Changes And Clinical Significance Of T Lymphocyte Subsets And Cytokines In Blood Of Patients With Non-valvular

Objective:The pathogenesis of non-valvular atrial fibrillation(NVAF)remains unclear.Studies have found that T lymphocytes and their cytokines are closely related to the occurrence of NVAF,but there is no final conclusion.In this research,patients with non-valvular atrial fibrillation were selected as the study subjects to investigate the variations of T lymphocytes and their cytokines in the blood of patients,and to explore their significance for the occurrence and progress of NVAF in combination with the comprehensive analysis of relevant clinical indicators,and to further explore whether there is a correlation between T lymphocytes and their cytokines and the degree of myocardial fibrosis in patients with NVAF,providing novel ideas for the treatment and prognosis.Methods:The patients with non-valvular atrial fibrillation who visited our hospital from November 2019 to December 2020 were selected as the experimental group(37 males and 19 females;mean age 67.48±12.65 years),and the outpatients and inpatients excluded from the diagnosis of NVAF in our hospital during the same period were chosen as the control group(27 males and 22 females,mean age 58.12 ±14.52 years).Comprehensive basic data were gathered from all patients,such as name,gender,age,underlying diseases,medication history,family genetic history,etc.;blood routine,liver function,renal function,thyroid function,16 antinuclear antibodies(ANA),fasting blood glucose,12-lead bedside ECG,24-hour dynamic ECG,echocardiography,transesophageal echocardiography and other examinations were completed after admission;fasting venous blood was collected the next morning,and the levels of T lymphocyte panel and 12 cytokines in the samples to be texted were detected by ELISA.Several patients in the experimental group(17 males and 7 females)underwent delayed gadolinium enhanced cardiac magnetic resonance(LGE-CMR)to determine whether there was myocardial fibrosis according to the presence or absence of delayed gadolinium enhancement.They were divided into three groups base on the degree of myocardial fibrosis:group ①:7 males and 3 females,mean age 67.20 ± 14.19 years,with no indication of myocardial fibrosis;group ②:5 males and 1 female,mean age 62.00 ± 17.10 years,with myocardial fibrosis between 3 and 5;group③:5 males and 3 females,mean age 60.00 ± 6.89 years,with myocardial fibrosis larger than 6.The discrepancies in the general data,T lymphocyte and cytokine levels between the experimental group and the control group were compared;the correlation between T lymphocyte,cytokine levels,LVEF,LVEDD,RAD,LAD and other indicators in echocardiography and non-valvular atrial fibrillation was analyzed;the differences in T lymphocytes and their cytokines in the blood of patients with varying degrees of myocardial fibrosis were compared;the predictive significance of the two factors for the occurrence of non-valvular atrial fibrillation and the evaluation meaning for the degree of myocardial fibrosis were further explored.Results:1.Compared with the control group,the levels of IL-1β,IL-4,IL-6 and IL-8 in the blood of the experimental group rose,age,LAD,LVEDD and RAD increased,while the levels of IFN-y and IL-12p70 decreased,LVEF reduced,and the differences were statistically significant(P<0.05);IL-1β,IFN-γ,IL-12p70,IL-4 and LAD were independent factors of non-valvular atrial fibrillation;while there was no statistical difference in gender,hypertension,diabetes,coronary heart disease,thyroid function,ANA 16 items,TNF-α and IL-10(P>0.05).2.Applying the data of IL-1 β,IFN-y,IL-12p70,IL-4,LAD and combined predictor L of the patients,with NVAF as the state variable,the area under the ROC curve(AUC)was 0.636(p<0.05)if IL-1β was set as the test variable;0.618(p<0.05)if IFN-y was set as the test variable;0.618(p<0.05)if IL-12p70 was set as the test variable;0.797(p<0.001)if IL-4 was set as the test variable;0.797(p<0.001)if LAD set as the test variable;and 0.959(p<0.001)if combined predictor L was set as the test variable.Therefore,the combined predictor L had a high accuracy for judging whether the disease existed,with a maximum Youden index of 0.781,a cut-off point of 0.9093,a sensitivity of 82.1%,and a specificity of 95.9%.3.In patients with NVAF,compared with group ① there were significant differences in gender,history of hypertension and ANA in group③,LVEDD was remarkably increased,and the differences were statistically significant(P<0.05);while there was no significant difference in age,T lymphocytes and their cytokines,presence of arrhythmia,diabetes,thyroid function,LVEF,LAD and RAD among the three groups(P>0.05).Conclusion:1.The occurrence of NVAF was correlated with the levels of cytokines IL-6,IL-1β,IL-8,IL-4,IFN-y,IL-12p70 and inflammatory response,but not with each T lymphocyte.2.There is no significant correlation between the degree of myocardial fibrosis and the levels of T lymphocytes and their cytokines in patients with NVAF,but it is necessary to further expand the sample size and optimize the study protocol.3.The levels of IL-1 β,IFN-γ,IL-12p70,and IL-4 have certain diagnostic value for NVAF;the combined predictor L has a high accuracy for judging whether there was NVAF,the sensitivity and specificity of developing NVAF are 82.1%and 95.9%respectively,suggesting that this combined predictor can be applied as a predictor of NVAF.