节点文献
心房颤动的炎症反应研究
【作者】 姚述远；
【作者基本信息】 中国协和医科大学 ， 心血管内科， 2008， 博士
【摘要】 目的:探讨孤立性心房颤动患者的炎症反应与心房颤动(atrialfibrillation,AF)之间的相互关系。方法:根据入选标准和排除标准,入选2005年10月至2007年10月期间在阜外心血管病医院住院的孤立性AF患者及拟行导管消融治疗的预激综合症患者,其中预激综合症患者根据年龄、性别匹配的原则随机入选作为对照组。于入院第二天采集静脉血标本检测血浆C—反应蛋白水半(C—reactive protein,CRP)、白细胞和中性粒细胞计数,同时行心电监测以鉴别患者采血时的心律。根据ACC/AHA/ESC的标准,将AF患者分为持续性AF组和阵发性AF组,阵发性AF患者根据采血时的心律进一步分为窦性心律组和AF心律组。所有研究对象均行病史询问、体格检查、常规的实验室检查、心电图、胸部X线、甲状腺功能检测和心脏超声检查。为了确诊孤立性AF,所有入选的AF患者均行运动试验、核素心肌显像和/或冠状动脉造影,同时行经胸和/或经食道超声检查以评估是否合并有潜在心血管疾病以及左心房的大小、左心室射血分数和左心室舒张末期容积。采用SPSS13.0统计软件分析,P＜0.05为有统计学差异。结果:总共411例患者入选,其中孤立性AF患者333例,预激综合症患者78例。孤立性AF中,72例为持续性AF,261例为阵发性AF。阵发性AF中,采血时窦性心律的患者为203例,AF心律的患者为58例。除了心脏超声指标的差异以外,对照组、AF组及AF各亚组之间在性别、年龄、吸烟史、体重指数及所合并的糖尿病、高脂血症上均无统计学差异。在炎症指标CRP上,孤立性AF组(中值:1.00mg/L,四分位值:1.00～2.54)较对照组(中值:1.00mg/L,四分位值:1.00～1.55)增高(P=0.016),持续性AF组(中值:1.62mg/L,四分位值:1.00～3.98)较阵发性AF组(中值:1.00mg/L,四分位值:1.00～2.10)增高(P=0.022),阵发性AF中的AF心律组(中值:2.11mg/L,四分位值:1.00～3.60)较窦性心律组(中值:1.00mg/L,四分位值:1.00～1.76)增高(P=0.000);而持续性AF组与阵发性AF中的AF心律组之间(P=0.922)以及对照组与阵发性AF中的窦性心律组之间(P=0.483)无统计学差异。在白细胞及中性粒细胞计数上,阵发性AF中的AF心律组均较窦性心律组增高(P=0.003,P=0.002),其余各组之间均无统计学差异。在所有AF患者中,多因素logistical回归分析示采血时的AF心律(包括持续性AF和阵发性AF中的AF心律)为血浆CRP水平增高唯一独立的预测因子(Exp(B)=4.85,95%CI:2.61～8.99)。结论:在孤立性AF患者中,AF与炎症之间存在着相互的联系,采血时的AF心律是血浆CRP水平增高的独立预测因子。目的:探讨合并有高血压病的心房颤动患者的炎症反应与心房颤动(atrialfibrillation,AF)之间的相互关系。方法:所有研究对象均来自于2005年10月至2007年10月期间在阜外心血管病医院住院的合并有高血压病的AF患者、高血压病患者和拟行导管消融治疗的预激综合症患者,其中高血压病、预激综合症患者根据年龄、性别匹配原则随机入选。于入院第二天采集静脉血.标本检测血浆C—反应蛋白水平(C-reactive protein,CRP)、白细胞和中性粒细胞计数,同时行心电监测以鉴别患者采血时的心律。根据ACC/AHA/ESC的标准,将AF患者分为持续性AF组和阵发性AF组,其中阵发性AF患者根据采血时的心律进一步分为窦性心律组和AF心律组。所有研究对象均行病史询问、体格检查、常规的实验室检查、心电图、胸部X线、甲状腺功能检测和心脏超声检查。所有AF患者均行运动试验、核素心肌显像和/或冠状动脉造影,同时行经胸和/或经食道超声检查以评估是否合并有其他潜在心血管疾病以及左心房的大小、左心室射血分数和左心室舒张末期容积。采用SPSS13.0统计软件分析,P＜0.05为有统计学差异。结果:根据入选标准和排除标准,共有500例合并高血压病的AF患者、185例高血压病患者和132例作为对照组的预激综合症患者入选。AF患者中400例为阵发性AF,100为例持续性AF。阵发性AF患者中,316例为窦性心律,84例为AF心律。各组之间的年龄、性别相互匹配,在体重指数,糖尿病、高脂血症的合并症、心脏超声指标及药物治疗上存在统计学差异。炎症指标中,AF组血浆CRP水平为中值1.91 mg/L,四分位值1.00～3.63mg/L,高血压组为中值2.32 mg/L,四分位值1.00～3.97 mg/L,两者之间无统计学差异(P=0.559),但均较对照组(中值1.23 mg/L,四分位值1.00～1.65 mg/L)增高(P=0.00和P=0.000)。AF组的中性粒细胞计数为3.63±1.12,高血压组为3.63±1.08,两者之间无统计学差异(P=0.960),但均较对照组(3.27±1.10)增高(P=0.01和P=0.004)。在白细胞计数上,三者之间均无统计学差异(P＞0.05)。在AF各亚组中,持续性AF组的血浆CRP水平为中值2.30mg/L,四分化值1.00～3.94mg/L;阵发性AF组为中值1.79mg/L,四分位值1.00～3.59 mg/L;阵发性AF中的窦性心律组为中值1.75mg/L,四分位值1.00～3.46 mg/L:AF心律组为中值2.30mg/L,四分位值1.14～4.44 mg/L。持续性AF组与阵发性AF中的AF心律组无统计学差异(P=0.681),但两者均较阵发性AF中的窦性心律组增高((P=0.035和P=0.014)。在白细胞和中性粒细胞计数上,各亚组之间均无统计学差异(P均＞0.05)。所有研究对象中,多因素logistical回归分析示高血压的病史(Exp(B)=0.308,P=0.001,95%CI:0.150～0.632)、女性(Exp(B)=0.481,P=0.000,95%CI:0.322～0.719)、高龄(Exp(B)=1.018,P=0.045,95%CI:1.000～1.036)及左心房的直径(B=1.061,P=0.003,95%CI:1.021～1.103)为血浆CRP水平增高的独立预测因子。结论:本研究结果显示合并有高血压病的AF中,AF与炎症反应之间存在着相关性,虽然这种相关性可为高血压病的炎症反应所掩盖。目的:探讨心房颤动(atrial fibrillation,AF)早期复发的相关因素及C—反应蛋白(C-reactive protein,CRP)是否能够预测AF早期复发。方法:所有研究对象均来自2005年10月至2007年10月期间在阜外心血管病医院住院的孤立性AF患者和合并高血压病的AF患者。于入院第二天采集静脉血标本检测血浆CRP、白细胞和中性粒细胞计数,采血的同时行心电监测,为窦性心律的患者入选。所有入选对象均行病史询问、体格检查、常规的实验室检查、心电图、胸部X线、甲状腺功能检测、运动试验、核素心肌显像和/或冠状动脉造影,同时行经胸和/或经食道超声检查以评估是否合并有潜在心血管疾病以及左心房的大小、左心室射血分数和左心室舒张末期容积。随访时间为10天(包括住院时间)。随访期间每天行心电图检查、至少行一次24小时Holter监测,患者有症状时随时行心电图检查。AF复发是指随访期间有AF发作,每次发作时间至少大于1分钟。采用SPSS13.0统计软件分析,P＜0.05为有统计学差异。结果:根据入选标准和排除标准,共有162例孤立性AF患者和290例合并高血压的AF患者入选。与孤立性AF患者相比,合并高血压的AF患者年龄、体重指数更大,糖尿病、高脂血症的合并症更多,同时更多患者服用药物治疗。在心脏超声指标中,合并高血压的AF组左心房直径较孤立性AF组增大(35.8±4.1 versus 34.0±4.6,P=0.000),左心室舒张末期容积(48.7±4.5 versus 48.2±4.6,P=0.311)、左心室射血分数(0.65±0.08 versus 0.64±0.07,P=0.526)两者之间无统计学差异。在炎症指标中,合并高血压的AF组血浆CRP水平(中值1.75mg/l,四分位值1.00～3.47)和中性粒细胞计数(3.54±1.07)分别较孤立性AF组的CRP(中值1.00mg/l,四分位值1.00～1.73)和中性粒细胞计数(3.27±1.14)增高(P=0.012和P=0.000)。白细胞计数也较孤立性AF组有增高的趋势,但两者间无统计学差异(5.98±1.40 versus 5.71±1.39,P=0.055)。在10天的随访期间,共有243例(53.7%)患者AF复发,其中96例(59.3%)为孤立性AF患者,147例(50.7%)为合并高血压的AF患者。多因素分析显示只有高血压的合并症(Exp(B)=2.431,P=0.000,95%CI:1.556～3.797),胺碘酮治疗(Exp(B)=-1.545,P=0.000,95%CI:0.111～0.411)和Ic类抗心律失常药物治疗(Exp(B)=-0.769,P=0.015,95%CI:0.250～0.860)与AF早期复发相关。炎症指标包括CRP、中性粒细胞和白细胞计数均与AF早期复发无关。结论:合并高血压的AF患者血浆CRP水平及中性粒细胞计数均较孤立性AF患者增高;血浆炎症指标对AF早期复发无预测意义。
【Abstract】 Objectives:This study was designed to evaluate the correlation between lone atrial fibrillation and inflammation.Methods:A total of 411 subjects were enrolled in this study,including 333 lone atrial fibrillation patients and 78 controls.C-reactive protein (CRP) and echocardiography were evaluated,and electrocardiography was monitored to identify cardiac rhythm at the time of blood sampling.According to the rhythm, paroxysmal atrial fibrillation was divided into presence and absence of atrial fibrillation.Results:Subjects with lone atrial fibrillation had higher CRP level than controls(media,1.00mg/L;IQR,1.00 to 2.54 versus media,1.00mg/L;IQR,1.00 to 1.55;P=0.016) and persistent atrial fibrillation had higher CRP level than paroxysmal atrial fibrillation(media,1.62mg/L;IQR,1.00 to 3.98 versus media,1.00mg/L,IQR, 1.00 to 2.10;P=-0.022),and so did presence of atrial fibrillation than absence of atrial fibrillation(media,2.11mg/L;IQR,1.00 to 3.60 versus media,1.00mg/L;IQR,1.00 to 1.76;P=0.000) in paroxysmal atrial fibrillation.However,there was no significant difference in CRP level between persistent atrial fibrillation and presence of atrial fibrillation in paroxysmal atrial fibrillation(P=0.992).Neither did between absence of atrial fibrillation in paroxysmal atrial fibrillation and controls(P=0.483).In patients with lone atrial fibrillation,atrial fibrillation rhythm(Exp(B)=4.85,95%CI:2.61-8.99) was the only independent predictor of elevated CRP level after adjusted covariates.Conclusions:Patients with lone atrial fibrillation had elevated CRP level only when they were in atrial fibrillation rhythm and elevated CRP level was not related to duration time or history of atrial fibrillation. Objectives:The present study was designed to evaluate the correlation between atria fibrillation(AF) with hypertension and inflammation.Methods:A total of 817 subjects were included in the case-control study,including 500 patients with AF and hypertension,185 patients with hypertension and 132 controls.C-reactive protein (CRP),white blood count(WBC),neutrophil granulocyte count(NGC) and echocardiography were evaluated,and electrocardiography was monitored to identify cardiac rhythm at the time of blood sampling.According to the rhythm,paroxysmal AF was divided into presence and absence of AF.Results:Subjects with AF and hypertension had higher CRP level(media,1.91mg/L;IQR,1.00 to 3.63) and NGC (3.63? 12) than controls(media,1.23mg/L;IQR,1.00 to 1.65;P=0.000 and 3.27? 10,P=0.004).So did subjects with hypertension than controls(media, 2.32mg/L;IQR,1.00 to 3.97,P=0.000;and 3.63? 08,P=0.01).However,there was no significant difference in CRP level and NGC between AF with hypertension and hypertension(P=0.559 and P=0.960).In AF subgroups,CRP level in persistent AF (media,2.30mg/L;IQR,1.00 to 3.94) and in presence of AF(media,2.30mg/L;IQR, 1.14 to 4.44) were higher than absence of AF(media,1.75mg/L;IQR,1.00 to 3.46; P=0.035 and P=0.014),though CRP level between patients with persistent AF and with presence of AF in paroxysmal AF was no significant difference(P=0.681). Multiple factors analysis demonstrated that hypertension(Exp(B)=0.308,P=0.001, 95%CI:0.150-0.632),female(Exp(B)=0.481,P=0.000,95%CI:0.322-0.719),older age(Exp(B)=l.018,P=0.045,95%CI:1.000-1.036) and dilated left atrial dimension (Exp(B)=1.061,P=0.003,95%CI:1.021-1.103) were predictors of elevated CRP levels after adjusted covariates in all subjects.Conclusion:A correlation exists between AF with hypertension and inflammation,which can be masked by the elevated inflammation faction in hypertension. Objectives:To explore whether the CRP levels can predict the early recurrence of atrial fibrillation(AF),the present study enrolled a large cohort of paroxysmal lone AF and AF only with hypertension patients.Methods:From October 2005 to October 2007,a total of 452 cases were enrolled including 162 lone AF and 290 AF only with hypertension patients.Blood sample collection and echocardiograph were performed during sinus rhythm in each patient.Blood measurements included C-reactive protein (CRP),white blood count(WBC) and neutrophil granulocyte count(NGC).During 10-day follow-up,all AF patients received at least one 24-hour-Holter, electrocardiography check every day and whenever patients had complaint.Results: AF with hypertension patients had older age(P=0.000),larger body mass index (P=0.004),dilated left atria dimension(P=0.000),and more co-morbidities of diabetes mellitus(P=0.000) and/or high blood cholesterol(P=0.000) than lone AF patients.CRP and NGC were higher in AF with hypertension patients(media 1.75, IQR 1.00 to 3.47 and 3.54? 07) than those in lone AF patients(media 1.00,IQR 1.00 to 1.73 and 3.27? 14;P=0.000 and P=0.012).During follow-up of 10 days including admission time,243(53.7%) patients including 96 patients in lone AF.group and 147 patients in AF with hypertension group had recurrence of AF No inflammatory indexes were significantly associated with the early recurrence of AF.Conclusion: AF with hypertension had elevated inflammatory reaction indicated by CRP and NGC than lone AF.Plasma CRP levels did not predict the early recurrence of AF.