摘要
目的 探究老年非瓣膜性心房颤动(NVAF)患者血清骨膜蛋白(Periostin)、尿酸/清蛋白比率(UAR)水平与射频消融术(RFCA)后复发的相关性。方法 选取2019年1月~2022年10月在首都医科大学附属北京同仁医院心血管中心接受RFCA治疗的108例老年NAVF患者为观察组,选取同期在首都医科大学附属北京同仁医院体检的108例健康者作为对照组,对患者进行为期一年的随访,根据随访情况将其分为复发组(n=42)和未复发组(n=66)。收集患者性别、年龄、体质量指数(BMI)、高血压史、糖尿病史、高血脂史、吸烟史、饮酒史、左心室射血分数(LVEF)、左心室舒张末期直径(LVEDD)和白细胞计数(WBC);采用酶联免疫吸附测定法(ELISA)检测血清Periostin含量;采用全自动生化分析仪测定血清清蛋白(ALB)和尿酸(UA)含量,其比值即为UAR水平。采用Logistic回归分析NVAF患者RFCA后复发的影响因素;受试者工作特征(ROC)曲线分析血清Periostin,UAR水平对老年NAVF患者RFCA后复发的预测价值。结果 观察组术前Periostin(53.53±6.27 ng/L),UAR(4.09±0.78)水平显著高于术后(50.53±7.23 ng/L,3.41±0.91)和对照组(31.29±4.21 ng/L,1.24±0.27),差异具有统计学意义(t=3.258,30.603;5.896,35.883,均P<0.05)。复发组LVEF(51.16%±6.49%)低于未复发组(55.39%±6.71%),UAR(4.01±0.92)、Periostin(55.77±6.56 ng/L)和高血脂史占比(66.67%)水平高于未复发组(3.02±0.63,47.19±5.44ng/L,34.85%),差异具有统计学意义(χ^(2)/t=3.234,6.458,7.180,10.426,均P<0.05)。血清Periostin[OR(95%CI):1.856(1.148~3.000)],UAR[OR(95%CI):2.127(1.145~3.951)]为患者RFCA后复发的独立危险因素(均P<0.05);血清Periostin,UAR水平预测老年NAVF患者RFCA后复发的曲线下面积(95%置信区间)[AUC(95%CI)]分别为0.856(0.776~0.916),0.817(0.731~0.884),截断值分别为53.00ng/L,3.99,约登指数分别为0.569,0.509,敏感度分别为88.10%,85.71%,特异度分别为71.21%,65.15%;二者联合预测的AUC(95%CI),约登指数、敏感度、特异度分别为0.924(0.857~0.966),0.736,85.71%和87.88%,二者联合预测高于各指标单独预测(Z=2.296,2.880;P=0.022,0.004)。结论 老年NAVF患者血清Periostin,UAR水平上调,与RFCA后复发存在一定的关联,二者联合预测老年NAVF患者RFCA后复发具有较高效能。
Objective To exploring the correlation between serum periostin,uric acid/albumen ratio(UAR)levels and recurrence after radiofrequency ablation(RFCA)in elderly patients with nonvalvular atrial fibrillation(NVAF).Methods The 108 elderly NAVF patients who received RFCA treatment at the Cardiovascular Center of Peking Tongren Hospital Affiliated to Capital Medical University from January 2019 to October 2022 were selected as the observation group,selected 108 healthy individuals who had medical checkups at Beijing Tongren Hospital Affiliated to Capital Medical University during the same period as the control group,and the patients were followed up for a period of 1 year.And according to the follow-up,they were divided into the recurrence group(n=42)and the non-recurrence group(n=66).Sex,age,body mass index(BMI),history of hypertension,diabetes mellitus,hyperlipidemia,smoking,alcohol consumption,left ventricular ejection fraction(LVEF),left ventricular enddiastolic diameter(LVEDD),white blood cell counts were collected.Enzyme linked immunosorbent assay(ELISA)was applied to detect serum Periostin level.Fully automated biochemical analyzer was applied to measure the levels of serum albumin(ALB)and uric acid(UA),whose ratio was the level of UAR.Logistic regression was applied to analyze the influencing factors of recurrence in NVAF patients after RFCA.Receiver Operating Characteristic(ROC)curve was applied to analyze the predictive value of serum Periostin and UAR levels for recurrence after RFCA in elderly NAVF patients.Results Preoperative Periostin,UAR levels in the observation group were significantly higher than serum Periostin(53.53±6.27ng/L),UAR(4.09±0.78)in the postoperative(50.53±7.23 ng/L,3.41±0.91)and control groups(31.29±4.21 ng/L,1.24±0.27),and the differences were statistically significant(t=3.258,30.603;5.896,35.883,all P<0.05).The LVEF was lower in the recurrent group(51.16%±6.49%)than in the non-recurrent group(55.39%±6.71%),the levels of UAR(4.01±0.92),Periostin(55.77±6.56 ng/L)and percentage of history of hyperlipidemia(66.67%)were higher in the relapse group than those in the non-relapse group(3.02±0.63,47.19±5.44 ng/L,34.85%),and the differences were statistically significant(χ^(2)/t=3.234,6.458,7.180,10.426,all P<0.05).Serum Periostin[OR(95%CI):1.856(1.148~3.000)]and UAR[OR(95%CI):2.127(1.145~3.951)]were independent risk factors for recurrence after RFCA in patients(P<0.05).The area under the curve(95%confidence interval)[AUC(95%CI)]of serum Periostin and UAR levels to predict relapse after RFCA in elderly NAVF patients were 0.856(0.776~0.916),0.817(0.731~0.884),respectively,the cutoff values were 53.00 ng/L,3.99,the Youden index was 0.569,0.509,the sensitivity was 88.10%,85.71%and the specificity was 71.21%,65.15%,respectively.The combined predicted of the AUC(95%CI),Youdon index,sensitivity and specificity by the two method were as flows 0.924(0.857~0.966),0.736,85.71%and 87.88%,respectively.The combined prediction was significantly higher than that of each index alone(Z=2.296,2.880,P=0.022,0.004).Conclusion Serum Periostin and UAR levels are upregulated in elderly patients with NAVF,there is a certain correlation with recurrence after RFCA,the combination of the two has a high efficacy in predicting recurrence in elderly NAVF patients after RFCA.
作者
董丹丹
姜玉连
DONG Dandan;JIANG Yulian(Cardiovascular Center,Beijing Tongren Hospital Affiliated to Capital Medical University,Beijing 100176,China)
出处
《现代检验医学杂志》
2025年第1期138-142,共5页
Journal of Modern Laboratory Medicine
关键词
非瓣膜性心房颤动
骨膜蛋白
尿酸/清蛋白比率
射频消融术
non valvular atrial fibrillation
periostin
uric acid/albumen
radiofrequency catheter ablation
