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血清sST2、FGF-23、GDF-15对阵发性房颤的预测价值探讨
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Abstract:
目的：检测阵发性心房颤动(Paroxysmal Atrial Fibrillation, PAF)患者与非心房颤动(Atrial Fibrillation, AF)患者血清可溶性生长刺激基因表达蛋白2 (Soluble Growth Stimulating Gene Expression Protein 2, sST2)、成纤维细胞生长因子-23 (Fibroblast Gowth Factor-23, FGF-23)、人生长分化因子15 (Growth differentiation factor 15, GDF-15)水平，探讨此三个因子对PAF的预测价值。方法：选取符合入排标准的PAF患者61例作为观察组，非AF患者61例作为对照组。应用酶联吸附免疫实验法(Enzyme linked immunosorbent assay, ELISA)测定两组患者血清sST2、FGF-23、GDF-15的浓度。比较两组患者的临床资料、血液学检测指标。采用Spearman相关性分析sST2、FGF-23、GDF-15与炎症指标及其与超声心动图各参数的相关性。采用单因素及多因素logistic回归分析PAF发生的相关因素。结果：与非AF组比较，PAF组血清sST2、FGF-23、GDF-15水平均明显升高(P < 0.05)。Spearman相关性分析显示，血清sST2与FGF-23呈正相关(r = 0.219, P = 0.015)，sST2与GDF-15呈正相关(r = 0.211, P = 0.020)，FGF-23与GDF-15呈正相关(r = 0.198, P = 0.028)。sST2与中性粒细胞呈正相关(r = 0.268, P = 0.003)、与NLR呈正相关(r = 0.265, P = 0.003)，与白细胞、淋巴细胞无显著相关性；FGF-23、GDF-15与炎症指标均无显著相关性。sST2、FGF-23、GDF-15均与超声心动图各参数无显著相关性。单因素logistic回归分析显示，年龄、心率、舒张压、左房前后径、右房长径、右房横径、sST2、FGF-23、GDF-15、谷丙转氨酶、总胆红素、直接胆红素、肌酐、肾小球滤过率、高密度脂蛋白胆固醇(P < 0.05)是PAF的危险因素。多因素logistic回归分析显示，年龄(OR = 1.197, 95%CI 1.066~1.343, P = 0.002)、FGF-23 (OR = 1.006, 95%CI 1.002~1.011, P = 0.009)、GDF-15 (OR = 1.003, 95%CI 1.001~1.005, P < 0.001)、高密度脂蛋白胆固醇(OR = 19.136, 95%CI 1.050~348.601, P = 0.046)是PAF的独立危险因素。结论：1) PAF组血清sST2、FGF-23、GDF-15水平较非AF组明显升高，多因素logistic回归分析显示FGF-23、GDF-15是PAF的独立危险因素。2) 血清sST2、FGF-23、GDF-15浓度两两呈正相关性，sST2与中性粒细胞、NLR呈正相关性，提示炎症反应参与了PAF的发生发展。3) 血清sST2、FGF-23、GDF-15水平均与超声心动图参数无显著相关性，其与房颤发生的相关性可能独立于心脏结构改变之外。
Objective: To detect the levels of serum sST2, FGF-23 and GDF-15 in patients with PAF and without AF, and investigate the predictive value of these three factors on PAF. Methods: 61 patients with PAF who met the inclusion criteria were selected as the observation group, and 61 patients without AF were selected as the control group. Serum levels of sST2, FGF-23 and GDF-15 were determined by ELISA. The clinical data and hematological indicators of the two groups were compared. Spearman correlation analysis was used to analyze the correlation between sST2, FGF-23, GDF-15 and inflammatory indicators and echocardiographic parameters. The factors related to the occurrence of PAF were analyzed by univariate and multivariate logistic regression. Results: Compared with non-AF group, serum levels of sST2, FGF-23 and GDF-15 in PAF group were significantly increased (P < 0.05). Spearman correlation analysis showed that serum sST2 was positively correlated
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