心房纤颤患者血浆TMAO、BNP及心房内径变化的意义
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摘要
目的观察不同程度心房纤颤(房颤)患者血浆氧化三甲胺(TMAO)、B型利钠肽(BNP)水平与左心房内径(LAD)的变化,并探讨其与房颤病情严重程度的关系。方法选取2016年6月—2018年10月自贡市第一人民医院由心电图或动态心电图确诊为房颤患者160例为房颤组,其中阵发性房颤42例,持续性房颤54例,永久性房颤64例。另取同期体检的无房颤病史的健康者120例为健康对照组。比较2组研究对象血浆TMAO、BNP水平及LAD,并分析三者与房颤严重程度的相关性。结果与健康对照组相比,房颤组患者血浆TMAO、BNP显著增高,LAD显著增大,差异有统计学意义(t=-13.62、-26. 73、-4. 38,P均<0.01)。不同程度房颤患者随病情严重程度加重,TMAO、BNP水平及LAD增高,阵发性房颤亚组<持续性房颤亚组<永久性房颤亚组,差异有统计学意义(F=56. 94、216.32、12.401,P均<0.01)。血浆TMAO、BNP水平与LAD均呈正相关(r/P=0. 658/0. 003、0.679/0. 001)。结论房颤患者TMAO、BNP水平及左心房内径明显升高,并与房颤的严重程度有关。
Objective To observe the changes of plasma trimethylamine oxide(TMAO) and B-type natriuretic peptide(BNP) levels and left atrial diameter(LAD) in patients with different degrees of atrial fibrillation( AF), and to explore their relationship with the severity of AF. Methods One hundred and sixty patients with atrial fibrillation diagnosed by electrocardiogram or dynamic electrocardiogram in the First People's Hospital of Zigong City from June 2016 to October 2018 were selected as atrial fibrillation group, including 42 cases of paroxysmal atrial fibrillation, 54 cases of persistent atrial fibrillation and 64 cases of permanent atrial fibrillation. Another 120 healthy persons without history of atrial fibrillation were selected as healthy control group. The plasma levels of TMAO, BNP and LAD were compared between the two groups, and the correlation between them and the severity of atrial fibrillation was analyzed. Results Compared with healthy controls, plasma TMAO and BNP were significantly increased in patients with atrial fibrillation, and LAD was significantly increased(t=-13. 62, t =-26.73, t=-4.38, P<0.01). Patients with different degrees of atrial fibrillation were aggravated with severity, TMAO,BNP levels and LAD increased, paroxysmal atrial fibrillation group < persistent atrial fibrillation group < permanent atrial fibrillation subgroup, the difference was statistically significant( F = 56. 94, F = 216. 32,F = 12. 401,P <0. 01). Plasma TMAO and BNP levels were positively correlated with LAD(r/P = 0.658/0.003, r/P =0.679/0.001). Conclusion The levels of TMAO, BNP and left atrial diameter were significantly increased in patients with atrial fibrillation, which was related to the severity of atrial fibrillation.
Objective To observe the changes of plasma trimethylamine oxide(TMAO) and B-type natriuretic peptide(BNP) levels and left atrial diameter(LAD) in patients with different degrees of atrial fibrillation( AF), and to explore their relationship with the severity of AF. Methods One hundred and sixty patients with atrial fibrillation diagnosed by electrocardiogram or dynamic electrocardiogram in the First People's Hospital of Zigong City from June 2016 to October 2018 were selected as atrial fibrillation group, including 42 cases of paroxysmal atrial fibrillation, 54 cases of persistent atrial fibrillation and 64 cases of permanent atrial fibrillation. Another 120 healthy persons without history of atrial fibrillation were selected as healthy control group. The plasma levels of TMAO, BNP and LAD were compared between the two groups, and the correlation between them and the severity of atrial fibrillation was analyzed. Results Compared with healthy controls, plasma TMAO and BNP were significantly increased in patients with atrial fibrillation, and LAD was significantly increased(t=-13. 62, t =-26.73, t=-4.38, P<0.01). Patients with different degrees of atrial fibrillation were aggravated with severity, TMAO,BNP levels and LAD increased, paroxysmal atrial fibrillation group < persistent atrial fibrillation group < permanent atrial fibrillation subgroup, the difference was statistically significant( F = 56. 94, F = 216. 32,F = 12. 401,P <0. 01). Plasma TMAO and BNP levels were positively correlated with LAD(r/P = 0.658/0.003, r/P =0.679/0.001). Conclusion The levels of TMAO, BNP and left atrial diameter were significantly increased in patients with atrial fibrillation, which was related to the severity of atrial fibrillation.
引文
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[14]张鹏,张瑞妮,李飞,等.高敏C反应蛋白、脑钠肽及内皮素-1与非瓣膜性心房颤动的相关性[J].心血管康复医学杂志,2018,27(6):650-653. DOI:10.3969/j. issn. 1008-0074.2018.06.09.
[15]Chang KW, Hsu JC, Toomu A, et al. Clinical Applications of Biomarkers in Atrial Fibrillation[J]. Am J Med,2017,130(12):1351-1357. DOI:10.1016/j. amjmed.2017.08.003.
[2]周自强,胡大一,陈捷,等.中国心房颤动现状的流行病学研究[J].中华内科杂志,2004,43(7):491494.DOI:10.3760/j.issn:0578-1426.2004.07.005.
[3] Heianza Y, Ma W, Manson JE, et al. Gut Microbiota Metabolites and Risk of Major Adverse Cardiovascular Disease Events and Death:A Systematic Review and Meta-Analysis of Prospective Studies[J]. J Am Heart Assoc,2017,6(7):e004947. DOI:10. 1161/JAHA. 116.004947.
[4] Zhu W, Gregory JC, Org E, et al. Gut Microbial Metabolite TMAO Enhances Platelet Hyperreactivity and Thrombosis Risk[J]. Cell,2016,165(1):111-124. DOI:10.1016/j.cell.2016.02.011.
[5]王焕辉,王蓓,覃咏梅,等.氧化三甲胺致动脉粥样硬化作用及其防治的研究进展[J].中国动脉硬化杂志,2019,27(2):175-179. DOI:10.3969/j. issn. 1007-3949.2019.02.015.
[6]王少君,庞文跃,任丽,等.急性冠状动脉综合征患者BNP、Hcy及hs-CRP水平与TIMI危险评分的相关性分析[J].疑难病杂志,2018,17(12):1306-1310. DOI:10. 3969/j. issn. 1671-6450.2018.12.003.
[7]曹文斋,钟德超,石兆云,等.参松养心胶囊辅治心房颤动临床疗效及对血清炎性因子水平的影响[J].疑难病杂志,2015,14(4):387-390. DOI:10.3969/j.issn. 1671-6450.2015.04.017.
[8]林明宽,刘浩,何喜民,等.左心房内径与心房颤动的关系[J].中国循证心血管医学杂志,2015,7(3):414415. DOI:10. 3969/j. 1674-4055.2015.03.44.
[9] De Vos CB, Pisters R, Nieuwlaat R, et al. Progression From Paroxysmal to Persistent Atrial Fibrillation:Clinical Correlates and Prognosis[J]. Journal of the American College of Cardiology, 2010, 55(8):725-731. DOI:10.1016/j.jacc. 2009.11.040.
[10] Kirchhof P, Benussi S, Kotecha D, et al. 2016 ESC Guidelines for the Management of Atrial Fibrillation Developed in Collaboration With EACTS[J]. Rev Esp Cardiol(Engl Ed),2017,70(1):50.DOI:10. 1016/j.rec.2016.11.033.
[11] Yu D, Shu XO, Rivera ES, et al. Urinary Levels of Trimethylamine-N-Oxide and Incident Coronary Heart Disease:A Prospective Investigation Among Urban Chinese Adults[J]. J Am Heart Assoc,2019,8(1):e10606. DOI:10.1161/JAHA. 118.010606.
[12] Svingen G, Zuo H, Ueland PM, et al. Increased plasma trimethylamine-N-oxide is associated with incident atrial fibrillation[J]. Int J Cardiol,2018,267:100-106. DOI:10. 1016/j. ijcard. 2018. 04.128.
[13] Yu L, Meng G, Huang B, et al. A potential relationship between gut microbes and atrial fibrillation:Trimethylamine N-oxide, a gut microbe-derived metabolite, facilitates the progression of atrial fibrillation[J]. Int J Cardiol,2018,255:92-98. DOI:10.1016/j. ijcard.2017.11.071.
[14]张鹏,张瑞妮,李飞,等.高敏C反应蛋白、脑钠肽及内皮素-1与非瓣膜性心房颤动的相关性[J].心血管康复医学杂志,2018,27(6):650-653. DOI:10.3969/j. issn. 1008-0074.2018.06.09.
[15]Chang KW, Hsu JC, Toomu A, et al. Clinical Applications of Biomarkers in Atrial Fibrillation[J]. Am J Med,2017,130(12):1351-1357. DOI:10.1016/j. amjmed.2017.08.003.