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目的:研究热休克蛋白27(HSP27)在心房颤动(房颤)患者血清中的表达及其与射频消融术成功率的关系。方法:纳入60例患者,其中30例行环肺静脉电隔离术的房颤患者为房颤组,另30例行射频消融术的阵发性室上性心动过速(PSVT)患者为对照组。所有患者均于术前采集静脉血,用ELISA法测定血清HSP27水平。房颤组于术后3个月随访,并复查血清HSP27水平。比较各组的血清HSP27水平差异及其与房颤术后复发的相关性。结果:房颤组患者血清HSP27水平显著高于对照组(P=0.028)。房颤组术后3个月复查时,9例有房颤复发(复发组),21例维持窦律(窦律组);窦律组术前血清HSP27水平较复发组无显著差异(P=0.757),而术后血清HSP27水平显著高于复发组(P<0.001)。消融术后3个月时,窦律组血清HSP27水平较术前有显著性升高(P<0.001),而复发组无显著升高(P=0.505)。与消融术后房颤复发显著相关的变量为:老龄(P=0.025)、左心房直径(P=0.04)、高血压(P=0.048)、术后HSP27血清水平(P<0.001)及△HSP27(术后3个月HSP27变化量,P=0.044),其中老龄(OR=6.4,95%CI:1.156~35.437,P=0.034)、术后HSP27血清水平(OR=0.964,95%CI:0.939~0.990,P=0.006)及左心房直径(OR=1.259,95%CI:1.047~1.515,P=0.015)是复发的独立预测因素。结论:消融术后血清HSP27水平显著升高的患者复发风险较小。术后定期复查血清HSP27水平可能有助于评估消融术后的复发风险。
Objective: To investigate the expression of heat shock protein 27 (HSP27) in serum of patients with atrial fibrillation (AF) and its relationship with radiofrequency ablation success rate. Methods: Sixty patients were enrolled. Thirty patients with atrial fibrillation undergoing circumferential pulmonary vein isolation were treated with atrial fibrillation. The other 30 patients with paroxysmal supraventricular tachycardia (PSVT) underwent radiofrequency catheter ablation were selected as the control group. Venous blood was collected in all patients before surgery, and serum HSP27 level was measured by ELISA. Atrial fibrillation group were followed up for 3 months after operation, and serum HSP27 level was reexamined. The difference of serum HSP27 levels in each group and its correlation with postoperative recurrence of AF were compared. Results: Serum HSP27 levels in patients with atrial fibrillation were significantly higher than those in the control group (P = 0.028). Atrial fibrillation group 3 months after the review, 9 cases of atrial fibrillation recurrence (recurrence group), 21 cases of sinus rhythm (sinus rhythm group); sinus rhythm group preoperative serum HSP27 levels compared with the recurrence group was no significant difference (P = 0.757), while postoperative serum HSP27 levels were significantly higher than those in the recurrent group (P <0.001). At 3 months after ablation, the level of serum HSP27 in sinus rhythm group was significantly higher than that before operation (P <0.001), but not in recurrence group (P = 0.505). The variables related to the recurrence of atrial fibrillation after ablation were: age (P = 0.025), left atrial diameter (P = 0.04), hypertension (P = 0.048), postoperative HSP27 serum levels (OR = 6.4,95% CI: 1.156 ~ 35.437, P = 0.034), postoperative HSP27 serum levels (OR = 0.964, 95% CI: 0.939 ~ 0.990, P = 0.006) and left atrial diameter (OR = 1.259, 95% CI: 1.047-1.515, P = 0.015) were independent predictors of recurrence. Conclusions: Patients with significantly elevated serum HSP27 levels after ablation have a lower risk of recurrence. Regular postoperative review of serum HSP27 levels may be helpful in assessing the risk of recurrence after ablation.