血清可溶性尿激酶纤维蛋白酶原激活受体浓度与老年高血压患者心房颤动和心功能指标的关系
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摘要
目的探讨老年高血压患者血清可溶性尿激酶纤维蛋白酶原激活受体(soluble urokinase plasminogen activator receptor,suPAR)水平与心房颤动(atrial fibrillation,AF)和心功能指标的关系。方法选取2014-05～2016-10在本院就诊的65岁以上高血压合并阵发性AF患者64例,并选择同期来院治疗的65岁以上单纯性高血压患者85例作为对照。检测比较两组患者suPAR及血生化指标和心脏结构功能参数,分析suPAR浓度与心脏结构功能参数的相关性。多因素Logistic回归分析研究影响老年高血压患者阵发性AF发生的危险因素。Kaplan-Meier分析suPAR蛋白浓度与无AF复发生存期的关系。结果 AF组患者suPAR、hs-CRP、总胆固醇以及NT-proBNP水平明显高于对照组(均P <0. 05)。相关性分析显示血清suPAR浓度与LVEF呈负相关,与NT-proBNP正相关。suPAR低于3. 5 ng/ml的患者,AF的发生率为26. 1%,suPAR高于3. 5 ng/ml的患者,AF的发生率为57. 5%。Logistic回归显示suPAR水平是老年高血压患者AF发生的独立危险因素(OR=1. 201,95%CI 1. 117-1. 435,P=0. 020)。随访过程中AF组患者18例房颤复发,suPAR高于和低于3. 5 ng/ml两组患者AF复发率和无AF复发生存期差异无统计学意义。结论血清suPAR水平是老年高血压患者AF发生的独立危险因素,但与AF的复发无明显关系。
Objective To investigate the association between soluble urokinase plasminogen activator receptor( suPAR) and atrial fibrillation( AF) as well as cardiac functions in elder patients with hypertension. Methods Totally 64 patients aged over 65 years with hypertension and paroxysmal atrial fibrillation( AF group) were recruited from May 2014 to October 2016 in this study,and 85 patients with sole hypertension were simultaneously recruited as control group. The blood suPAR,serum biochemical and cardiac parameters between the two groups were compared. The correlations between blood suPAR level and cardiac parameters were analyzed. Multivariate Logistic regression analysis was used to screen the risk factors for the onset of AF in elder patients with hypertension. Kaplan-Meier survival analysis was used to evaluate the association between suPAR concentration and AF recurrence-free survival time. Results The suPAR,hs-CRP,total cholesterol and NT-proBNP levels were significantly higher in patients with AF than in controls( P < 0. 05).The suPAR level was negatively correlated with LVEF and positively correlated to NT-proBNP concentration. The incidence of AF was 26. 1% in patients with suPAR < 3. 5 ng/ml,and 57. 5% in patients with suPAR ≥ 3. 5 ng/ml. Multivariate regression analysis showed that serum suPAR level was one of independent risk factors associated with the onset of AF in elderly patients with hypertension( OR = 1. 201,95% CI 1. 117-1. 435,P = 0. 020). Eighteen patients in AF group were found recurrence in the follow-up. There was no significant difference in AF recurrence rate and AF recurrence-free survival time between suPAR < 3. 5 ng/ml group and suPAR≥3. 5 ng/ml group. Conclusion Serum suPAR level is an independent risk factor for the incidence of atrial fibrillation in elder patients with hypertension. The baseline suPAR concentration is not necessarily associated with the recurrence of AF.
Objective To investigate the association between soluble urokinase plasminogen activator receptor( suPAR) and atrial fibrillation( AF) as well as cardiac functions in elder patients with hypertension. Methods Totally 64 patients aged over 65 years with hypertension and paroxysmal atrial fibrillation( AF group) were recruited from May 2014 to October 2016 in this study,and 85 patients with sole hypertension were simultaneously recruited as control group. The blood suPAR,serum biochemical and cardiac parameters between the two groups were compared. The correlations between blood suPAR level and cardiac parameters were analyzed. Multivariate Logistic regression analysis was used to screen the risk factors for the onset of AF in elder patients with hypertension. Kaplan-Meier survival analysis was used to evaluate the association between suPAR concentration and AF recurrence-free survival time. Results The suPAR,hs-CRP,total cholesterol and NT-proBNP levels were significantly higher in patients with AF than in controls( P < 0. 05).The suPAR level was negatively correlated with LVEF and positively correlated to NT-proBNP concentration. The incidence of AF was 26. 1% in patients with suPAR < 3. 5 ng/ml,and 57. 5% in patients with suPAR ≥ 3. 5 ng/ml. Multivariate regression analysis showed that serum suPAR level was one of independent risk factors associated with the onset of AF in elderly patients with hypertension( OR = 1. 201,95% CI 1. 117-1. 435,P = 0. 020). Eighteen patients in AF group were found recurrence in the follow-up. There was no significant difference in AF recurrence rate and AF recurrence-free survival time between suPAR < 3. 5 ng/ml group and suPAR≥3. 5 ng/ml group. Conclusion Serum suPAR level is an independent risk factor for the incidence of atrial fibrillation in elder patients with hypertension. The baseline suPAR concentration is not necessarily associated with the recurrence of AF.
引文
[1]詹碧鸣,孙文华,董一飞,等.老年高血压合并心房颤动患者脉压与血栓前状态分子标志物的关系研究[J].中国全科医学,2016,19(16):1887-1890.
[2]Musetti C,Quaglia M,Cena T,et al.Circulating su PAR levels are affected by glomerular filtration rate and proteinuria in primary and secondary glomerulonephritis[J].J Nephrol,2015,28(3):299-305.
[3]Trachtman H.su PAR and team nephrology[J].BMC Med,2014,12:82.
[4]Hodges GW,Bang CN,Wachtell K,et al.su PAR:a new biomarker for cardiovascular disease[J].Can J Cardiol,2015,31(10):1293-1302.
[5]Diederichsen MZ,Diederichsen SZ,Mickley H,et al.Prognostic value of suPAR and hs-CRP on cardiovascular disease[J].Atherosclerosis,2018,271:245-251.
[6]Ali AN,Athavale NV,Abdelhafiz AH.Anemia:an independent predictor of adverse outcomes in older patients with atrial fibrillation[J].J Atr Fibrillation,2016,8(6):1366.
[7]Kivimaki M,Nyberg ST,Batty GD,et al.Long working hours as a risk factor for atrial fibrillation:a multi-cohort study[J].Eur Heart J,2017,38(34):2621-2628.
[8]Hodges GW,Bang CN,Eugen-Olsen J,et al.SuPAR predicts postoperative complications and mortality in patients with asymptomatic aortic stenosis[J].Open Heart,2018,5(1):e000743.
[9]Backes Y,van der Sluijs KF,Mackie DP,et al.Usefulness of su PAR as a biological marker in patients with systemic inflammation or infection:a systematic review[J].Intensive Care Med,2012,38(9):1418-1428.
[10]牛镜磊,彭瑜,白明,等.血浆可溶性尿激酶型纤溶酶原激活物受体水平与急性冠状动脉综合征的相关性及其影响因素的研究[J].中国循环杂志,2017,32(10):970-974.
[11]王彦军,朱琳,俞天虹,等.血浆suPAR水平与冠心病患者冠状动脉斑块稳定性、病变程度及冠心病预测之间的关系[J],中国动脉硬化杂志,2015,23(12):1236-1240.
[12]Eapen DJ,Manocha P,Ghasemzadeh N,et al.Soluble urokinase plasminogen activator receptor level is an independent predictor of the presence and severity of coronary artery disease and of future adverse events[J].J Am Heart Assoc,2014,3(5):e001118.
[13]Koller L,Stojkovic S,Richter B,et al.Soluble urokinase-type plasminogen activator receptor improves risk prediction in patients with chronic heart failure[J].Wiener Klinische Wochenschrift,2017,128(4):S269.
[14]Borne Y,Persson M,Melander O,et al.Increased plasma level of soluble urokinase plasminogen activator receptor is associated with incidence of heart failure but not atrial fibrillation[J].Eur JHeart Fail,2014,16(4):377-383.
[15]Hu YF,Chen YJ,Lin YJ,et al.Inflammation and the pathogenesis of atrial fibrillation[J].Nat Rev Cardiol,2015,12(4):230-243.
[16]Smith HW,Marshall CJ.Regulation of cell signalling by uPAR[J].Nat Rev Mol Cell Biol,2010,11(1):23-36.
[17]Westin O,Rasmussen LJH,Andersen O,et al.Soluble urokinase plasminogen activator receptor(su PAR)as a predictor of incident atrial fibrillation[J].J Atr Fibrillation,2018,10(6):1801.
[18]Muresan L,Petcu A,Muresan C,et al.The role of NT-proBNPin the diagnosis of ventricular arrhythmias in patients with systemic sclerosis[J].Iran J Public Health,2017,46(7):906-916.
[19]Svennberg E,Lindahl B,Berglund L,et al.NT-proBNP is a powerful predictor for incident atrial fibrillation-validation of a multimarker approach[J].Int J Cardiol,2016,223:74-81.
[2]Musetti C,Quaglia M,Cena T,et al.Circulating su PAR levels are affected by glomerular filtration rate and proteinuria in primary and secondary glomerulonephritis[J].J Nephrol,2015,28(3):299-305.
[3]Trachtman H.su PAR and team nephrology[J].BMC Med,2014,12:82.
[4]Hodges GW,Bang CN,Wachtell K,et al.su PAR:a new biomarker for cardiovascular disease[J].Can J Cardiol,2015,31(10):1293-1302.
[5]Diederichsen MZ,Diederichsen SZ,Mickley H,et al.Prognostic value of suPAR and hs-CRP on cardiovascular disease[J].Atherosclerosis,2018,271:245-251.
[6]Ali AN,Athavale NV,Abdelhafiz AH.Anemia:an independent predictor of adverse outcomes in older patients with atrial fibrillation[J].J Atr Fibrillation,2016,8(6):1366.
[7]Kivimaki M,Nyberg ST,Batty GD,et al.Long working hours as a risk factor for atrial fibrillation:a multi-cohort study[J].Eur Heart J,2017,38(34):2621-2628.
[8]Hodges GW,Bang CN,Eugen-Olsen J,et al.SuPAR predicts postoperative complications and mortality in patients with asymptomatic aortic stenosis[J].Open Heart,2018,5(1):e000743.
[9]Backes Y,van der Sluijs KF,Mackie DP,et al.Usefulness of su PAR as a biological marker in patients with systemic inflammation or infection:a systematic review[J].Intensive Care Med,2012,38(9):1418-1428.
[10]牛镜磊,彭瑜,白明,等.血浆可溶性尿激酶型纤溶酶原激活物受体水平与急性冠状动脉综合征的相关性及其影响因素的研究[J].中国循环杂志,2017,32(10):970-974.
[11]王彦军,朱琳,俞天虹,等.血浆suPAR水平与冠心病患者冠状动脉斑块稳定性、病变程度及冠心病预测之间的关系[J],中国动脉硬化杂志,2015,23(12):1236-1240.
[12]Eapen DJ,Manocha P,Ghasemzadeh N,et al.Soluble urokinase plasminogen activator receptor level is an independent predictor of the presence and severity of coronary artery disease and of future adverse events[J].J Am Heart Assoc,2014,3(5):e001118.
[13]Koller L,Stojkovic S,Richter B,et al.Soluble urokinase-type plasminogen activator receptor improves risk prediction in patients with chronic heart failure[J].Wiener Klinische Wochenschrift,2017,128(4):S269.
[14]Borne Y,Persson M,Melander O,et al.Increased plasma level of soluble urokinase plasminogen activator receptor is associated with incidence of heart failure but not atrial fibrillation[J].Eur JHeart Fail,2014,16(4):377-383.
[15]Hu YF,Chen YJ,Lin YJ,et al.Inflammation and the pathogenesis of atrial fibrillation[J].Nat Rev Cardiol,2015,12(4):230-243.
[16]Smith HW,Marshall CJ.Regulation of cell signalling by uPAR[J].Nat Rev Mol Cell Biol,2010,11(1):23-36.
[17]Westin O,Rasmussen LJH,Andersen O,et al.Soluble urokinase plasminogen activator receptor(su PAR)as a predictor of incident atrial fibrillation[J].J Atr Fibrillation,2018,10(6):1801.
[18]Muresan L,Petcu A,Muresan C,et al.The role of NT-proBNPin the diagnosis of ventricular arrhythmias in patients with systemic sclerosis[J].Iran J Public Health,2017,46(7):906-916.
[19]Svennberg E,Lindahl B,Berglund L,et al.NT-proBNP is a powerful predictor for incident atrial fibrillation-validation of a multimarker approach[J].Int J Cardiol,2016,223:74-81.