心房颤动患者血浆儿茶酚抑素水平及其与心房颤动类型的关系

摘要

目的：探讨心房颤动患者血浆儿茶酚抑素(CST)水平,比较不同类型心房颤动患者血浆 CST 的变化及可能的临床意义。方法入选2013年12月至2014年12月于北京大学第三医院就诊的心房颤动患者84例(阵发性心房颤动61例,慢性心房颤动23例),以及合并疾病相匹配、无心房颤动史的窦性心律患者46例为对照组。记录患者病史及体格检查、实验室和超声心动图检查指标,留取血浆标本, ELISA 方法测定患者血浆 CST 水平并比较组间差异。结果心房颤动组血浆 CST 水平明显低于对照组[0.54(0.34~0.96) mg/ L 比0.87(0.59~1.31) mg/ L,Z =-3.491,P <0.001]。亚组分析显示：阵发性心房颤动组[0.58(0.36~0.98) mg/ L,Z =-2.807,P =0.005]、慢性心房颤动组[0.43(0.27~0.78)mg/ L,Z =-3.450,P <0.001]血浆 CST 水平均较对照组明显降低,且慢性心房颤动组较阵发性心房颤动组更低,但差异无统计学意义(Z =-1.495,P =0.136)。心房颤动发作组[0.59(0.33~0.92) mg/ L,Z =-3.091,P =0.002]与转复后组[0.51(0.34~1.00) mg/ L,Z =-2.859,P =0.004]血浆 CST 水平也较对照组明显降低,两组间差异无统计学意义(Z =-0.028,P =0.980)。多因素 Logistic 回归分析显示,血浆 CST 降低(OR =0.631,P =0.049)、N 末端脑钠肽前体(NT-proBNP)升高(>125 ng/ L)(OR =12.416,P <0.001)是心房颤动发生的独立危险因素。采用ROC 曲线分析,血浆 CST 诊断阵发性心房颤动的最佳临界值为0.73 mg/ L,敏感度为60.9%,特异度为63.9%,曲线下面积0.659(P =0.005)。结论心房颤动患者血浆 CST 水平明显降低,CST 降低可能是心房颤动发生的独立预测因素。%Objective To analyze plasma level of catestatin and its clinical significance in patients with different types of atrial fibrillation. Methods A total of 84 consecutive patients with atrial fibrillation were enrolled in this study. Atrial fibrillation was categorized as paroxysmal atrial fibrillation(n = 61) and chronic atrial fibrillation (n = 23). Another 46 patients matched for concomitant diseases in sinus rhythm without any atrial fibrillation history consisted of control group. Medical history, physical examination, laboratory parameters and echocardiography were recorded. Plasma levels of catestatin were measured by ELISA and compared between groups. Results Plasma catestatin levels were decreased in overall atrial fibrillation group than in control group [0. 54 (0. 34 - 0. 96) mg/ L vs. 0. 87 (0. 59 - 1. 31) mg/ L, Z =- 3. 491, P < 0. 001]. In subgroup analysis, compared with the control group, plasma catestatin levels were significantly decreased in both paroxysmal atrial fibrillation [0. 58(0. 36 - 0. 98) mg/ L, Z = - 2. 807, P =0. 005] and chronic atrial fibrillation [0. 43 (0. 27 - 0. 78) mg/ L, Z = - 3. 450, P < 0. 001] groups. Compared with paroxysmal atrial fibrillation group, plasma catestatin levels were decreased in chronic atrial fibrillation group, although it was not statistically significant (Z = - 1. 495, P = 0. 136). Plasma catestatin levels of the patients in atrial fibrillation and in sinus rhythm at the time of catestatin sampling were similar (Z = - 0. 028, P = 0. 980), but both decreased than in the control group [0. 59(0. 33 - 0. 92) mg/ L, Z =- 3. 091, P = 0. 002; 0. 51 (0. 34 - 1. 00) mg/ L, Z = - 2. 859, P = 0. 004] . Multivariate logistic regression analysis showed that lower CST level ( OR = 0. 631, P = 0. 049 ) and elevated NT-proBNP ( > 125 ng/ L) (OR = 12. 416,P < 0. 001) were the independent predictors of atrial fibrillation. Using a receiver operating characteristic curve, the optimal cut-off value for plasma CST was 0. 73 mg/ L in the diagnosis of paroxysmal atrial fibrillation with 60. 9% sensitivity and 63. 9% specificity, the area under the curve( AUC) was 0. 659 ( P = 0. 005) . Conclusions Plasma catestatin levels of patients with atrial fibrillation are significantly decreased. Lower catestatin level may be the independent factor associated with atrial fibrillation incidence.