阵发性心房颤动患者血清炎性因子水平及其来源

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.

The level and source of inflammatory factors in patients with paroxysmal atrial fibrillation

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.