【摘要】：目的:通過探討半乳糖凝集素-3、超敏C反應(yīng)蛋白以及同型半胱氨酸跟左心房容積指數(shù)的相關(guān)性,來研究它們?cè)谧笮姆拷Y(jié)構(gòu)重構(gòu)和房顫發(fā)生發(fā)展過程中作用,進(jìn)一步增進(jìn)對(duì)房顫發(fā)生發(fā)展機(jī)制及危險(xiǎn)因素的認(rèn)識(shí),為臨床房顫的預(yù)防與治療提供更多的思路。方法:選取2013年09月至2014年09月在南昌大學(xué)第二附屬醫(yī)院心血管內(nèi)科住院房顫病人107例(男51例,女56例),年齡(65.2±8.6)歲。其中持續(xù)性房顫(61例),陣發(fā)性房顫(46例)。同時(shí)選取40例基本資料與房顫組相類似的竇性心律者作為對(duì)照組。所有患者入院后收集一般資料,包括:性別、年齡、身高、體重等。入院后次日清晨空腹抽外周血查肝腎功能、血糖、血脂、甲狀腺功能等常規(guī)實(shí)驗(yàn)室檢查,進(jìn)行床邊心電圖、24小時(shí)動(dòng)態(tài)心電圖檢查。心臟彩超檢查記錄左心房?jī)?nèi)徑、左室射血分?jǐn)?shù)等指標(biāo),運(yùn)用心臟彩超測(cè)量并計(jì)算出左心房容積指數(shù)。ELISA法檢測(cè)半乳糖凝集素-3及同型半胱氨酸水平,免疫比濁法檢測(cè)超敏C反應(yīng)蛋白水平。根據(jù)房顫類型分組(持續(xù)性房顫組、陣發(fā)性房顫組)及對(duì)照組進(jìn)行分析,比較三組間半乳糖凝集素-3、同型半胱氨酸、超敏C反應(yīng)蛋白的差異,Pearson分析半乳糖凝集素-3、同型半胱氨酸、超敏C反應(yīng)蛋白水平跟左心房容積指數(shù)的關(guān)系,對(duì)左心房容積指數(shù)行多因素線性回歸分析,對(duì)房顫危險(xiǎn)因素進(jìn)行多因素Logistic回歸分析。結(jié)果:1、持續(xù)性房顫組血清半乳糖凝集素-3水平(1567.1±185.3 pg/ml)顯著高于陣發(fā)性房顫組(1482.5±107.3 pg/ml)及對(duì)照組(1389.4±121.2 pg/ml)(P0.05),且陣發(fā)性房顫組高于對(duì)照組(P0.05);持續(xù)性房顫組超敏C反應(yīng)蛋白水平(3.85±3.01mg/L)顯著高于陣發(fā)性房顫組(2.84±2.21mg/L)及對(duì)照組(1.71±1.40mg/L)(P0.05),且陣發(fā)性房顫組高于對(duì)照組(P0.05);持續(xù)性房顫組同型半胱氨酸水平(12.12±4.40μmol/L)高于陣發(fā)性房顫組(10.31±3.41μmol/L)及對(duì)照組(8.36±2.91μmol/L)(P0.05),且陣發(fā)性房顫組高于對(duì)照組(P0.05);2、持續(xù)性房顫組左心房容積指數(shù)(40.90±7.87ml/m2)顯著大于陣發(fā)性房顫組(35.48±7.20ml/m2)及對(duì)照組(31.39±4.51ml/m2)(P0.05),且陣發(fā)性房顫組大于對(duì)照組(P0.05);Pearson相關(guān)性分析顯示:左心房容積指數(shù)與半乳糖凝集素-3(r=0.618,P0.01)、超敏C反應(yīng)蛋白(r=0.602,P0.01)、同型半胱氨酸(r=0.348,P0.01)呈正相關(guān)。多元線性回歸分析結(jié)果顯示:左心房容積指數(shù)與左房?jī)?nèi)徑、血清半乳糖凝集素-3水平、外周血超敏C反應(yīng)蛋白水平以及心房顫動(dòng)呈線性相關(guān);3、多因素Logistic回歸分析結(jié)果顯示:半乳糖凝集素-3、超敏C反應(yīng)蛋白、年齡及左心房容積指數(shù)是心房顫動(dòng)的發(fā)生的危險(xiǎn)因素。結(jié)論:1、持續(xù)性及陣發(fā)性房顫患者半乳糖凝集素-3、同型半胱氨酸及超敏C反應(yīng)蛋白水平均高于竇性心律者,且持續(xù)性房顫高于陣發(fā)性房顫;2、房顫患者半乳糖凝集素-3及超敏C反應(yīng)蛋白與左心房容積指數(shù)呈線性相關(guān),提示心房纖維化及炎癥反應(yīng)參與了左心房結(jié)構(gòu)重構(gòu),在房顫的發(fā)生、發(fā)展與維持過程中起重要作用;3、房顫患者同型半胱氨酸與左心房容積指數(shù)呈正相關(guān),氧化應(yīng)激可能參與了左心房結(jié)構(gòu)重構(gòu)。
[Abstract]:Objective: To study the correlation between galactose agglutinin -3, hypersensitive C reactive protein and homocysteine and left atrial volume index, to study their role in the remodeling of left atrium and the development of atrial fibrillation, and to further enhance the understanding of the mechanism and risk factors of atrial fibrillation, and to prevent and treat clinical atrial fibrillation. Methods: 107 patients (51 men, 56 women), aged (65.2 + 8.6) years of age (61 cases) and paroxysmal atrial fibrillation (46 cases), were selected from 09 months to 09 months in the Second Affiliated Hospital of Nanchang University from 2013 to 09 months in the Department of cardiovascular medicine, the second Affiliated Hospital of Nanchang University. Control group. All the patients were admitted to the hospital after admission, including sex, age, height, weight and so on. After the next day, the liver and kidney function, blood sugar, blood lipid and thyroid function were examined on the next morning, and the bedside electrocardiogram and 24 hour dynamic electrocardiogram were performed. The left atrium diameter and left ventricular ejection were recorded by echocardiography. The blood fraction and other indexes were measured by echocardiography and the left atrial volume index (.ELISA) was used to detect the level of galactose agglutinin -3 and homocysteine. Immunoturbidimetry was used to detect the level of hypersensitive C reaction protein. The three groups of galactose were compared according to the group of atrial fibrillation type (persistent atrial fibrillation group, paroxysmal atrial fibrillation group) and control group. The difference of lectin -3, homocysteine, hypersensitive C reactive protein, Pearson analysis of the relationship between galactose lectin -3, homocysteine, hypersensitivity C reaction protein and left atrial volume index, multiple factor linear regression analysis of left atrial volume index, multiple factor Logistic regression analysis on risk factors for atrial fibrillation. Results: 1, continuous The level of serum galactoagglutinin -3 (1567.1 + 185.3 pg/ml) in sexual atrial fibrillation group was significantly higher than that in paroxysmal atrial fibrillation group (1482.5 + 107.3 pg/ml) and control group (1389.4 + 121.2 pg/ml) (P0.05), and paroxysmal atrial fibrillation group was higher than that of control group (P0.05). The level of hypersensitive C reverse protein (3.85 + 3.01mg/L) in persistent atrial fibrillation group was significantly higher than that in paroxysmal atrial fibrillation group (2.84 + 2.). 21mg/L) and the control group (1.71 + 1.40mg/L) (P0.05), and paroxysmal atrial fibrillation group was higher than the control group (P0.05); the level of homocysteine in the persistent atrial fibrillation group (12.12 + 4.40 mu mol/L) was higher than that of paroxysmal atrial fibrillation group (10.31 + 3.41 micron mol/L) and control group (8.36 + 2.91 mol/L) (P0.05), and paroxysmal atrial fibrillation group was higher than the control group (P0.05); 2, left atrial fibrillation group left Atrial volume index (40.90 + 7.87ml/m2) was significantly greater than that in paroxysmal atrial fibrillation group (35.48 + 7.20ml/m2) and control group (31.39 + 4.51ml/m2) (P0.05), and paroxysmal atrial fibrillation group was larger than control group (P0.05); Pearson correlation analysis showed that the left atrium volume index and galactose agglutinin -3 (r=0.618, P0.01), hypersensitive C reactive protein (r=0.602, P0.01), homotypic half R=0.348 (P0.01) showed positive correlation. Multivariate linear regression analysis showed that the left atrium volume index was linearly related to the left atrial diameter, serum galactose -3 level, peripheral blood hypersensitivity C reaction protein level and atrial fibrillation; 3, multifactor Logistic regression analysis showed that galactose agglutinin -3, hypersensitive C reactive protein, Age and left atrial volume index were risk factors for atrial fibrillation. Conclusion: 1, the levels of galactose -3, homocysteine and hypersensitivity C reaction protein in patients with persistent and paroxysmal atrial fibrillation are higher than those in sinus rhythm, and persistent atrial fibrillation is higher than paroxysmal atrial fibrillation; 2, atrial fibrillation patients with galactose agglutinin -3 and hypersensitive C reaction eggs There is a linear correlation between white and left atrial volume index, suggesting that atrial fibrosis and inflammatory reactions participate in the remodeling of the left atrium, and play an important role in the occurrence, development and maintenance of atrial fibrillation. 3, the homocysteine of atrial fibrillation is positively correlated with the left atrium volume index, and oxygen stress may be involved in the remodeling of the left atrium.
【學(xué)位授予單位】：南昌大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2015
【分類號(hào)】：R541.75

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