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核苷酸结合寡聚化结构域样受体蛋白3与非瓣膜性心房颤动患者心房重构的关系

Correlation between plasma NLRP3 inflammasome and atrial remodeling in patients with non-valvular atrial fibrillation

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目的 探讨血浆核苷酸结合寡聚化结构域样受体蛋白3(nucleotide-binding oligomerized domain-like receptor protein 3,NLRP3)炎性小体与非瓣膜性心房颤动(non-valvular atrial fibrillation,NVAF)患者心房重构的相关性.方法 选择2019年7月至2020年10月昆明医科大学第一附属医院心内科住院的老年NVAF患者199例,采用酶联免疫法检测血浆NLRP3、白细胞介素1β(interleukin-1 beta,IL-1β)等炎性因子水平,收集患者临床资料和超声心动图指标.根据左心房内径(left atrial diameter,LAD)第一四分位数分为LAD≤36 mm组52例和LAD>36 mm组147例.以血浆NLRP3均值97 ng/L分为NLRP3低水平组95例(NLRP3<97 ng/L)和NLRP3高水平组104例(NLRP3≥97 ng/L).以I.-1β第一四分位数49 ng/L和第三四分位数106 ng/L分为IL-1β低水平组40例(IL-1β≤49 ng/L)、IL-1β 中间水平组 82 例(49 ng/L<IL-1β<106 ng/L)和 IL-1β 高水平组 77 例(IL-1β≥106 ng/L).分析血浆NLRP3、IL-1β水平与心房重构的相关性,多因素logistic回归分析NLRP3炎性小体是否为NVAF患者心房重构的独立影响因素.结果 与LAD≤36 mm组比较,LAD>36 mm组IL-1β和NLRP3水平明显升高,差异有统计学意义(P<0.05,P<0.01).与NLRP3低水平组比较,NLRP3高水平组右心房中部横径明显升高,差异有统计学意义(P<0.05).IL-1β高水平组LADI较低水平组和IL-1β中间水平组明显升高,右心房长径较IL-1β低水平组明显升高,差异有统计学意义(P<0.05).血浆NLRP3水平与LAD、右心房中部横径呈正相关(r=0.143,P=0.044;r=0.180,P=0.011).血浆 IL-1β 水平与 LAD、LADI、右心房长径呈正相关(r=0.153,P=0.031;r=0.148,P=0.037;r=0.142,P=0.046).多因素logistic回归分析显示,持续性心房颤动、肌酐、肺动脉收缩压、NLRP3是左心房扩张的独立危险因素(P<0.05,P<0.01).结论 NLRP3炎性小体与老年NVAF患者心房重构关系密切,血浆NLRP3水平升高是左心房重构的独立危险因素.
Objective To investigate the correlation between plasma nucleotide-binding oligomer-ization domain-like receptor protein 3(NLRP3)inflammasome and atrial remodeling in patients with non-valvular atrial fibrillation(NVAF).Methods A total of 199 elderly NVAF patients hos-pitalized in the Department of Cardiology of the First Affiliated Kunming Medical University from July 2019 to October 2020 were enrolled in this study.The levels of inflammatory factors,such as plasma NLRP3 and IL-1β were detected using ELISA.Their clinical data and echocardio-graphic indicators were collected.According to the first quartile of left atrial diameter(LAD),they were divided into a LAD ≤36 mm group(52 cases)and a LAD>36 mm group(147 cases).Based on the mean level of NLRP3(97 ng/L),the patients were assigned into a low level group(95 ca-ses)and a high level group(104 cases).Using the first quartile of IL-1β at 49 ng/L and the third quartile at 106 ng/L,they were categorized into low,middle and high level groups(40,82 and 77 cases,respectively).The correlation between plasma NLRP3 and IL-1β levels and atrial remode-ling were analyzed.Multivariate logistic regression analysis was conducted to determine whether NLRP3 inflammasome was an independent influencing factor of atrial remodeling in NVAF pa-tients.Results The IL-1β and NLRP3 levels were significantly elevated in the LAD>36 mm group than the LAD ≤36 mm group(P<0.05,P<0.01).The patients with high NLRP3 level had an obviously larger transverse diameter of the middle right atrium than those with low level(P<0.05).Higher LAD index(LADI)was found in the high IL-1β level group than the low and middle level groups,and larger long diameter of right atrium was observed in the high level group than the low level group(P<0.05).Plasma NLRP3 level was positively correlated with LAD and transverse diameter of the middle right atrium(r=0.143,P=0.044;r=0.180,P=0.011),and plasma IL-1β level was positively correlated with LAD,LADI,and long diameter of the right atri-um(r=0.153,P=0.031;r=0.148,P=0.037;r=0.142,P=0.046).Multivariate logistic regres-sion analysis indicated that persistent atrial fibrillation,creatinine,pulmonary artery systolic pres-sure,and NLRP3 were independent risk factors for left atrial enlargement(P<0.05,P<0.01).Conclusion NLRP3 inflammasome is closely associated with atrial remodeling in elderly NVAF patients,and elevated plasma NLRP3 level is an independent risk factor of left atrial remodeling.

atrial fibrillationatrial remodelingNLR family,pyrin domain-containing 3 protein

马航、李谧、张杰、王维雯、李琳

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657000 昭通,云南省滇东北中心医院心内科

曲靖市第一人民医院肾内科

昆明医科大学第一附属医院心内科

云南省阜外心血管病医院心内科

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心房颤动 心房重构 NLR家族,热蛋白结构域包含蛋白3

2025

中华老年心脑血管病杂志
中国人民解放军总医院

中华老年心脑血管病杂志

北大核心
影响因子:2.328
ISSN:1009-0126
年,卷(期):2025.27(1)