冠状动脉旁路移植术后新发心房颤动的血浆预测因子:倾向性评分匹配研究

doi:10.19723/j.issn.1671-167X.2021.06.022

摘要/Abstract

摘要：

目的:研究术前血浆白细胞介素-1(interleukin-1,IL-1)、IL-6、肿瘤坏死因子-α(tumor necrosis factor-α,TNF-α)、同型半胱氨酸(homocysteine,Hcy)、内皮素-1(endothelin-1,ET-1)水平与冠状动脉旁路移植(coronary artery bypass grafting,CABG)术后新发心房颤动(简称房颤,atrial fibrillation,AF)之间的相关性。方法:选取2017年1月1日至12月30日在北京大学人民医院心脏中心行择期单纯CABG的患者148人,采集患者术前24 h内空腹静脉血,用酶联免疫吸附法检测血浆IL-1、IL-6、TNF-α、Hcy、ET-1的含量,其中术后新发房颤患者39人,以术后是否新发房颤为标准将患者分为房颤组和非房颤组,进行1 ∶1倾向性评分匹配后两组各38人。将匹配后两组患者的5个指标分别进行配对t检验,如果不符合正态分布则进行Wilcoxon符号秩和检验,然后将各指标进行条件Logistic回归分析,探究术前各指标血浆水平与术后新发房颤之间的相关性。结果:经1 ∶1倾向性匹配后,两组均衡可比,匹配后房颤组的IL-1、IL-6、TNF-α、Hcy血浆水平均大于非房颤组[(0.867±0.589) ng/L vs. (0.742±0.262) ng/L,21.55 (6.50, 209.90) ng/L vs. 17.95 (3.60, 86.70) ng/L,20.30 (5.70, 361.00) ng/L vs. 21.50 (7.50, 251.80) ng/L,(0.29±0.11) μmol/L vs. (0.27±0.09) μmol/L],但两组差异均无统计学意义(P=0.165,P=0.891,P=0.817,P=0.285),经条件Logistic回归分析后,上述4个变量均不是CABG术后新发房颤的预测因子。倾向性匹配后,房颤组和非房颤组的ET-1分别为(25.80±6.20) ng/L、(29.10±8.54) ng/L,患者术前较低的血浆ET-1水平与CABG术后新发房颤有统计学相关性(P=0.003),条件Logistic回归分析也显示术前血浆ET-1水平与CABG术后新发房颤有相关性(P=0.039,调整后OR=0.637,95%CI: 0.415~0.977)。结论:CABG术后新发房颤患者的术前血浆IL-1、IL-6、TNF-α及Hcy的水平均高于术后无房颤的患者,但差异无统计学意义,术前血浆低ET-1水平与CABG术后新发房颤有关。

关键词: 冠状动脉疾病, 冠状动脉分流术, 心房颤动, 危险因素

Abstract:

Objective: To study the relationship between preoperative plasma interleukin-1 (IL-1), interleukin-6 (IL-6), tumor necrosis factor-α (TNF-α), homocysteine (Hcy), endothelin-1 (ET-1) levels and new-onset atrial fibrillation (AF) after coronary artery bypass grafting (CABG). Methods: In the study, 148 patients who underwent isolated CABG in Peking University People’s Hospital from January 1, 2017 to December 30, 2017 were enrolled, of whom 39 had new-onset AF. The fasting venous blood was collected within 24 hours before the surgery. The preoperative plasma IL-1, IL-6, TNF-α, Hcy, ET-1 levels were detected by enzyme-linked immunosorbent assay (ELISA). The patients were divided into AF group and non-AF group according to whether new-onset AF occurred after operation. After 1 ∶1 propensity score matching (PSM), 38 people were in each group. The paired sample t-tests were performed on the five factors’ concentrations of the matched AF group and the non-AF group respectively. If the concentration values did not conform to the normal distribution, the Wilcoxon signed rank sum test was performed. Conditional Logistic regression analysis was performed on the concentrations of the five indicators to explore the correlation between preoperative plasma concentrations of IL-1, IL-6, TNF-α, Hcy, ET-1 and postoperative new-onset AF after CABG. Results: After a 1 ∶1 propensity score matching, the AF group was comparable to the non-AF group. The concentrations of IL-1, IL-6, TNF-α, and Hcy in the AF group were higher than those in the non-AF group [(0.867±0.589) ng/L vs. (0.742±0.262) ng/L, 21.55 (6.50, 209.90) ng/L vs. 17.95 (3.60, 86.70) ng/L, 20.30 (5.70, 361.00) ng/L vs. 21.50 (7.50, 251.80) ng/L, (0.29±0.11) μmol/L vs. (0.27±0.09) μmol/L], but the differences were not statistically significant (P=0.165, P=0.891, P=0.817, P=0.285). After the conditional Logistic regression analysis, the above four variables were not predictors of new-onset AF after CABG. The concentrations of ET-1 in the matched AF group and non-AF group were (25.80±6.20) ng/L and (29.10±8.54) ng/L, respectively. The correlation between preoperative low plasma ET-1 concentration and the new-onset AF after CABG were statistically significant (P=0.003). After conditional Logistic regression analysis, preoperative plasma ET-1 concentration was correlated with postoperative new-onset AF after CABG (P=0.039, adjusted OR=0.637, 95%CI: 0.415-0.977). Conclusion: The levels of preoperative plasma IL-1, IL-6, TNF-α and Hcy in the patients with new-onset AF after CABG were higher than those in the patients without AF, but the difference was not statistically significant. Preoperative plasma low ET-1 concentration was statistically associated with new-onset AF after CABG.

Key words: Coronary artery disease, Coronary artery bypass, Atrial fibrillation, Risk factors

中图分类号:

R541.75

许昊,张国栋,范桄溥,陈彧. 冠状动脉旁路移植术后新发心房颤动的血浆预测因子:倾向性评分匹配研究[J]. 北京大学学报（医学版）, 2021, 53(6): 1139-1143.

XU Hao,ZHANG Guo-dong,FAN Guang-pu,CHEN Yu. Preoperative plasma predictive factors of new-onset atrial fibrillation after coronary artery bypass graft surgery: A propensity score matching study[J]. Journal of Peking University (Health Sciences), 2021, 53(6): 1139-1143.

图/表 3

表1

倾向性评分未匹配和匹配后两组患者的基线资料"

Items	Before matched			After matched
Items	AF group (n=39)	non-AF group (n=109)	P	AF group (n=38)	non-AF group (n=38)	P
Age/years	63.10±8.52	63.50±9.52	0.800	62.68±8.61	62.86±10.99	0.363
Male	27 (69.2)	80 (73.4)	0.618	27 (71.1)	29 (76.3)	0.602
Body mass index/(kg/m²)	26.79±4.44	25.10±4.16	0.034	26.03±4.54	25.75±5.32	0.816
Smoking	21 (53.8)	49 (45.0)	0.340	18 (47.4)	17 (44.7)	0.818
Diabetes mellitus	18 (46.2)	31 (28.4)	0.044	16 (42.1)	11 (28.9)	0.231
Hypertension	27 (69.2)	63 (57.8)	0.209	27 (71.1)	25 (65.8)	0.622
Hyperlipidemia	4 (10.3)	10 (9.2)	0.843	4 (10.5)	5 (13.2)	>0.999
Left atrium diameter/mm	38.00±5.48	38.21±5.19	0.812	38.79±6.00	38.04±4.19	0.530
LVEF/%	60.75±14.33	61.04±12.84	0.910	61.20±8.99	62.21±11.21	0.725
NYHA class			0.332			0.602
Ⅰ	0 (0)	1 (0.9)		0 (0)	0 (0)
Ⅱ	30 (76.9)	91 (83.5)		27 (71.1)	29 (76.3)
Ⅲ	9 (23.1)	15 (13.8)		11 (28.9)	9 (23.7)
Ⅳ	0 (0)	2 (1.8)		0 (0)	0 (0)
Prior cardiac surgery/PCI	6 (15.4)	16 (14.7)	0.915	6 (15.8)	8 (21.1)	0.554
Preoperative laboratory parameters
Creatinine/(μmol/L)	69.0 (46.0, 214.0)	69.5 (38.0, 173.0)	0.029	72.0 (46.0, 214.0)	66.5 (42.0, 173.0)	0.939
Total cholesterol/(mmol/L)	4.05±1.45	3.85±1.17	0.379	4.05±1.46	4.00±1.00	0.872
LDL/(mmol/L)	2.18 (1.17, 6.00)	2.40 (0.64, 6.51)	0.237	2.45 (1.00, 6.00)	2.09 (1.00, 4.00)	0.858
Blood glucose/(mmol/L)	6.22 (4.23, 13.20)	5.48 (3.79, 14.71)	0.337	5.76 (4.00, 11.00)	5.50 (4.00, 13.00)	0.534
Cardiopulmonary bypass			0.935			0.798
On-pump	11 (28.2)	30 (27.5)		11 (28.9)	10 (26.3)
Off-pump	28 (71.8)	79 (72.5)		27 (71.1)	28 (73.7)
IABP	3 (7.7)	5 (4.6)	0.746	1 (2.6)	3 (7.9)	0.607
Blood transfusion	20 (51.3)	50 (45.9)	0.561	17 (44.7)	19 (50.0)	0.646
Ventilation time	13 (5, 283)	12 (3, 253)	0.794	12 (5, 250)	10 (5, 222)	0.392
Re-intubation	1 (2.6)	1 (0.9)	0.459	0 (0)	0 (0)	>0.999
ICU time/h	23 (7, 293)	20 (6, 288)	0.088	21 (7, 271)	23 (8, 263)	0.564
Preoperative medication
Nitroglycerin	35 (89.7)	98 (89.9)	>0.999	35 (92.1)	34 (89.5)	>0.999
Catecholamine	0 (0)	0 (0)	>0.999	0 (0)	0 (0)	>0.999
Beta-blocker	36 (92.3)	103 (94.5)	0.920	36 (94.7)	35 (92.1)	>0.999
ACEI/ARB	8 (20.5)	17 (15.6)	0.482	8 (21.1)	8 (21.1)	>0.999
Statin	37 (94.9)	109 (100.0)	0.116	37 (97.4)	38 (100.0)	>0.999
Asprin	37 (94.9)	98 (89.9)	0.542	36 (94.7)	33 (86.8)	0.428
Clopidogrel	4 (10.3)	10 (9.2)	>0.999	2 (5.3)	4 (10.5)	0.671
Ticagrelor	0 (0)	0 (0)	>0.999	0 (0)	0 (0)	>0.999
Postoperative medication
Catecholamine	37 (94.9)	105 (96.3)	>0.999	36 (94.7)	36 (94.7)	>0.999
Nitroglycerin	37 (94.9)	104 (95.4)	>0.999	36 (94.7)	38 (100.0)	0.474
Beta-blocker	38 (25.6)	109 (100.0)	0.590	37 (97.4)	38 (100.0)	>0.999
ACEI/ARB	10 (7.7)	16 (14.7)	0.194	8 (21.1)	8 (21.1)	>0.999
Statin	38 (97.4)	106 (97.2)	>0.999	37 (97.4)	36 (94.7)	>0.999
Asprin	38 (97.4)	107 (98.2)	>0.999	37 (97.4)	38 (100.0)	>0.999
Clopidogrel	9 (23.1)	24 (22.0)	0.892	6 (15.8)	6 (15.8)	>0.999
Ticagrelor	0 (0)	0 (0)	>0.999	0 (0)	0 (0)	>0.999

表1

表2

表3

参考文献 12

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Items	P	Adjusted OR	95%CI
IL-1	0.573	2.131	0.153-29.612
IL-6	0.366	0.978	0.933-1.026
TNF-α	0.131	1.026	0.992-1.061
Hcy	0.413	4.333	0.111-168.320
ET-1	0.039	0.637	0.415-0.977

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