摘要
目的探究阵发性心房颤动(PAF)患者血清高迁移率族蛋白B1(HMGB1),心肌肌球蛋白轻链4(MYL4)与射频消融术(RFA)后复发的相关性研究。方法回顾性选取2022年5月至2023年12月于沧州市人民医院接受RFA治疗的115例PAF患者作为患病组,随访1年,根据复发情况将其分为复发组(n=38)和未复发组(n=77)。另选取115名同期来本院体检的健康者作为对照组。采用酶联免疫吸附试验法检测血清HMGB1、MYL4水平。比较患病组与对照组的血清HMGB1、MYL4水平,并比较复发组与未复发组的临床资料[年龄、性别、体重指数、病程、血压、高血压、基础病史、左心室射血分数(LVEF)、左心房内径(LAD)、左心室舒张末期内径(LVEDD)、左心室收缩末期内径(LVESD)]和血清HMGB1、MYL4水平。多因素Logistic回归分析探讨PAF患者RFA后复发的影响因素;采用受试者操作特征(ROC)曲线分析血清HMGB1、MYL4水平对PAF患者RFA后复发的预测价值。结果患病组血清HMGB1水平为(3.54±0.78)ng/L,显著高于对照组[(2.72±0.65)ng/L],MYL4水平为(0.46±0.15)pg/mL,显著低于对照组[(1.94±0.53)pg/mL],差异均有统计学意义(P<0.05)。复发组与未复发组的年龄、性别、体重指数、病程、收缩压、舒张压、高血压、糖尿病、冠心病、心力衰竭、LVEF比较,差异均无统计学意义(P>0.05),复发组的LAD、LVEDD、LVESD、HMGB1水平分别为(44.26±5.64)mm、(49.52±5.37)mm、(33.89±4.62)mm、(4.28±1.22)ng/L,均显著高于未复发组[(41.58±5.39)mm、(47.33±5.41)mm、(32.02±4.54)mm、(3.17±0.56)ng/L],MYL4水平为(0.26±0.08)pg/mL,显著低于未复发组[(0.54±0.18)pg/mL],差异均有统计学意义(P<0.05)。多因素Logistic回归分析结果显示,LAD、HMGB1、MYL4均为患者RFA后复发的影响因素(P<0.05)。血清HMGB1、MYL4水平预测患者RFA后复发的曲线下面积(AUC)分别为0.782、0.780,二者联合预测的AUC为0.895,二者联合预测优于各指标单独预测(P<0.05)。结论PAF患者血清HMGB1水平上调,MYL4水平下调,且HMGB1、MYL4水平为PAF患者RFA后复发的影响因素,二者联合具有更高的预测价值。
Objective To investigate the correlation between serum high mobility group protein B1(HMGB1),myosin light chain 4(MYL4),and recurrence after radiofrequency ablation(RFA)in patients with paroxysmal atrial fibrillation(PAF).Methods A total of 115 patients with PAF who underwent RFA in Cangzhou People's Hospital from May 2022 to December 2023 were retrospectively selected as the disease group.After 1 year of follow-up,they were divided into the recurrence group(n=38)and the non-recurrence group(n=77)according to recurrence status.Another 115 healthy individuals who came to the outhors'hospital for physical examination were regarded as the control group.Serum HMGB1 and MYL4 levels were detected by enzyme-linked immunosorbent assay.Serum HMGB1 and MYL4 levels were compared between the disease group and the control group,and the clinical data[age,gender,body mass index,course of disease,blood pressure,hypertension,basic medical history,left ventricular ejection fraction(LVEF),left atrial diameter(LAD),left ventricular end-diastolic diameter(LVEDD),left ventricular end-systolic diameter(LVESD)]and serum HMGB1 and MYL4 levels were compared between the recurrence group and the non-recurrence group.The influencing factors of recurrence after RFA in PAF patients were analyzed by multivariate Logistic regression analysis.The predictive value of serum HMGB1 and MYL4 for recurrence after RFA in PAF patients was analyzed by receiver operating characteristic(ROC)curve.Results The serum HMGB1 level of the patients was(3.54±0.78)ng/L,which was significantly higher than that of the control group[(2.72±0.65)ng/L],and the MYL4 level was(0.46±0.15)pg/mL,which was significantly lower than that of the control group[(1.94±0.53)pg/mL],the differences were statistically significant(P<0.05).There were no statistically significant differences in age,gender,body mass index,course of disease,systolic blood pressure,diastolic blood pressure,hypertension,diabetes,coronary heart disease,heart failure and LVEF between the recurrence group and the non-recurrence group(P>0.05).The levels of LAD,LVEDD,LVESD and HMGB1 in the recurrence group were(44.26±5.64)mm,(49.52±5.37)mm,(33.89±4.62)mm and(4.28±1.22)ng/L,respectively,which were significantly higher than those in the non-recurrence group[(41.58±5.39)mm,(47.33±5.41)mm,(32.02±4.54)mm,(3.17±0.56)ng/L],and the MYL4 level was(0.26±0.08)pg/mL,which was significantly lower than that in the non-recurrence group[(0.54±0.18)pg/mL],the differences were statistically significant(P<0.05).Multivariate Logistic regression analysis showed that LAD,HMGB1 and MYL4 were the influencing factors of recurrence after RFA(P<0.05).The AUC of serum HMGB1 and MYL4 levels in predicting recurrence after RFA in patients was 0.782 and 0.780,respectively,the AUC predicted by the combination of the two was 0.895,and the combined prediction of the two was better than the individual prediction of various indicators(P<0.05).Conclusion Serum HMGB1 level is up-regulated and MYL4 level is down-regulated in patients with PAF,and the levels of serum HMGB1 and MYL4 are the influencing factors for recurrence after RFA.The combination of the two has higher predictive value.
作者
张颖
李晶晶
刘恩香
王岳胜
刘晓晨
ZHANG Ying;LI Jing-jing;LIU En-xiang(Department of Cardiology,Cangzhou People's Hospital,Cangzhou Hebei 061000,China)
出处
《临床和实验医学杂志》
2025年第10期1028-1032,共5页
Journal of Clinical and Experimental Medicine
基金
河北省卫生健康委科研基金项目(编号:20200292)。
