| Part one Correlation between PITX2 gene polymorphism and patients with atrial fibrillationPurposeWith the rapid development of genetic studies,many genes associated with atrial fibrillation(AF)have been discovered.Among them,PITX2 is the most popular gene with AF.Previous studies have confirmed that a single nucleotide polymorphism(rs2200733)at chromosome 4q25(near PITX2)is strongly associated with AF.But there are differences in repetitive studies in China.Our study was to explore the correlation between PITX2 gene polymorphism and atrial fibrillation and to provide possibility for early diagnosis of silent atrial fibrillation and high-risk atrial fibrillation.MethodsThe cases consisted of 98 atrial fibrillation patients and 88 non-atrial fibrillation patients in Affiliated Hospital of Yangzhou University were enrolled in a case-control study.The single nucleotide polymorphism of rs2200733 at 4q25 near PITX2 was genotyped by polymerase chain reaction-restriction fragment length polymorphism(PCR-RFLP)analysis.All statistics of patients'basic clinical data and laboratory results were also recorded.Relevant statistical analysis was earried out.Results1.The different genotype frequencies of rs2200733(TT,TC,and CC)were 44.9%,50%,and 5.1%in patients with AF,and 29.55%,53.41%,and 17.05%in controls respectively.The distribution of genotypes of rs2200733 between two groups was statistically significant(?2=9.159,P=0,01).2.The frequency of TT genotype in AF group was higher than that in the control group(?2=4.416,P=0.031),and the frequency of CC genotype was significantly lower than that of the control group(?2=6.892,P=0.009).The difference were statistically significant.However,there was no significant difference in TC genotype frequency between groups(P=0.642).3.The frequency of T allele in patients with AF was significantly higher than that in controls(?2=7.447,P=0.006).The risk of AF in the population carrying the T allele was 1.806 times that of the control group(OR=1.806,95%CI=1.179?2.766,P=0.006).4.According to logistic regression analysis,taking the CC genotype as a reference,carrying the TC genotype(OR=3.128,95%CI=1.053?9.287,P=0.04)or TT genotype(OR=5.077,95%CI=1,653?15.595,P=0.005)increased the risk of AF,and carrying TT genotype increased more.After adjusting for age,gender,coronary heart disease,hypertension and smoking,carrying TT genotype still increased the risk of AF(AOR*=4.557,95%CI=1.129?18.396,P*=0.033).However,there was no difference between TC genotype and CC genotype in the risk of AF(P=0.259).5.By establishing a genetic model,genotype TC and CC reduced the risk of AF(OR=0.515,95%CI=0.281?0.944,P=0.032)compared with TT.There was still a statistical significance after adjusting age,gender,coronary heart disease,hypertension and smoking(AOR*=0.425,95%CI=0.201?0.900,P*=0.025).ConclusionThe genotype and allele frequency distribution of rs2200733(T/C)near PITX2 is different in the AF group and the control group.The T allele is a risk factor for atrial fibrillation.Compared with the CC genotype,the TT genotype increased the risk of AF.Part two Comparison of ABC-stroke and CHA2DS2-VASc scores for risk stratification of ischemic stroke in patients with non-valvular atrial fibrillationPurposeAtrial fibrillation significantly increases the risk of stroke.A new ABC stroke risk score was reported to improve prognostication of stroke in patients with AF,but whether it has an advantage over the traditional CHA2DS2-VASc risk score is controversial.Our study was to compare the risk stratification of ABC stroke risk score and CHA2DS2-VASc score in patients with AF,and provide improved decision support in patients with non-valvular atrial fibrillation.MethodsPatients with non-valvular AF in the Department of Cardiology,Affiliated Hospital of Yangzhou University were enrolled.The basic clinical data and laboratory results of the enrolled patients were collected.The risk of stroke was assessed according to CHA2DS2-VASc score and ABC score.The acute ischemic stroke was followed for one year.All statistical analysis was performed using SPSS 23.0 software and Excel 2016.Results1.We calculated each patient's score according to CHA2DS2-VASc score and ABC risk score and the risk stratification was performed.The CHA2DS2-VASc score showed 1,2,and 149 patients in the low-risk,middle-risk,and high-risk groups,and the ABC scores were 20,69,and 63,respectively.The McNemar test indicated a significant difference between the two scoring methods(?2=86.33,P<0.001).The Kappa test indicated that there was no consistency between the two scoring methods(P=0.890,Kappa=0.002).2.The stratification of the two scoring methods was compared.There was 1 case in the low-risk group of CHA2DS2-VASc score,which was significantly lower than 20 cases in the ABC score.There was a significant difference between the two methods in the low-risk group(P<0.001).Kappa test showed no consistency(P=0.696).There were 2 cases in the middle-risk group of CHA2DS2-VASc score,which was significantly lower than 69 cases in the ABC score.There were significant differences between the two scoring methods in the middle-risk group(P<0.001),and Kappa test showed no consistency(P=0.194).There were 149 patients in the high-risk group with CHA2DS2-VASc score,which was significantly higher than 63 patients in the ABC score.There were significant differences between the two groups in the high-risk group(P<0.001),and Kappa test showed no consistency(P=0.141).3.A total of 5 patients developed acute ischemic stroke after following up one year.These patients with stroke were calculated by CHA2DS2-VASc score.The low-risk,middle-risk,and high-risk group were 0,0,and 5,respectively.According to the ABC stroke risk score,the low-risk,middle-risk and high-risk group were 0,1,and 4,respectively.The stroke detection rate was 75%.Fisher's exact test showed that there was no difference among the two methods(P>0.05).ConclusionThe ABC stroke risk score was not superior to the CHA2DS2-VASc score in stroke risk stratification in patients with non-valvular atrial fibrillation. |
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