【摘要】 目的 探讨行射频消融术治疗的心房颤动患者血清N-乙酰神经氨酸(Neu5Ac)、硫酸吲哚酚(IS)与炎症标志物、心房纤维化标志物、心肌损伤标志物的相关性及其与术后复发的关系。方法 将2020年2月至2021年5月于大庆龙南医院行射频消融术治疗的AF患者156例纳入研究作为AF组。另外，选取100例同期体检健康者作为对照组。检测并比较两组血清Neu5Ac、IS、炎症标志物[超敏C反应蛋白(hs-CRP)、白细胞介素6(IL-6)]、心房纤维化标志物[Ⅰ型胶原羧基端前肽(PⅠCP)、Ⅲ型胶原前多肽(PⅢNP)、基质金属蛋白酶-1(MMP-1)、组织型基质金属蛋白酶抑制因子-1(TIMP-1)、透明质酸(HA)、层黏连蛋白(LN)]及心肌损伤标志物[肌红蛋白(MYO)、心肌肌钙蛋白I(cTnI)、肌酸激酶同工酶(CK-MB)]水平。采用Pearson相关分析血清Neu5Ac、IS与炎症标志物、心房纤维化标志物及心肌损伤标志物水平的相关性。术后对AF患者进行随访，根据1年内的复发情况将纳入研究的患者分为复发组和未复发组，比较两组临床资料及各项标志物。采用多因素Logistic回归分析AF患者射频消融术后复发的危险因素。结果 AF组血清Neu5Ac、IS水平高于对照组(P<0.05)。AF组血清hs-CRP、IL-6、PⅠCP、PⅢNP、MMP-1、TIMP-1、HA、LN、MYO、cTnI、CK-MB水平高于对照组(P<0.05)。Pearson相关分析显示：血清Neu5Ac、IS与hs-CRP、IL-6、PⅠCP、PⅢNP、MMP-1、TIMP-1、HA、LN、MYO、cTnI、CK-MB水平均呈正相关(P<0.05)。随访结果显示：患者术后复发42例，复发率为26.92%(42/156)。复发组与未复发组病程、AF类型、QRS时限(QRSd)值、左房内径、左室射血分数、左房容积指数及血清Neu5Ac、IS、hs-CRP、IL-6、PⅠCP、PⅢNP、MMP-1、TIMP-1、HA、LN、MYO、cTnI、CK-MB水平比较差异有统计学意义(P<0.05)。多因素Logistic回归分析显示：血清Neu5Ac、IS、hs-CRP、IL-6、PⅠCP、MMP-1、HA、MYO、cTnI、CK-MB水平升高均为AF患者术后复发的危险因素(P<0.05)。结论 行射频消融术治疗的AF患者血清Neu5Ac、IS水平升高，与炎症标志物、心房纤维化及心肌损伤标志物水平呈正相关，是患者术后复发的危险因素。更多还原

【Abstract】 Objective To investigate the correlation of serum N-acetylneuraminic acid(Neu5Ac) and indoxyl sulfate(IS) with inflammatory, atrial fibrosis, myocardial injury markers and their relationship with postoperative recurrence in patients with atrial fibrillation(AF) treated with radiofrequency ablation.Methods A total of 156 AF patients who underwent radiofrequency ablation in Daqing Longnan Hospital from February 2020 to May 2021 were enrolled in the study as the AF group.In addition, 100 healthy people were enrolled as the control group.Serum Neu5Ac, IS, inflammatory markers [hypersensitive C-reactive protein(hs-CRP),interleukin 6(IL-6)],atrial fibrosis markers [type Ⅰ procollagen carboxyl-terminal peptide(PⅠCP),type Ⅲ procollagen amino-terminal peptide(PⅢNP),matrix metalloproteinase-1(MMP-1),tissue matrix metalloproteinase-1(TIMP-1),hyaluronic acid(HA),laminin(LN)] and myocardial injury markers [myoglobin(MYO),cardiac troponin I(cTn I),creatine kinase isoenzyme(CK-MB)] were detected and compared between the two groups.Pearson correlation was used to analyze the correlation between the levels of serum Neu5Ac and IS and the levels of inflammatory, atrial fibrosis and myocardial injury markers.AF patients were followed up after surgery, and patients included in the study were divided into recurrence and non-recurrence groups according to recurrence within 1 year, and the clinical data and serum indicators of the two groups were compared.Multi-factor Logistic regression was used to analyze the risk factors for recurrence after radiofrequency ablation in AF patients.Results Serum Neu5Ac and IS levels in the AF group were higher than those in the control group(P<0.05).The serum hs-CRP,IL-6,PⅠCP,PⅢNP,MMP-1,TIMP-1,HA,LN,MYO,cTnI and CK-MB levels in the AF group were higher than those in the control group(P<0.05).Pearson correlation analysis showed that serum Neu5Ac and IS were positively correlated with hs-CRP,IL-6,PⅠCP,PⅢNP,MMP-1,TIMP-1,HA,LN,MYO,cTnI and CK-MB levels(P<0.05).The follow-up results showed that 42 patients had recurrence after operation, and the recurrence rate was 26.92%(42/156).There were statistically significant differences in the course of disease, AF type, QRS duration(QRSd),left atrial diameter, left ventricular ejection fraction, left atrial volume index and serum Neu5Ac, IS, hs-CRP,IL-6,PⅠCP,PⅢNP,MMP-1,TIMP-1,HA,LN,MYO,cTnI and CK-MB levels between the recurrence group and the non-recurrence group(P<0.05).Multivariate Logistic regression analysis showed that elevated serum Neu5Ac, IS, hs-CRP,IL-6,PⅠCP,MMP-1,HA,MYO,cTnI and CK-MB levels were risk factors for postoperative recurrence of patients(P<0.05).Conclusion Serum Neu5Ac and IS levels increased in AF patients treated with radiofrequency ablation, which are positively correlated with inflammatory, atrial fibrosis and myocardial injury markers, and are risk factors for postoperative recurrence of AF patients.更多还原