the level of suPAR in AF patients and its relationship with AF recurrence are still unknown.Objectives1. To research the difference of the baseline suPAR, MMP-2, hsCRP levels between AF patients and the control group.2. To research the change of the inflammation factor levels after the RFCA procedure.3. To research the recurrence of AF after RFCA and the relative clinical factors, and to research the relationship between the levels of suPAR, MMP-2and hsCRP and the recurrence.Methods1. The AF patients that underwent RFCA in the cardiology department of Peking Union medical college hospital between July,2011and February,2012were included in this research. The clinical data and blood samples at baseline were collected. The recurrence in the follow-up was recorded.2. The subjects of the control group are selected from the people that underwent phisycal examination at the PUMCH physical examination center in May,2012. The age, gender, and history of hypertension, diabetes mellitus, CVD and smoking were matched with the AF group. Anyone with AF history or other kinds of arrhythmia was concluded.3. The plasma levels of MMP-2and suPAR were determined with double-antibody sandwich enzyme-linked immunosorbent assay (ELISA). The serum levels of hsCRP were determined with immune transmission turbidity method. The baseline levels of inflammation factors were detected and the relationships with AF were analyzed.4. The levels of inflammation factors at baseline and after the RFCA procedure were determined.5. The relativity and value of inflammation factors in the recurrence of AF after RFCA were analyzed.Result1. The baseline level of plasma MMP-2in the persistent AF patients is significantly higher than the control group, and the baseline level of plasma suPAR in the paroxysmal AF patients is lower than the control group.2. The plasma level of suPAR in AF patients is positively related to age and the levels of serum creatine (SCr), hsCRP and MMP-2.3. The level of hsCRP increases greatly at1-4days after ablation. The amplitude in the patients with early recurrence of AF in one week after ablation is significantly higher than the patients without recurrence. However the early recurrence shows no relationship with the recurrence during follow-up.4. There are no significant differences between the levels of baseline MMP-2, suPAR and hsCRP in the recurrence gtoup and non-recurrence group.5. There are no significant differences between the left atrial dimensions and left atrial volumes of the recurrence group and non-recurrence group, the left atrial volume index (LAVI) of the recurrence group is significantly higher than the non-recurrence group.Conclusions1. In this research the baseline MMP-2, suPAR and hsCRP levels cannot predict the AF recurrence after RFCA.2. The early AF recurrence in one week after RFCA is related the increase of inflammation level. 3. The increase of LAVI is better related to the risk of AF recurrence after RFCA than left atrial dimension and volume.更多还原