外周血Th17/Treg平衡与冠状动脉旁路移植术后心房颤动发生的关系
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摘要
目的研究外周血辅助性T细胞17(Th17)/调节性T细胞(Treg)平衡与冠状动脉旁路移植术后心房颤动发生的关系。方法选取2015年1月至2017年12月于郑州市第七人民医院接受冠状动脉旁路移植术治疗的患者200例为研究对象,根据术后是否发生心房颤动分为心房颤动组46例与非心房颤动组154例。比较两组患者一般资料,外周血Th17、Treg细胞比例、Th17/Treg水平,外周血Th17、Treg相关细胞因子变化情况。并应用多因素Logistic回归分析分析冠状动脉旁路移植术后心房颤动发生的危险因素。结果心房颤动组性别、年龄、体质指数(BMI)、脑卒中、心肌梗死、高脂血症、糖尿病、高血压及肾功能不全情况与非心房颤动组对比差异均无统计学意义(P>0.05)。心房颤动组外周血Th17细胞比例以及Th17/Treg水平均高于非心房颤动组(P<0.05),两组Treg细胞比例比较差异无统计学意义(P>0.05)。心房颤动组外周血白细胞介素-6(IL-6)、白细胞介素-17(IL-17)水平均高于非心房颤动组(P<0.05),两组白细胞介素-10(IL-10)、转化生长因子-β(TGF-β)水平比较无统计学意义(P>0.05)。经多因素Logistic回归分析:Th17/Treg、IL-6、IL-17均是影响冠状动脉旁路移植术后心房颤动发生的独立危险因素(P<0.05)。结论冠状动脉旁路移植术后心房颤动患者存在明显的Th17/Treg细胞平衡紊乱,临床工作中可能通过调节Th17/Treg细胞平衡,从而达到降低冠状动脉旁路移植术后心房颤动发生的风险。
Objective To study the relationship between peripheral blood Th17/Treg balance and atrial fibrillation(AF) after coronary artery bypass grafting(CABG). Methods The patients(n=200) received CABG were chosen from the Seventh People's Hospital of Zhengzhou City from Jan. 2015 to Dec. 2017, and divided, according to whether or not they had AF after CABG, into AF group(n=46) and non-AF group(n=154). The general data, proportions of Th17 and Treg in peripheral blood, level of Th17/Treg and changes of cytokines related to Th17 and Treg were compared between 2 groups. The risk factors of AF occurrence after CABG were analyzed by using multi-factor Logistic regression analysis. Results The difference in sex, age, BMI, stroke, myocardial infarction, hyperlipidemia, diabetes, hypertension and renal insufficiency had no statistical significance between 2 groups(P>0.05). The proportion of Th17 and level of Th17/Treg in peripheral blood were higher in AF group than those in non-AF group(P<0.05), and proportion of Treg had no statistical difference between 2 groups(P>0.05). The levels of IL-6 and IL-17 were higher in AF group than those in non0 AF group(P<0.05), and IL-10 and TGF-β had no statistical difference between 2 groups(P>0.05). The results of multi-factor Logistic regression analysis showed that Th17/Treg, IL-6 and IL-17 were independent risk factors influencing on AF occurrence after CABG(P<0.05). Conclusion AF patients have disorders of Th17/Treg balance after CABG. The risk of AF after CABG may be reduced through regulating Th17/Treg balance in clinical practice.
Objective To study the relationship between peripheral blood Th17/Treg balance and atrial fibrillation(AF) after coronary artery bypass grafting(CABG). Methods The patients(n=200) received CABG were chosen from the Seventh People's Hospital of Zhengzhou City from Jan. 2015 to Dec. 2017, and divided, according to whether or not they had AF after CABG, into AF group(n=46) and non-AF group(n=154). The general data, proportions of Th17 and Treg in peripheral blood, level of Th17/Treg and changes of cytokines related to Th17 and Treg were compared between 2 groups. The risk factors of AF occurrence after CABG were analyzed by using multi-factor Logistic regression analysis. Results The difference in sex, age, BMI, stroke, myocardial infarction, hyperlipidemia, diabetes, hypertension and renal insufficiency had no statistical significance between 2 groups(P>0.05). The proportion of Th17 and level of Th17/Treg in peripheral blood were higher in AF group than those in non-AF group(P<0.05), and proportion of Treg had no statistical difference between 2 groups(P>0.05). The levels of IL-6 and IL-17 were higher in AF group than those in non0 AF group(P<0.05), and IL-10 and TGF-β had no statistical difference between 2 groups(P>0.05). The results of multi-factor Logistic regression analysis showed that Th17/Treg, IL-6 and IL-17 were independent risk factors influencing on AF occurrence after CABG(P<0.05). Conclusion AF patients have disorders of Th17/Treg balance after CABG. The risk of AF after CABG may be reduced through regulating Th17/Treg balance in clinical practice.
引文
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[9]郑帅,焦玉清,张海波,等.同期外科心房颤动射频消融对冠状动脉旁路移植围术期风险的影响[J].中国综合临床,2016,32(6):499-502.
[10]陆杰,李东玉,徐世安,等.冠状动脉旁路移植术后新发心房颤动的多因素分析[J].中国医科大学学报,2016,45(3):273-7.
[11]王恒,李立环,姚允泰,等.亚临床甲状腺功能减退与冠状动脉旁路移植术后患者院内治疗相关性研究[J].中国循环杂志,2016,31(9):870-3.
[12]Zhu XM,Shi YZ,Cheng M,et al.Serum IL-6,IL-23 profile and Treg/Th17 peripheral cell populations in pediatric patients with inflammatory bowel disease[J].Pharmazie,2017,72(5):283-7.
[13]Synetos A,Karanasos A,Spyropoulos S,et al.Expression of Lectin-Like Oxidized Low-Density Lipoprotein Receptor-1 in Human Epicardial and Intramyocardial Coronary Arteries of Male Patients Undergoing Coronary Artery Bypass Grafting[J].Cardiology,2018,139(4):203-7.
[14]卢爽,黄茜,吴艳,等.非体外循环下冠状动脉旁路移植术术后房颤的易患因素及护理[J].国际护理学杂志,2013,32(4):793-4.
[15]Farhangi MA,Najafi M.Dietary inflammatory index:a potent association with cardiovascular risk factors among patients candidate for coronary artery bypass grafting(CABG)surgery[J].Nutr J,2018,17(1):20.
[16]俞国军,严飞,朱涛,等.老年冠心病患者非体外循环冠状动脉旁路移植术后新发心房颤动的危险因素分析[J].中国心血管杂志,2015,32(2):136-40.
[17]何婷婷,肖坤,刘强,等.炎症因子白细胞介素1β、白细胞介素33、中性粒细胞淋巴细胞比值与心房颤动的相关性[J].中国综合临床,2017,33(9):786-9.
[2]张航,虞敏,冀涛,等.NSAIDs对预防CABG术后心房颤动疗效及主要不良事件的Meta分析[J].浙江临床医学,2017,19(10):1832-4.
[3]张磊,王春,谷天祥,等.心原性休克患者非体外循环冠状动脉旁路移植术围手术期血清血栓调节蛋白水平的变化[J].中华心血管病杂志,2017,45(9):777-81.
[4]金文杰,李修远,郝瑞,等.非体外循环与体外循环冠状动脉旁路移植术治疗对老年冠心病患者脏器损伤及Th1/Th2免疫平衡的影响[J].中国循证心血管医学杂志,2017,9(6):712-5.
[5]付蕾,孙国建,何浪,等.探讨心房颤动导管消融术后早期复发与炎症反应和细胞外基质生物标志物的关系[J].中国现代医生,2017,55(24):26-9.
[6]Som A,Sen C,Goswami A,et al.Prophylactic amiodarone vs dronedarone for prevention of perioperative arrhythmias in offpump coronary artery bypass grafting:A pilot randomized controlled trial[J].J Perioper Pract,2017,27(1):9-14.
[7]Su CS,Chen YW,Shen CH,et al.Clinical outcomes of left main coronary artery disease patients undergoing three different revascularization approaches[J].Medicine(Baltimore),2018,97(7):e9778.
[8]刘运仲,刘苏,潘松利,等.稳定性冠状动脉疾病患者冠状动脉旁路移植术后心房颤动的影响因素研究[J].实用心脑肺血管病杂志,2017,25(5):28-31.
[9]郑帅,焦玉清,张海波,等.同期外科心房颤动射频消融对冠状动脉旁路移植围术期风险的影响[J].中国综合临床,2016,32(6):499-502.
[10]陆杰,李东玉,徐世安,等.冠状动脉旁路移植术后新发心房颤动的多因素分析[J].中国医科大学学报,2016,45(3):273-7.
[11]王恒,李立环,姚允泰,等.亚临床甲状腺功能减退与冠状动脉旁路移植术后患者院内治疗相关性研究[J].中国循环杂志,2016,31(9):870-3.
[12]Zhu XM,Shi YZ,Cheng M,et al.Serum IL-6,IL-23 profile and Treg/Th17 peripheral cell populations in pediatric patients with inflammatory bowel disease[J].Pharmazie,2017,72(5):283-7.
[13]Synetos A,Karanasos A,Spyropoulos S,et al.Expression of Lectin-Like Oxidized Low-Density Lipoprotein Receptor-1 in Human Epicardial and Intramyocardial Coronary Arteries of Male Patients Undergoing Coronary Artery Bypass Grafting[J].Cardiology,2018,139(4):203-7.
[14]卢爽,黄茜,吴艳,等.非体外循环下冠状动脉旁路移植术术后房颤的易患因素及护理[J].国际护理学杂志,2013,32(4):793-4.
[15]Farhangi MA,Najafi M.Dietary inflammatory index:a potent association with cardiovascular risk factors among patients candidate for coronary artery bypass grafting(CABG)surgery[J].Nutr J,2018,17(1):20.
[16]俞国军,严飞,朱涛,等.老年冠心病患者非体外循环冠状动脉旁路移植术后新发心房颤动的危险因素分析[J].中国心血管杂志,2015,32(2):136-40.
[17]何婷婷,肖坤,刘强,等.炎症因子白细胞介素1β、白细胞介素33、中性粒细胞淋巴细胞比值与心房颤动的相关性[J].中国综合临床,2017,33(9):786-9.