外周血Th17/Treg平衡与冠状动脉旁路移植术后心房颤动发生的关系

摘要

To study the relationship between peripheral blood Th17/Treg balance and atrial fibrillation (AF) after coronary artery bypass grafting (CABG). Methods The patients (n=200) received CABG were chosen from the Seventh People’s Hospital of Zhengzhou City from Jan. 2015 to Dec. 2017, and divided, according to whether or not they had AF after CABG, into AF group (n=46) and non-AF group (n=154). The general data, proportions of Th17 and Treg in peripheral blood, level of Th17/Treg and changes of cytokines related to Th17 and Treg were compared between 2 groups. The risk factors of AF occurrence after CABG were analyzed by using multi-factor Logistic regression analysis. Results The difference in sex, age, BMI, stroke, myocardial infarction, hyperlipidemia, diabetes, hypertension and renal insufficiency had no statistical significance between 2 groups (P>0.05). The proportion of Th17 and level of Th17/Treg in peripheral blood were higher in AF group than those in non-AF group (P0.05). The levels of IL-6 and IL-17 were higher in AF group than those in non0AF group (P0.05). The results of multi-factor Logistic regression analysis showed that Th17/Treg, IL-6 and IL-17 were independent risk factors influencing on AF occurrence after CABG (P<0.05). Conclusion AF patients have disorders of Th17/Treg balance after CABG. The risk of AF after CABG may be reduced through regulating Th17/Treg balance in clinical practice.%目的 研究外周血辅助性T细胞17(Th17)/调节性T细胞(Treg)平衡与冠状动脉旁路移植术后心房颤动发生的关系.方法 选取2015年1月至2017年12月于郑州市第七人民医院接受冠状动脉旁路移植术治疗的患者200例为研究对象,根据术后是否发生心房颤动分为心房颤动组46例与非心房颤动组154例.比较两组患者一般资料,外周血Th17、Treg细胞比例、Th17/Treg水平,外周血Th17、Treg相关细胞因子变化情况.并应用多因素Logistic回归分析分析冠状动脉旁路移植术后心房颤动发生的危险因素.结果 心房颤动组性别、年龄、体质指数(BMI)、脑卒中、心肌梗死、高脂血症、糖尿病、高血压及肾功能不全情况与非心房颤动组对比差异均无统计学意义(P＞0.05).心房颤动组外周血Th17细胞比例以及Th17/Treg水平均高于非心房颤动组(P＜0.05),两组Treg细胞比例比较差异无统计学意义(P＞0.05).心房颤动组外周血白细胞介素-6(IL-6)、白细胞介素-17(IL-17)水平均高于非心房颤动组(P＜0.05),两组白细胞介素-10(IL-10)、转化生长因子-β(TGF-β)水平比较无统计学意义(P＞0.05).经多因素Logistic回归分析:Th17/Treg、IL-6、IL-17均是影响冠状动脉旁路移植术后心房颤动发生的独立危险因素(P＜0.05).结论 冠状动脉旁路移植术后心房颤动患者存在明显的Th17/Treg细胞平衡紊乱,临床工作中可能通过调节Th17/Treg细胞平衡,从而达到降低冠状动脉旁路移植术后心房颤动发生的风险.