心脏瓣膜置换术后新发心房颤动患者血清Angpt1、内皮素-1水平变化及其临床意义  

Changes of serum levels of Angpt1 and endothelin-1 in patients with newly-onset atrial fibrillation after heart valve replacement and its clinical significance

作　　者：费俊杰 罗勇[1] 陈剑[1] 陈杰 李金泽 高兰英 FEI Jun-jie;LUO Yong;CHEN Jian;CHEN Jie;LI Jin-ze;GAO Lan-ying(Department of Cardiothoracic Surgery,Chengdu Third People's Hospital,Chengdu,Sichuan,610000,China)

机构地区：[1]成都市第三人民医院心脏大血管外科,四川成都610000

出　　处：《心血管康复医学杂志》2024年第4期425-430,共6页Chinese Journal of Cardiovascular Rehabilitation Medicine

基　　金：四川省卫生健康委员会科研课题任务(19PJ011)。

摘　　要：目的:探究心脏瓣膜置换术后新发心房颤动(AF)患者血清血管生成素-1(Angpt1)、内皮素-1(ET-1)的水平变化,并分析二者的临床意义。方法:选择2020年1月~2022年3月于本院行心脏瓣膜置换术的130例患者,根据术后7d有无AF分为无AF组(72例)及AF组(58例)。采用ELISA法检测两组血清Angpt1、ET-1水平;采用Pearson法分析AF患者血清Angpt1、ET-1水平的相关性;采用ROC曲线分析血清Angpt1、ET-1水平对此类患者术后发生AF的预测价值;采用Logistic回归分析此类患者术后发生AF的影响因素。结果:AF组左心房内径(LAD)、NYHA心功能Ⅳ级比例、体外循环时间均显著高于无AF组(P<0.05或<0.01)。术后1d,与无AF组比较,AF组血清Angpt1水平显著降低,ET-1水平显著升高(P均<0.001)。Pearson相关分析显示,AF患者血清Angpt1水平与ET-1水平呈显著负相关(r=-0.366,P=0.005)。ROC分析显示,血清Angpt1、ET-1水平联合预测心脏瓣膜置换术后AF发生的曲线下面积(AUC)显著高于二者单独预测(Z=2.761、1.998,P=0.006、0.046)。多因素Logistic回归分析显示LAD、NYHAⅣ级、体外循环时间及术后ET-1是此类患者术后发生AF的独立危险因素(OR=1.471~1.739,P<0.05或<0.01),而术后Angpt1是其独立保护因素(OR=0.634,P=0.004)。结论:心脏瓣膜置换术后新发AF患者术后血清Angpt1水平显著降低,ET-1水平显著升高,联合检测Angpt1、ET-1水平对术后AF发生的预测价值较高。Objective:To explore the changes of serum levels of angiopoietin-1(Angpt1)and endothelin-1(ET-1)in patients with newly-onset atrial fibrillation(AF)after heart valve replacement,and analyze their clinical significance.Methods:A total of 130 patients who underwent heart valve replacement in our hospital from January 2020 to March 2022 were divided into no AF group(n=72)and AF group(n=58)according to presence of AF within 7d after surgery.Serum levels of Angpt1 and ET-1 were detected by ELISA in two groups;the correlation between serum Angpt1 and ET-1 was analyzed by Pearson method in AF patients;ROC curve analysis was used to analyze the predictive value of serum Angpt1 and ET-1 levels for postoperative AF in these patients;Logistic regression was used to analyze the influencing factors of postoperative AF in these patients.Results:The left atrial diameter(LAD),proportion of NYHA class IV and cardiopulmonary bypass time in AF group were significantly higher than those of no AF group(P<0.05 or<0.01).One day after surgery,compared with no AF group,serum Angpt1 level significantly reduced and ET-1 level significantly increased in AF group(P<0.001 both).Pearson correlation analysis indicated that serum Angpt1 level was significant inversely correlated with ET-1 level in AF patients(r=-0.366,P=0.005).ROC analysis indicated that area under the curve(AUC)of combined detection of serum Angpt1 and ET-1 in predicting AF after heart valve replacement was significantly higher than those of each single detection(Z=2.761,1.998,P=0.006,0.046).Multivariate Logistic regression analysis indicated that LAD,NYHA class IV,cardiopulmonary bypass time and postoperative ET-1 were independent risk factors for postoperative AF in these patients(OR=1.471~1.739,P<0.05 or<0.01),while postoperative Angpt1 was its independent protective factor(OR=0.634,P=0.004).Conclusion:Serum Angpt1 level significantly reduces and ET-1 level significantly increases in patients with newly-onset AF after heart valve replacement.Combined detection of Angpt1 and

关 键 词：心房颤动 心脏瓣膜假体植入 血管生成素类 

分 类 号：R541.75[医药卫生—心血管疾病]