文章摘要
戴 婷,郭俊平,王 健,史国振,曹海龙,陈亦江,谈永飞.术前血清sRANKL/OPG对瓣膜病合并房颤行改良迷宫术后房颤复发的预测价值[J].南京医科大学学报,2017,(6):703~708
术前血清sRANKL/OPG对瓣膜病合并房颤行改良迷宫术后房颤复发的预测价值
Preoperative serum sRANKL/OPG stabilization predicts restored sinus rhythm in persistent atrial fibrillation patients after valve surgery with concomitant modified maze procedure
投稿时间:2016-09-08  
DOI:10.7655/NYDXBNS20170610
中文关键词: 心房颤动  OPG  sRANKL  窦性心律的维持  改良迷宫手术
英文关键词: atrial fibrillation  osteoprotegerin  soluble receptor activator of nuclear factor-κB ligand  sinus rhythm stabilization  modified maze procedure
基金项目:无锡市卫生局面上科研项目(MS201407)
作者单位
戴 婷 宜兴市人民医院药学部 
郭俊平 宜兴市人民医院药学部 
王 健 心胸外科江苏 宜兴 214200 
史国振 心胸外科江苏 宜兴 214200 
曹海龙 南京大学附属鼓楼医院心胸外科江苏 南京 210008 
陈亦江 南京医科大学第一附属医院心胸外科江苏 南京 210029 
谈永飞 心胸外科江苏 宜兴 214200 
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中文摘要:
      目的:探讨术前血清护骨素(osteoprotegerin,OPG)、可溶性核因子κB受体活化因子配体(soluble receptor activator of nuclear factor-κB ligand,sRANKL)水平和sRANKL/OPG比值能否预测瓣膜病合并房颤患者行改良迷宫术后房颤复发的风险。方法:选取瓣膜病合并持续性房颤行改良迷宫术患者共114例,以术后3个月内房颤是否复发分为房颤组和窦性心律组。术前采集患者的桡动脉血,采用ELISA法检测血清中OPG和sRANKL的水平。结果:① 房颤组术前血清中OPG、sRANKL水平和sRANKL/OPG比值均显著高于窦性心律组;②多因素Logistic回归分析结果显示,除左房内径外,术前血清sRANKL水平和sRANKL/OPG比值也能独立预测改良迷宫术后房颤的复发;③ROC曲线评价血清sRANKL水平与sRANKL/OPG比值用来预测改良迷宫术后房颤复发的最佳截断点分别为6.75 pmol/L和0.87,最佳截断点上血清sRANKL(>6.75 pmol/L)预测术后房颤复发的敏感性、特异性和正确率分别为89.7%、89.3%、89.5%,而sRANKL/OPG比值(>0.87)分别为92.3%、98.7%、92.1%。结论:术前血清sRANKL水平和sRANKL/OPG比值能独立预测瓣膜病合并房颤患者行改良迷宫术后房颤的复发,因此可用来筛选术中是否适合行改良迷宫手术的患者,或用作术前术后尽早干预的靶点以减少房颤的复发。
英文摘要:
      Objective:To investigate whether preoperative serum soluble receptor activator of nuclear factor-кB ligand(sRANKL),osteoprotegerin(OPG),and sRANKL/OPG ratio are associated with the stabilization of restored sinus rhythm(SR) in persistent atrial fibrillation(AF) patients after valve surgery with concomitant modified maze procedure. Methods:We enrolled 114 patients with persistent AF who restored SR after valve surgery with concomitant modified maze procedure. According to the clinical follow-up outcomes at the third months after surgery,all the patients were divided into the AF recurrence group and the non recurrence group, respectively. Preoperative radial artery blood samples were obtained for measurement of serum sRANKL and OPG by ELISA. Results:Preoperative serum levels of sRANKL,OPG and sRANKL/OPG ratio were significantly higher in the AF recurrence group than those in the group with no AF recurrence. In multivariate Logistic regression analysis, except left atrial diameter,preoperative serum sRANKL level and sRANKL/OPG ratio independently predicted AF recurrence. According to ROC curve analysis,the best diagnostic values of serum sRANKL level and sRANKL/OPG ratio for predicting AF recurrence were 6.75 pmol/L and 0.87,respectively. The sensitivity,specificity, and accuracy of the recurrence predicted by sRANKL(>6.75 pmol/L)were 89.7%,89.3% and 89.5%,respectively,and those by the sRANKL/OPG ratio(>0.87)were 92.3%,98.7% and 92.1%,respectively. Conclusion:These findings suggest that preoperative serum sRANKL level and sRANKL/OPG ratio independently predict the recurrence of AF after valve surgery with concomitant modified maze procedure. Therefore,it can be used to screen patients who are suitable for the modified maze procedure or to be used as the target of early intervention to reduce the recurrence of AF.
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