CAJ | 학술논문

目的探讨阵发性心房颤动患者肿瘤坏死因子(TNF)-α、白细胞介素(IL)-6和可溶性肿瘤坏死因子受体1 (sTNFR1)的变化及其可能来源.方法连续采集30例行射频消融术治疗的阵发性心房颤动患者(阵发性心房颤动组)股静脉、高位右房、冠状窦及左房血液样本,酶联免疫吸附法检测血清TNF-α、sTNFR1和IL-6水平,与相同部位采血的20例阵发性室上性心动过速患者(阵发性室上性心动过速组,左侧旁路)进行比较.结果阵发性心房颤动组股静脉、高位右房、冠状窦及左房血清TNF-α和IL-6水平较阵发性室上性心动过速组增高[TNF-α:(4.45±1.76) ng/L比(0.59±0.36) ng/L、(6.67±1.43) ng/L比(0.51±0.30) ng/L、(8.35±2.03) ng/L比(0.85±0.50) ng/L、(9.97±2.70) ng/L比(0.28±0.29) ng/L;IL-6:(2.02±0.87) ng/L比(1.04±0.63) ng/L、(1.51±0.68) ng/L比(0.74±0.26) ng/L、(2.00±0.51)ng/L比(0.88±0.35) ng/L、(1.32±0.47) ng/L比(0.48±0.28) ng/L],差异有统计学意义(P=0.000).阵发性心房颤动组高敏C反应蛋白(hs-CRP)水平高于阵发性室上性心动过速组[(2.41±1.35) mg/L比(1.10±0.53) mg/L,P=0.002].阵发性心房颤动组左房TNF-α水平较其他三个部位增高,差异有统计学意义(P=0.000)；IL-6水平在股静脉和冠状窦增高,与高位右房和左房比较差异有统计学意义(P＜ 0.05); sTNFR1水平在股静脉、高位右房、冠状窦比较差异无统计学意义(P＞0.05),但均高于左房,差异有统计学意义(P＜0.05).各部位血清TNF-α、IL-6水平及肘静脉hs-CRP水平与左房内径(LAD)存在相关性(P＜ 0.01或＜0.05)；左房sTNFR1水平与LAD呈正相关,而右房sTNFR1水平与LAD呈负相关(P＜0.01).结论阵发性心房颤动患者血清hs-CRP、TNF-α及IL-6水平增高,心房颤动患者TNF-α、IL-6水平增高可能来源于心肌分泌,并与左房增大有关.
목적 탐토진발성심방전동환자종류배사인자(TNF)-α、백세포개소(IL)-6화가용성종류배사인자수체1 (sTNFR1)적변화급기가능래원.방법 련속채집30례행사빈소융술치료적진발성심방전동환자(진발성심방전동조)고정맥、고위우방、관상두급좌방혈액양본,매련면역흡부법검측혈청TNF-α、sTNFR1화IL-6수평,여상동부위채혈적20례진발성실상성심동과속환자(진발성실상성심동과속조,좌측방로)진행비교.결과 진발성심방전동조고정맥、고위우방、관상두급좌방혈청TNF-α화IL-6수평교진발성실상성심동과속조증고[TNF-α:(4.45±1.76) ng/L비(0.59±0.36) ng/L、(6.67±1.43) ng/L비(0.51±0.30) ng/L、(8.35±2.03) ng/L비(0.85±0.50) ng/L、(9.97±2.70) ng/L비(0.28±0.29) ng/L;IL-6:(2.02±0.87) ng/L비(1.04±0.63) ng/L、(1.51±0.68) ng/L비(0.74±0.26) ng/L、(2.00±0.51)ng/L비(0.88±0.35) ng/L、(1.32±0.47) ng/L비(0.48±0.28) ng/L],차이유통계학의의(P=0.000).진발성심방전동조고민C반응단백(hs-CRP)수평고우진발성실상성심동과속조[(2.41±1.35) mg/L비(1.10±0.53) mg/L,P=0.002].진발성심방전동조좌방TNF-α수평교기타삼개부위증고,차이유통계학의의(P=0.000)；IL-6수평재고정맥화관상두증고,여고위우방화좌방비교차이유통계학의의(P＜ 0.05); sTNFR1수평재고정맥、고위우방、관상두비교차이무통계학의의(P＞0.05),단균고우좌방,차이유통계학의의(P＜0.05).각부위혈청TNF-α、IL-6수평급주정맥hs-CRP수평여좌방내경(LAD)존재상관성(P＜ 0.01혹＜0.05)；좌방sTNFR1수평여LAD정정상관,이우방sTNFR1수평여LAD정부상관(P＜0.01).결론 진발성심방전동환자혈청hs-CRP、TNF-α급IL-6수평증고,심방전동환자TNF-α、IL-6수평증고가능래원우심기분비,병여좌방증대유관.
Objective To investigate the level and the source of inflammatory factors in patients with paroxysmal atrial fibrillation.Methods Thirty patients with paroxysmal atrial fibrillation were selected as observation group,and 20 cases of patients with paroxysmal supraventricular tachycardia were selected as control group.The blood samples of coronary sinus,right atria,left atria and femoral vein were consecutively collected during the procedure of radiofrequency ablation.The level of tumor necrosis factor (TNF)-α,soluble tumor necrosis factor receptor-1 (sTNFR1),and interleukin(IL)-6 was detected by ELISA separately and compared between two groups.Results The level of TNF-α and IL-6 of coronary sinus,right atria,left atria and femoral vein in observation group was significantly higher than that in control group [TNF-α:(4.45 ± 1.76) ng/L vs.(0.59 ± 0.36) ng/L,(6.67 ± 1.43) ng/L vs.(0.51 ± 0.30) ng/L,(8.35 ± 2.03) ng/L vs.(0.85 ± 0.50) ng/L,(9.97 ± 2.70) ng/L vs.(0.28 ± 0.29) ng/L,P=0.000;IL-6:(2.02 ± 0.87) ng/L vs.(1.04 ± 0.63) ng/L,(1.51 ± 0.68) ng/L vs.(0.74 ± 0.26) ng/L,(2.00 ± 0.51) ng/L vs.(0.88 ± 0.35) ng/L,(1.32 ±0.47) ng/L vs.(0.48 ±0.28) ng/L,P =0.000].The level of high sensitivity C reactive protein (hs-CRP) in observation group was significantly higher than that in control group [(2.41 ± 1.35) mg/L vs.(1.10 ±0.53) mg/L,P =0.002].The level of TNF-αof left atrium in observation group was significantly higher than that of other three sites (P=0.000).The level of IL-6 in the coronary sinus and femoral vein was significantly increased,compared with that in the right atria and left atria (P ＜ 0.05).The level of sTNFR 1 in the femoral vein,right atria and coronary sinus difference was not statistically significant (P ＞ 0.05),but was significantly higher than that in the left atria(P ＜ 0.05).The level of TNF-α,IL-6 and hs-CRP was correlated with the diameter of left atrium (LAD) (P ＜ 0.01 or ＜ 0.05).The level of sTNFR1 in left atria was positively correlated with LAD,and the level of sTNFR1 in right atria was negatively correlated with LAD (P ＜ 0.01).Conclusions The level of TNF-α,IL-6 and hs-CRP is increased in patients with paroxysmal atrial fibrillation.TNF-α and IL-6 may come from the heart and is related with the enlargement of left atrium.