血清超敏C反應蛋白、白介素6、腫瘤壞死因子α水平與持續性心房顫動并肺部感染患者左心房結構改變的關系研究

唐建琴

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·論著·

血清超敏C反應蛋白、白介素6、腫瘤壞死因子α水平與持續性心房顫動并肺部感染患者左心房結構改變的關系研究

唐建琴

目的 分析血清超敏C反應蛋白(hs-CRP)、白介素6(IL-6)、腫瘤壞死因子α(TNF-α)水平與持續性心房顫動并肺部感染患者左心房結構改變的關系。方法 選取2014年6月—2015年6月成都市郫縣中醫醫院內一科收治的持續性心房顫動患者150例作為房顫組，根據有無肺部感染分為肺部感染組54例，無肺部感染組96例；根據左心房內徑(LAD)分為LAD>40 mm組92例和LAD≤40 mm組58例。選取同期在本院門診體檢的竇性心律者50例作為對照組。比較對照組與觀察組受試者血清hs-CRP、IL-6、TNF-α水平及左心房結構指標〔LAD、左心房后壁背向散射積分(IBS)及背向散射積分周期變化值(CVIB)〕，比較肺部感染組與無肺部感染組患者血清hs-CRP、IL-6、TNF-α水平及左心房結構指標，比較LAD>40 mm組與LAD≤40 mm組患者血清hs-CRP、IL-6、TNF-α水平。結果 房顫組患者血清hs-CRP、IL-6、TNF-α水平及IBS高于對照組，LAD大于對照組，CVIB低于對照組(P<0.05)。肺部感染組患者血清hs-CRP、IL-6、TNF-α水平高于無肺部感染組(P<0.05)；兩組患者LAD、IBS、CVIB比較，差異無統計學意義(P>0.05)。LAD>40 mm組患者血清hs-CRP、IL-6、TNF-α水平高于LAD≤40 mm組(P<0.05)。結論 持續性心房顫動并肺部感染患者血清hs-CRP、IL-6、TNF-α水平升高，左心房增大并伴有心肌纖維化，hs-CRP、IL-6、TNF-α可能參與左心房結構改變過程。

心房顫動；肺部感染；炎性因子；左心房

唐建琴.血清超敏C反應蛋白、白介素6、腫瘤壞死因子α水平與持續性心房顫動并肺部感染患者左心房結構改變的關系研究[J].實用心腦肺血管病雜志，2016，24(10)：15-18.[www.syxnf.net]

TANG J Q.Correlations between serum levels of hs-CRP，IL-6 and TNF-α and left atrium structure change of persistent atrial fibrillation patients complicated with pulmonary infection[J].Practical Journal of Cardiac Cerebral Pneumal and Vascular Disease，2016，24(10)：15-18.

心房顫動(atrial fibrillation)是心律失常的常見類型之一，老年人多發病及常見病，隨著年齡增長其發病率呈升高趨勢。冠心病是引發心房顫動的最常見疾病[1-2]，部分冠心病患者甚至出現持續性心房顫動，同時易并發肺部感染[3-4]。臨床研究顯示，炎性因子所致的炎性反應可能參與心房顫動的發生過程，且肺部感染患者多種血清炎性因子水平出現異常升高[5-8]。本研究旨在分析血清超敏C反應蛋白(hs-CRP)、白介素6(IL-6)、腫瘤壞死因子α(TNF-α)水平與持續性心房顫動并肺部感染患者左心房結構改變的關系，并試著闡述炎性因子在持續性心房顫動并肺部感染患者左心房結構改變中的作用機制。

1 資料與方法

1.1 一般資料 選取2014年6月—2015年6月成都市郫縣中醫醫院內一科收治的持續性心房顫動患者150例作為房顫組，根據有無肺部感染分為肺部感染組54例，無肺部感染組96例；根據左心房內徑(LAD)分為LAD>40 mm組92例和LAD≤40 mm組58例。納入標準：(1)結合病史及心電圖檢查等確診為心房顫動，持續時間>7 d，符合持續性心房顫動診斷標準；(2)在納入研究前未進行系統治療；(3)停用抗心律失常藥物超過2個t1/2。排除標準：(1)合并除肺部感染之外其他急慢性感染性疾病者；(2)急性心肌炎等可逆性病因所致心房顫動者；(3)有心臟手術史者；(4)其他疾病終末期者；(5)近1個月內有免疫抑制劑等抗炎藥物治療史者；(6)合并惡性腫瘤、免疫系統疾病及組織損傷性疾病者。選取同期在本院門診體檢的竇性心律者50例作為對照組，排除標準同房顫組。兩組受試者性別、年齡、基礎疾病及吸煙史陽性率比較，差異均無統計學意義(P>0.05，見表1)，具有可比性。

1.2 方法

1.2.1 hs-CRP、IL-6、TNF-α檢測方法 房顫組患者入院后第1天、對照組受試者體檢當天均抽取空腹外周靜脈血5 ml，靜置4 h后3 000 r/min離心30 min，留取血清。采用免疫比濁法檢測血清hs-CRP水平，采用雙抗體酶聯免疫吸附法檢測血清IL-6、TNF-α水平，試劑盒均購自深圳晶美生物科技公司。

1.2.2 左心房結構指標測定方法 采用HP5500彩色多普勒超聲診斷儀(飛利浦公司生產)測定兩組受試者LAD，探頭頻率為2～4 MHz；測定左心房后壁背向散射積分(IBS)及背向散射積分周期變化值(CVIB)。

1.3 觀察指標 比較對照組與房顫組受試者血清hs-CRP、IL-6、TNF-α水平及左心房結構指標(LAD、IBS、CVIB)，比較肺部感染組與無肺部感染組患者血清hs-CRP、IL-6、TNF-α水平及左心房結構指標，比較LAD>40 mm組與LAD≤40 mm組患者血清hs-CRP、IL-6、TNF-α水平。

2 結果

2.1 對照組與房顫組受試者血清hs-CRP、IL-6、TNF-α水平及左心房結構指標比較 房顫組患者血清hs-CRP、IL-6、TNF-α水平及IBS高于對照組，LAD大于對照組，CVIB低于對照組，差異有統計學意義(P<0.05，見表2)。

2.2 肺部感染組與無肺部感染組患者血清hs-CRP、IL-6、TNF-α水平及左心房結構指標比較 肺部感染組患者血清hs-CRP、IL-6、TNF-α水平高于無肺部感染組，差異有統計學意義(P<0.05)；兩組患者LAD、IBS、CVIB比較，差異無統計學意義(P>0.05，見表3)。

2.3 LAD>40 mm組與LAD≤40 mm組患者血清hs-CRP、IL-6、TNF-α水平比較 LAD>40 mm組患者血清hs-CRP、IL-6、TNF-α水平高于LAD≤40 mm組，差異有統計學意義(P<0.05，見表4)。

表4 LAD>40 mm組與LAD≤40 mm組患者血清hs-CRP、IL-6、TNF-α水平比較

表1 對照組與房顫組受試者一般資料比較〔n(%)〕

表2 對照組與房顫組受試者血清hs-CRP、IL-6、TNF-α水平及左心房結構指標比較

表3 肺部感染組與無肺部感染組患者血清hs-CRP、IL-6、TNF-α水平及左心房結構指標比較

3 討論

血清及血漿中炎性反應標志物一般分為3類，包括急性時相蛋白、可溶性黏附因子和細胞因子，IL-6和TNF-α屬于細胞因子，主要由單核細胞產生；hs-CRP屬于急性時相蛋白，是非特異性炎性標志物，主要由肝細胞合成，由IL-6誘導產生，且其在機體炎癥初期即可在血液中檢測到[9]。IL-6的主要功能是調節機體免疫及代謝過程，其是多種病理過程中的主要遞質，同時還可誘導TNF-α產生。LAD、IBS、CVIB均是與左心房結構變化相關的指標，LAD增大提示左心房增大，IBS和CVIB的變化主要與心肌膠原含量及心肌纖維化程度有關，當心肌出現膠原沉積及纖維化時會導致IBS升高及CVIB降低。

臨床研究顯示，心房顫動是心肌退化和纖維化的結果[5-7]，且炎性反應可參與心房顫動的整個發病過程。冠心病的病理基礎是冠狀動脈粥樣硬化，而在動脈粥樣硬化斑塊中一直存在無菌性炎性反應，可表現為hs-CRP、IL-6、TNF-α等炎性因子異常表達[10-12]。肺部感染以細菌感染多見，肺組織中大量中性粒細胞、單核巨噬細胞浸潤可引起局部炎性因子大量釋放，從而激活補體系統及免疫過程。心房顫動和肺部感染均可導致炎性因子異常表達，但炎性反應是否對心房顫動并肺部感染患者左心房結構產生影響目前研究報道較少。本研究結果顯示，房顫組患者血清hs-CRP、IL-6、TNF-α水平及IBS高于對照組，LAD大于對照組，CVIB低于對照組，提示心房顫動患者存在炎性反應、左心房增大、心肌纖維化等；亞組分析結果顯示，肺部感染組患者血清hs-CRP、IL-6、TNF-α水平高于無肺部感染組，兩組患者LAD、IBS、CVIB間無差異，提示合并肺部感染的心房顫動患者機體內炎性反應過程可表現為急性反應，但肺部感染對左心房結構無影響，提示長期慢性炎性反應可能對左心房結構產生影響，但急性炎性反應對左心房結構影響輕微；進一步比較LAD>40 mm組與LAD≤40 mm組患者血清炎性因子水平發現，LAD>40 mm組患者血清hs-CRP、IL-6、TNF-α水平高于LAD≤40 mm組，推測炎性反應可能參與持續性心房顫動并肺部感染患者左心房結構改變過程。

綜上所述，持續性心房顫動并肺部感染患者血清hs-CRP、IL-6、TNF-α水平升高，左心房增大并伴有心肌纖維化，hs-CRP、IL-6、TNF-α可能參與左心房結構改變過程。

本文無利益沖突。

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(本文編輯：謝武英)

Correlations between Serum Levels of hs-CRP，IL-6 and TNF-α and Left Atrium Structure Change of Persistent Atrial Fibrillation Patients Complicated with Pulmonary Infection

TANGJian-qin.TheFirstDepartmentofInternalMedicine，theTraditionalChineseMedicineHospitalofPiCounty，Chengdu，Chengdu611730，China

Objective To analyze the correlations between serum levels of hs-CRP，IL-6 and TNF-α and left atrium structure change of persistent atrial fibrillation patients complicated with pulmonary infection.Methods From June 2014 to June 2015，a total of 150 patients with persistent atrial fibrillation were selected as case group in the First Department of Internal Medicine，the Traditional Chinese Medicine Hospital of Pi County，Chengdu，and they were divided into A1 group(complicated with pulmonary infection，n=54)and A2 group(did not complicate with pulmonary infection，n=96)according to the incidence of pulmonary infection，into B1 group(with LAD over 40 mm)and B2 group(with LAD equal or less than 40 mm)according to the LAD；and a total of 50 people with sinus rhythm who admitted to this hospital for physical examination were selected as control group at the same time.Serum levels of hs-CRP，IL-6 and TNF-α and left atrial structural parameters〔including LAD，integrated backscatter of left atrium posterior wall(IBS)and periodic change value of integrated backscatter(CVIB)〕 were compared between control group and case group，between A1 group and A2 group；meanwhile serum levels of hs-CRP，IL-6 and TNF-α were compared between B1 group and B2 group.Results Serum levels of hs-CRP，IL-6 and TNF-α，and IBS of case group were statistically significantly higher than those of control group，LAD of case group was statistically significantly larger than that of control group，while CVIB of case group was statistically significantly lower than that of control group(P<0.05).Serum levels of hs-CRP，IL-6 and TNF-α of A1 group were statistically significantly higher than those of control group(P<0.05)；no statistically significant differences of LAD，IBS or CVIB was found between A1 group and A2 group(P>0.05).Serum levels of hs-CRP，IL-6 and TNF-α of B1 group were statistically significantly higher than those of B2 group(P<0.05).Conclusion Serum levels of hs-CRP，IL-6 and TNF-α of persistent atrial fibrillation patients complicated with pulmonary infection are significantly elevated，existing left atrial enlargement and myocardial fibrosis，hs-CRP，IL-6 and TNF-α may play important roles in the change of left atrium structure.

Atrial fibrillation；Pulmonary infection；Inflammatory factor；Left atrium

611730四川省成都市郫縣中醫醫院內一科

R 541.75

A

10.3969/j.issn.1008-5971.2016.10.005

2016-07-15；

2016-10-13)