血清乙酰肝素酶、三甲胺N-氧化物与非瓣膜性房颤患者左心耳血栓形成的关系及预测效能OA
Relationship and predictive value of serum heparanase and trimethylamine N-oxide in left atrial appendage thrombosis among patients with non-valvular atrial fibrillation
目的 探讨血清乙酰肝素酶(HPA)、三甲胺N-氧化物(TMAO)与非瓣膜性房颤(NVAF)患者左心耳血栓(LAAT)形成的关系及其预测效能.方法 选取NVAF患者297例为NVAF组,另选取同期体检健康者123例为对照组.采用酶联免疫吸附法检测血清HPA、TMAO水平.根据经食管超声心动图判断是否有LAAT形成,将NVAF患者分为LAAT组和非LAAT组.分析NVAF患者LAAT形成的影响因素及血清HPA、TMAO水平的预测效能.结果 NVAF组血清HPA、TMAO水平高于对照组,差异有统计学意义(P＜0.001).LAAT组(n=98)与非LAAT组(n=199)的年龄、心力衰竭比例、持续性NVAF比例、CHA2DS2-VASc评分、左心房内径(LAD)、N末端B型脑钠肽原(NT-proBNP)比较,差异有统计学意义(P＜0.05);LAAT组的HPA、TMAO水平高于非LAAT组,差异有统计学意义(P＜0.001).多因素Logistic回归分析结果显示,年龄增加(OR=1.039,95％CI:1.002～1.078,P=0.038)、持续性 NVAF(OR=4.564,95％CI:2.004～10.399,P＜0.001)、CHA2DS2-VASc 评分增加(OR=2.135,95％CI:1.534～2.970,P＜0.001)、LAD 增加(OR=1.160,95％CI:1.070～1.259,P＜0.001)、HPA 升高(OR=1.177,95％CI:1.109～1.248,P＜0.001)、TMA O 升高(OR=2.455,95％CI:1.733～3.477,P＜0.001)为NVAF患者LAAT形成的独立危险因素.血清HPA、TMAO水平联合预测NVAF患者LAAT形成的受试者工作特征(ROC)曲线的曲线下面积为0.870,高于单独预测的0.767、0.799(P＜0.001).结论 血清HPA、TMAO水平升高为NVAF患者LAAT形成的独立危险因素.HPA、TMAO水平联合预测LAAT形成的效能较高,其有望成为NVAF患者LAAT形成的新辅助预测指标.
Objective To investigate the correlations of serum heparanase(HPA)and trimeth-ylamine N-oxide(TMAO)with left atrial appendage thrombosis(LAAT)formation in patients with non-valvular atrial fibrillation(NVAF),and to evaluate their predictive efficacy.Methods A total of 297 NVAF patients were enrolled as NVAF group,and 123 age-matched healthy subjects undergo-ing routine physical examinations during the same period were enrolled as control group.Serum HPA and TMAO levels were measured by enzyme-linked immunosorbent assay(ELISA).Transesophageal echocardiography was performed to determine the presence of LAAT,and NVAF patients were classi-fied into LAAT group and non-LAAT group.The influencing factors for LAAT formation in NVAF pa-tients and the predictive value of serum HPA and TMAO levels were analyzed.Results Serum HPA and TMAO levels in the NVAF group were significantly higher than those in the control group(P＜0.001).Significant differences were observed between the LAAT group(n=98)and non-LAAT group(n=199)in age,proportion of heart failure,proportion of persistent NVAF,CHA2DS2-VASc score,left atrial diameter(LAD)and N-terminal pro-B-type natriuretic peptide(NT-proBNP)(P＜0.05).Serum HPA and TMAO levels in the LAAT group were significantly higher than those in the non-LAAT group(P＜0.001).Multivariate logistic regression analysis revealed that increas-ing age(OR=1.039,95％CI:1.002 to 1.078,P=0.038),persistent NVAF(OR=4.564,95％CI:2.004 to 10.399,P＜0.001),higher CHA2DS2-VASc score(OR=2.135,95％CI:1.534 to 2.970,P＜0.001),increased LAD(OR=1.160,95％CI:1.070 to 1.259,P＜0.001),elevated HPA(OR=1.177,95％CI:1.109 to 1.248,P＜0.001)and elevated TMAO(OR=2.455,95％CI:1.733 to 3.477,P＜0.001)were independent risk factors for LAAT for-mation in NVAF patients.The area under the receiver operating characteristic(ROC)curve for the combined prediction of LAAT formation by serum HPA and TMAO levels was 0.870,which was sig-nificantly higher than that of HPA alone(0.767)or TMAO alone(0.799)(P＜0.001).Conclu-sion Elevated serum HPA and TMAO levels are independent risk factors for LAAT formation in NVAF patients.The combined prediction of HPA and TMAO levels demonstrates high efficacy and serve as novel auxiliary predictive biomarker for LAAT formation in NVAF patients.
田韵;何河;龚杰
银川市第一人民医院心血管内科,宁夏银川,750001联勤保障部队第942医院特诊科,宁夏银川,750001银川市第一人民医院心血管内科,宁夏银川,750001
医药卫生
非瓣膜性房颤乙酰肝素酶三甲胺N-氧化物左心耳血栓左心房内径影响因素预测效能受试者工作特征曲线
non-valvular atrial fibrillationheparanasetrimethylamine N-oxideleft atrial ap-pendage thrombosisleft atrial diameterinfluencing factorspredictive valuereceiver operating characteristic curve
《实用临床医药杂志》 2026 (10)
51-57,7
宁夏回族自治区卫生健康委科研项目(2023-NWKYP-053)
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