糖类抗原125水平对慢性心力衰竭患者新发心房颤动的预测价值

摘要

目的:探索血清糖类抗原125(CA-125)水平是否能够预测慢性心力衰竭(心衰)患者心房颤动(房颤)的发生.方法:入选2012-01至2016-01期间共200例既往和目前均无房颤的慢性心衰住院患者,经住院治疗病情稳定后检测其血清CA-125水平,并定期随访,观察房颤的发生情况,评估基线血清CA-125水平与新发房颤之间的关系.结果:8例患者在首次随访期(半年)内死亡,14例失访,故共178例患者完成至少一次随访.这些患者平均随访时间为(20.1±9.9)个月(6～54个月),其中40例(22％)患者出现新发房颤.与保持窦性心律的患者比较,新发房颤患者基线CA-125水平更高[108(44～228)U/ml vs 49(21～118)U/ml,P<0.001].受试者工作特征曲线显示,预测新发房颤的血清CA-125最佳截点为>72.58 U/ml.单因素分析发现,血清CA-125水平>72.58 U/ml、左心房内径增加、右心室扩大、肺动脉收缩压高、左心室射血分数低以及中到重度的二尖瓣反流对新发房颤有预测价值.校正单因素分析中有意义的变量后,多因素Cox回归分析发现,血清CA-125水平>72.58 U/ml(风险比=2.709,95％ 可信区间:1.308～6.876,P=0.008)和中到重度的二尖瓣反流(风险比=2.301,95％ 可信区间:1.204～5.334,P=0.01)是新发房颤的独立预测因素.结论:血清CA-125水平与慢性心衰患者新发房颤相关;血清CA-125水平升高的慢性心衰患者更容易发生房颤.%Objective: To investigate whether serum level of carbohydrate antigen-125 (CA-125) could predict the new-onset of atrial fibrillation (AF) in patients with chronic heart failure (CHF). Methods: A total of 200 CHF patients without previous and current AF admitted in our hospital from 2012-01 to 2016-01 were enrolled. Serum level of CA-125 was examined in all patients at their stable condition. Follow-up study was conducted to observe AF occurrence in order to evaluate the relationship between CA-125 level and new-onset of AF. Results: There were 8 patients died within 6 months, 14 lost contact and 178 finished at least 1 time follow-up at the mean of (20.1±9.9) months (from 6 to 54 months). 40/178 (22％) patients developed new-onset of AF. Compared with sinus rhythm, AF patients had the higher CA-125 level as 108 (44-228) U/ml vs 49 (21-118) U/ml, P=0.001. ROC indicated that CA-125>72.58 U/ml was the optimal cut-off value for predicting new-onset of AF. Single factor analysis indicated that serum CA-125>72.58 U/ml, increased left atrial diameter, right ventricular dilatation, pulmonary hypertension, lower LVEF and moderate to severe mitral regurgitation (MR) had the predictive value for new-onset of AF. With adjusted meaningful single factors, multivariate Cox regression analysis presented that serum CA-125>72.58 U/ml (HR=2.709, 95％ CI 1.308-6.876, P=0.008) and moderate to severe MR were the independent predictors for new-onset of AF. Conclusion: Serum CA-125 level was related to new-onset of AF in CHF patients; the patients with elevated CA-125 had the higher chance to develop new-onset of AF.