| Objective: This study retrospectively analyzed the relationship between homocysteine(Hcy),cystatin-C(Cys-C)and non-valvular atrial fibrillation(NVAF)in 182 patients,to explore whether Hcy and Cys-C can provide diagnostic means for identifying high-risk groups of NVAF.We further analyzed the correlationship between Hcy,Cys-C and LAD,while discussing the relationship between inflammation,oxidative stress and the remodeling of left atrium.Methods: 1.Patients with atrial fibrillation who were hospitalized in the department of Cardiology,the second hospital of jilin university from January 01,2016 to December 01,2017 were included.A total of 1886 patients were selected to analyze the etiology and related factors of atrial fibrillation;According to the 2014 ACC/AHA guidelines,patients diagnosed with NVAF were enrolled in the NVAF group(n=182),and patients with sinus rhythm were selected as the control group(n=100);2.According to the 2014 ACC/AHA atrial fibrillation guidelines,the NVAF group was divided into three subgroups: paroxysmal AF group(n=87),persistent AF group(n=52)and permanent AF group(n=43);3.A full set of patients’ clinical data was collected:(1)Baseline clinical data,laboratory examination indexes and ultrasonic cardiogram indexes;(2)Biomarkers consisting of Hcy、Cys-C,etc 4.A database was established,on which statistical analyses were conducted.The relationship between observation indexes of the NVAF group and the control group,together with that among subgroups were evaluated,and the results are statistically significant with P<0.05.Result: 1.The etiological factors and related factors of atrial fibrillation: The etiological factors and related factors of the patients with atrial fibrillation in 1886 were counted,including 1481 cases(78.5%)of non-valvular atrial fibrillation.The top five causes and related factors are hypertension in 906 cases(48.0%),coronary heart disease in 823 cases(43.6%),heart failure in 811 cases(43.0%),and diabetes in 387 cases(20.5%).Other etiologies and related factors,such as electrolyte disorder,chronic renal insufficiency and thyroid diseases,respectively cover 7.2%,5.7%,2.7%,etc.2.Comparison of general clinical data and blood biochemical parameters in each group: The average age and LDL-C of the NVAF group are higher than that in the control group,and the average age and LDL-C of the permanent AF group are higher than that of the paroxysmal AF group.The difference is statistically significant with P<0.05;In addition,there are no statistically significant difference in conventional blood biochemical parameters between the control group,NVAF group and AF subgroup with P>0.05.3.Comparison of Hcy,Cys-C and LAD in each group: 1)Comparison of Hcy,Cys-C and LAD in the NVAF group and the control group: Hcy and Cys-C level in the NVAF group respectively(18.80 ±8.75umol/l and 0.93±0.20 mg/l)are higher than those in the control group(13.64±5.00umol/l and 0.80±0.18 mg/l),the differences are statistically significant with P<0.05;LAD is larger in the NVAF group(39.62±6.26mm)than that in the control group(33.18±4.30mm);The difference is statistically significant with P<0.05;2)Comparison of Hcy,Cys-C and LAD between subgroups in the NVAF group: Hcy and Cys-C level and LAD in the permanent AF group are higher than those in the paroxysmal AF group,persistent AF group and control group,while the levels in the persistent AF group are higher than those in the paroxysmal AF group and control group,and the levels in the paroxysmal AF group are higher than those in the control group.The differences are statistically significant with P<0.05;4.Correlation analysis between Hcy,Cys-C and LAD in NVAF group: Hcy is positively correlated with Cys-C and LAD,and the correlation coefficients are respectively(r=0.271,P<0.001)and(r=0.204,P=0.006).Cys-C is positively correlated with Hcy,Hs-CRP and LAD,and the correlation coefficients are respectively(r=0.271,P<0.001),(r=0.180,P=0.015)and(r=0.281,P<0.001).5.Logistic regression analysis of patients with NVAF: Hcy,Cys-C and LAD expanded are all risk factors for NVAF.6.ROC curve analysis of HCY,Cys-C and LAD : the areas under the curve of HCY,Cys-C and LAD are respectively 0.671,0.711 and 0.792.The combined measurement of the three parameters has the largest area under the curve,which is 0.829,therefore indicating that the prediction ability of NVAF can be significantly improved through the combination of Hcy,Cys-C and LAD.Conclusion: 1.The levels of Hcy and Cys-C increase with the duration of atrial fibrillation and are higher in the NVAF group,which indicates that they are involved in the occurrence,development and maintenance of NVAF,and act as independent risk factors for patients with NVAF by Logistic regression analysis.2.The level of Hcy and Cys-C is linearly positive with LAD,suggesting that inflammation and oxidative stress may participate in left atrial remodeling of atrial fibrillation.All of three participate in the occurrence,development and maintenance of NVAF.A combined measurement of Hcy,Cys-C and LAD can improve the predictive value of NVAF and provide diagnostic means for identifying high-risk population of NVAF. |
