非对称性二甲基精氨酸在预测心房颤动血栓事件中的作用  

Effect of asymmetrical dimethylarginine for predicting pro-thrombotic risk in atrial fibrillation

作　　者：劳妙婵[1] 刘丽娟[1] 罗初凡[1] 卢贵华[1] 翟原生[1] 陈宣兰[1] 高修仁[1] 

机构地区：[1]中山大学附属第一医院心内科,广州510080

出　　处：《中华医学杂志》2016年第26期2059-2063,共5页National Medical Journal of China

基　　金：国家自然科学基金（81370284）;广州市科技计划基金（2011J4100111）;骏宏公司（东莞）横向基金

摘　　要：目的本研究通过检测心房颤动（简称房颤）患者及动物模型非对称性二甲基精氨酸（ADMA）水平的变化，探讨ADMA在预测房颤血栓事件中的作用。方法本试验共纳入2010—2012年在中山大学附属第一医院住院的138例患者，其中持续性房颤组（PAF）80例，阵发性房颤组（Paf）30例，对照组（窦性心律，SR）28例。分别用ELISA法测定血浆ADMA水平，评估各患者房颤卒中风险评分（CHADS2及CHA2DS2-VASc评分）。建立比格犬快速心房起搏模型，其中实验组8只，对照组6只。起搏4周后测定血浆ADMA水平。结果PAF组患者ADMA水平明显高于阵发性房颤组及对照组。ADMA与CHADS2评分、CHA2DS2-VASc评分呈正相关（均P〈0.05）。ADMA预测CHADS2评分≥2分及CHA2DS2-VASc评分≥2分的ROC曲线下面积分别为0.865、0.959（均P〈0.001）。建立快速心房起搏模型4周后，实验组ADMA水平明显高于基线水平及对照组。ADMA水平与房颤易感程度呈正相关（r＝0.686，P＝0.007）。结论房颤患者及房颤动物模型ADMA水平明显升高。且ADMA水平与卒中风险评分CHADS2评分、CHA2DS2-VASc评分呈正相关。ADMA可能成为预测心房颤动血栓事件的新型生物标志物，但需进一步临床试验证实。Objective Atrial fibrillation （AF） is responsible for some thromboembolic events. Asymmetrical dimethylarginine （ADMA） increases in atrial fibrillation （AF） animals with dysfunction of endothelium, but its role in pro-thrombotic state of AF was unknown. The aim of our study was to explore the role of ADMA in predicting the pro-thrombotic state in AF and to reveal its mechanism. Methods One hundred and thirty-eight patients in the First Affiliated Hospital, Sun Yat-sen University, from 2010 to 2012, were enrolled （ persistent atrial fibrillation group, PAF, n = 80 ; paroxysmal atrial fibrillation group, Paf, n = 30; sinus rhythm, SR, n = 28）. Plasma ADMA levels were detected by ELISA-kits. CHADS2 and CHA2 DS2-VASc scores were estimated for each patient. 14 Beagles （ pacing group, n = 8 ; sham group, n = 6） were subjected to rapid atrial pacing （RAP）. ADMA level was detected after 4 weeks of RAP. Results ADMA level was elevated significantly in patients with atrial fibrillation especially in patients with persistent atrial fibrillation, and showed a significant linear correlation to CHADS2 and CHA2 DS2-VASc score. With ADMA, ROC area under the curve was 0. 865 in CHADS2 score ≥2 and was 0. 959 in CHA2DS2-VASc score ≥2 （P 〈0. 001 respectively）. After 4 weeks of RAP, ADMA level was elevated compared to sham group and before operation. ADMA showed a linear correlation with atrial fibrillation susceptibility （r = 0. 686, P = 0. 007 ）. Conclusions ADMA levels are elevated both in AF patients and RAP beagles. ADMA correlates with stroke risk concerning with CHADS2/CHA2DS2-VASc score. ADMA may become a new biomarker for predicting pro-thrombotic risk in AF.

关 键 词：心房颤动 卒中 血栓栓塞 非对称性二甲基精氨酸 

分 类 号：R541.75[医药卫生—心血管疾病]