| BackgroundAtrial fibrillation (atrial fibrillation, AF) is a common clinical arrhythmia, along with the growth of the age, its incidence is increasing, because can cause reduced cardiac output, heart rate too fast or too slow, can increase myocardial ischemia, hypoxia and the deterioration of cardiac function, reduces the patient’s exercise tolerance, atrial blood stagnation, can form the left atrial thrombus and systemic embolism complications, the embolic stroke incidence increased significantly, increased patient mortality and morbidity, threatening people’s health. Therefore, the prevention of atrial fibrillation and cardioversion has become the focus of clinical work, has important clinical significance, but because atrial fibrillation and maintenance mechanism is still not clear, we lack effective clinical treatments.in recent years, inflammatory factors and oxidative stress as the study of the pathogenesis of atrial fibrillation has aroused great attention, studies have shown that inflammation and oxidative stress is closely related to the development of atrial fibrillation, and may be associated with myocardial remodeling process.But regarding the correlational high sensitivity c-reactive protein, homocysteine, leukocyte, neutrophil and atrial fibrillation myocardial remodeling and its interaction correlation studies reported in the literature on the degree of atrial fibrillation is various, whether they can predict the degree of risk for atrial fibrillation remains controversial.ObjectiveBy observing the change of atrial fibrillation patients and normal human serum high sensitivity c-reactive protein, homocysteine, white blood cell and neutrophil levels, and with its as observation index, to study their correlation with atrial fibrillation and myocardial remodeling,and to further explore the related factors in the occurrence, development and maintenance of atrial fibrillation the role and clinical significance.MethodsChoose people from2012October to2013October in Shanxi DaYi Hospital Department of Cardiology hospitalized patients with atrial fibrillation and normal healthy as research subjects. The diagnosis based on history, electrocardiogram in patients with atrial fibrillation or dynamic electrocardiogram diagnosed148cases as experimental group, including86cases of male, female62cases, age34-78years old, according to the American college of cardiology/American heart association/European heart association (ACC/AHA/ESC)AF treatment guidelines issued in2006,According to af duration selected cases can be divided into:paroxysmal atrial fibrillation group50patients, the atrial fibrillation time<7d, general<48h, self-cardioversion more for self limited; persistent AF group58cases, the atrial fibrillation time>7days, and<lyear, need electricity or drugs to restore sinus rhythm; permanent AF group40cases of atrial fibrillation, refers to the period of>1years, and after drugs or electrical cardioversion is still unable to maintain sinus rhytnm,or converted to sinus rhythm can’t use drugs to maintain; selected normal control group56cases, age34-72years, mean age (55.07±11.54) years old, were the Shan xi DaYi hospital health examination.any of the following circumstances be excluded to the research object:age>78; With organic heart disease such as coronary heart disease, cardiomyopathy, valvular heart disease, high blood pressure heart disease, congenital heart disease, sick sinus syndrome, rheumatic heart disease, heart function NYHA classification levels Ⅲ or Ⅳ and LVEF<40%of the left ventricular systolic function is not complete; Half a year of surgery and stroke; Infectious diseases; Thyroid function was abnormal; Diseases of the immune system; Secondary atrial fibrillation; Malignant tumor; Important viscera function failure, such as lung function and liver and renal failure. All of the subjects were in the hospital for echocardiography:left atrial diameter (LAd), right atrial diameter (RAd), left ventricular end diastolic diameter (LVEDD), left ventricular ejection fraction (LVEF), the second day morning admission, siphon the venous blood4ml after12h of fasting from peripheral, By the principle of immune chromatography, circulating enzymatic and Kurt’s principle were measured serum high sensitivity c-reactive protein, homocysteine, white blood cell and neutrophil levels, and analyse the correlation across these indexes and atrial fibrillation myocardial remodeling.Results1.In ultrasonic indicators, paroxysmal atrial fibrillation group compared with control group, the left atrium diameter has increased, but there was no statistically significant difference (p>0.05), left atrium diameter in persistent atrial fibrillation group and permanent atrial fibrillation group is greater than the paroxysmal atrial fibrillation group and the control group (p<0.05), left atrium diameter in permanent atrial fibrillation group increased obviously; Compared with the control group, left ventricular ejection fraction of atrial fibrillation group is decreased(P<0.05), left ventricular end-diastolic diameter has no significant difference (P>0.05).At the same time, analyses the RAD, finding that the change is consistent with LAD change.2.In inflammation index,serum hs-CRP, Hcy concentration of the atrial fibrillation group higher than that of control group (P<0.05); serum hs-CRP, Hcy concentration of continuity and permanent atrial fibrillation group higher than that of paroxysmal atrial fibrillation group (P<0.05), serum hs-CRP, Hcy concentration of permanent atrial fibrillation group and persistent atrial fibrillation group has no obvious difference (P>0.05). On the white blood cells and neutrophils count, has no statistical difference between the subgroups (P>0.05),but higher than the control group.3.Correlation analysis showed:The hs-CRP in the circulation of blood and left atrium diameter in patients with atrial fibrillation, right atrial diameter of upper and lower size was positively correlated (hs-CRP and left atrial diameter:r=0.28, P<0.001; hs-CRP and the right size:r=0.37, P<0.001), and negatively correlated with the left ventricular function (r=-0.20, P=0.013). At the same time, Hcy levels in patients with atrial fibrillation and left atrial diameter, right upper and lower diameter and left ventricular function has carried on the correlation analysis, also reached the same conclusion.Conclusion 1.high-sensitivity c-reactive protein, homocysteine concentrations associated with atrial fibrillation burden, for predicting the severity of atrial fibrillation have a certain significance.2.high-sensitivity c-reactive protein, homocysteine in patients with atrial fibrillation diameter of the left atrium, right atrium vertical diameter was positively correlated,with left ventricular function was negatively correlated.3.inflammation factors,oxidative stress is involved in myocardial remodeling, and played an important role in the occurrence, development and maintenance of atrial fibrillation in the process.4.When atrial fibrillation is about the left and right atrium diameter increases, morphological changes of right atrium in patients with atrial fibrillation to do the research. |
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