血清Nrf2、MCPIP1、BRD4水平与心房颤动患者射频消融术后复发的相关性及预测意义OA

Objective To explore the correlation and predictive significance of serum nuclear factor E2-related factor 2(Nrf2),monocyte chemoattractant protein-induced protein 1(MCPIP1),and bromodomain-containing protein 4(BRD4)ex-pression with postoperative recurrence in patients with atrial fibrillation(AF)undergoing radiofrequency ablation(RFA).Methods From July 2023 to July 2024,136 patients with atrial fibrillation(AF)admitted to the Second Department of Car-diovascular Medicine,Beidahuang Group General Hospital were selected as the AF group.According to the recurrence status after radiofrequency ablation(RFA),they were further divided into a recurrence subgroup(n=52)and a non-recurrence sub-group(n=84).Meanwhile,136 healthy individuals who underwent physical examinations at the same hospital during the same period were enrolled as the normal control(NC)group.ELISA method was implemented to detect serum Nrf2,MCPIP1,and BRD4 levels.Multi-factor Logical regression analysis was applied to identify factors related to post-RFA recurrence in AF pa-tients.ROC curve analysis was used to explore the predictive value of serum Nrf2,MCPIP1 and BRD4.DCA was performed to assess the clinical utility of the combined model.Results Compared with the NC group,the AF group had a lower serum Nrf2 level and higher serum MCPIP1 and BRD4 levels(t/P=8.026/＜0.001,t/P=12.905/＜0.001,t/P=12.889/＜0.001).Com-pared with the non-recurrence subgroup,the recurrence subgroup showed a decreased serum Nrf2 level,as well as increased left atrial diameter(LAD),heart rate,and serum levels of MCPIP1 and BRD4(t/P=6.596/＜0.001,t/P=6.705＜0.001,t/P=4.944＜0.001,t/P=8.550＜0.001,t/P=7.507＜0.001).Multivariate analysis revealed that larger LAD,faster heart rate,and higher serum levels of MCPIP1 and BRD4 were risk factors for post-RFA recurrence in AF patients,while higher serum Nrf2 level was a protective factor[odds ratio(95％confidence interval)=1.165(1.055-1.287),1.083(1.023-1.145),4.746(1.765-12.763),4.385(1.681-11.439),0.036(0.005-0.250)].The area under the receiver operating characteristic curve(AUC)of se-rum Nrf2,MCPIP1,BRD4 alone,and their combination for predicting post-RFA recurrence in AF patients was 0.813,0.820,0.819,and 0.921,respectively.Notably,the combined AUC was significantly higher than that of each single indicator(Z/P=2.560/0.010,Z/P=2.300/0.021,Z/P=2.323/0.020).Within the high-risk threshold range of 0.07～0.84,the combined model of serum Nrf2,MCPIP1,and BRD4 levels had a higher net benefit rate in predicting recurrence in AF patients after post-RFA re-currence than their individual predictions.Conclusion In AF patients,serum Nrf2 level is are downregulated,while serum MCPIP1 and BRD4 levels are upregulated.They are closely related to recurrence post-RFA recurrence and can serve as bio-markers for predicting postoperative recurrence in AF patients.