收缩性心力衰竭患者血清CA125水平变化与房颤发生的相关性

摘要

目的 探讨收缩性心力衰竭患者肿瘤标记物血清糖类抗原CA125与房颤发生的相关性及其预测房颤发生的最佳界值.方法 选取收缩性心力衰竭患者125例,根据心电图分为窦律组80例,房颤组45例.化学免疫发光法检测两组血清CA125浓度,分析血清CA125浓度与射血分数、肺动脉收缩压、二尖瓣反流、三尖瓣反流、左房内径、心包积液、丙氨酸转氨酶、肌酐和血红蛋白浓度的相关性,采用受试者工作特征曲线(ROC)分析血清CA125预测收缩性心力衰竭发生房颤的最佳界值.结果 房颤组血清CA125浓度与窦律组差异具有统计学意义[(65±10)vs(34±9)U/mL,P<0.05];血清CA125与肺动脉收缩压、二尖瓣反流、三尖瓣反流、左房内径、心包积液、丙氨酸转氨酶、肌酐呈正相关(r分别为0.352、0.536、0.411、0.302、0.576、0.237、0.275,P均<0.05),与射血分数和血红蛋白水平呈负相关(r分别为-0.223、-0.196,P均<0.05).Logistic回归分析发现血清CA125、二尖瓣反流、三尖瓣反流、左房内径为房颤发生的预测因子(P均<0.05).血清CA125水平升高与房颤的发生相关(OR=2.723,95％CI 1.917～7.716,P<0.05).血清CA125预测房颤的最佳界值为44.5 U/mL;其预测房颤发生的ROC曲线下面积为0.754(95％CI O.660～0.831,P<0.05),敏感度为82.22％,特异度为71.2％.结论 在收缩性心力衰竭患者中,肿瘤标记物血清CA125可用于预测房颤的发生.当血清CA125浓度值越接近44.5 U/mL时,发生房颤概率越高.%Objective To investigate the correlation between the serum carbohydrate antigen CA 125 and atrial fibrilla-tion in patients with systolic heart failure and to discuss the best boundary value for predicting the occurrence of atrial fibril -lation.Methods Totally 125 patients with systolic heart failure were divided into two groups according to the results of ECG:the sinus rhythm group ( n=80 ) and the atrial fibrillation group ( n=45 ) .Enzyme linked immunosorbent assay (ELISA) was used to measure the serum CA125 concentration, and to analyze the correlations of serum CA125 concentra-tion with ejection fraction , pulmonary artery systolic blood pressure , mitral regurgitation , three regurgitation , left atrial di-ameter, pericardial effusion, alanine aminotransferase, creatinine, and hemoglobin concentration.The ROC curve was used to analyze the optimal cut-off level of serum CA 125 for predicting the occurrence of atrial fibrillation in patients with systolic heart failure .Results Significant difference was found in the concentration of serum CA 125 between the atrial fibrillation group and the sinus rhythm group [(65 ±10) vs.(34 ±9) U/mL, P<0.05].The concentration of CA125 was positively correlated with pulmonary artery systolic pressure , mitral regurgitation , tricuspid regurgitation , left atrial diameter , pericar-dial effusion, alanine aminotransferase and creatinine (r=0.352, 0.536, 0.411, 0.302, 0.576, 0.237, and 0.275, all P<0.05).On the contrary, it was negatively correlated with the ejection fraction and hemoglobin ( r =-0.223,-0.196;P<0.05).Logistic regression analysis showed that serum CA125, mitral regurgitation (moderate to severe),tricuspid regurgitation ( moderate to severe ) , and diameter of the left atrium separately could predict the occurrence of atrial fibrillation in patients with heart failure (all P<0.05).The increased serum CA125 was related to the occurrence of atrial fibrillation (OR=2.723, 95％ CI=0.917～7.716, P=0.012).The best cut-off point of CA125 for predicting atrial fi-brillation was 44.5 U/mL, and the area under the ROC curve was 0.754 (95％ CI=0.660～0.831, P<0.01), with a sensitivity of 82.22％ and a specificity of 71.2％.Conclusion Serum CA125 could be used to predict the occurrence of atrial fibrillation in patients with systolic heart failure , and the incidence of atrial fibrillation will increase when the concen-tration of serum CA-125 reaches 44.5 U/mL.