A Circulating Biomarker Risk-Prediction Model Correlates with CHADS-2 Risk Score in Chronic Atrial Fibrillation.
A Circulating Biomarker Risk-Prediction Model Correlates with CHADS-2 Risk Score in Chronic Atrial Fibrillation.
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DOI：
10.1016/j.ijcme.2015.01.002
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发表时间：
2015-03
期刊：
影响因子：
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通讯作者：
Dudley, Samuel C Jr
中科院分区：
文献类型：
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作者：
Negi, Smita I;Greener, Ian;Anand, Aashish;Dudley, Samuel C Jr
炎症和氧化应激与心房颤动(房颤)的起源和持续有关。CHADS-2评分系统是一种风险分层方案，在预测房颤患者卒中方面得到了很好的验证。我们评估了慢性房颤患者氧化应激和炎症标志物与CHDS-2评分之间的关系。对慢性房颤患者进行CHADS-2评分。检测血清炎症标志物[C反应蛋白、白介素6、白介素1β、肿瘤坏死因子β、肿瘤坏死因子α]和氧化应激标志物[反应性氧代谢产物(DROMs)、异前列腺素(Isoprostanes)]。根据CHADS-2评分，20名受试者被分为0级(无风险)、24名为1级(中度风险)和20名为2级(重度风险)。高敏C反应蛋白(CHADS-2 0=40.0%，1=70.0%，2=90.0%；p=0.003)和DROMS(CHADS-2 0=45%，1=78%，2=80%；p=0.0 4)与CHADS-2风险评分呈正相关。在调整性别和高血压后，中到重度CHADS-2风险的受试者仍与hs-CRP异常(OR：5.3，95%CI：1.1-25.0)和DROMS(调整后的OR：6.7，95%CI：1.2-38.8)显著相关。在多因素Logistic交互作用模型中，hs-CRP和DROMS与CHADS-2风险类别之间没有显著的交互作用(p=0.64)。结合hs-CRP和DROMS的生物标记物风险模型与CHADS-2风险类别有很好的相关性(r=0.49，p<；0.001)。联合使用hs-CRP和DROMS的生物标记物风险模型与慢性房颤患者的CHADS-2风险评分有很好的相关性。这两个标记物中的一个或两个都可能为未来的中风风险预测模型增加预测能力。
Inflammation and oxidative stress have been linked to the origin and persistence of atrial fibrillation (AF). CHADS-2 scoring system is a risk stratification schema well validated in prognostication of stroke in AF. We evaluated the association of markers of oxidative stress and inflammation with CHADS-2 scores in chronic AF patients. CHADS-2 scores were calculated for 64 subjects with chronic AF. Serum markers of inflammation [C-reactive protein (hs-CRP), interleukin-6 (IL-6), interleukin 1β (IL-1β), tumor necrosis factor-α (TNF-α)] and of oxidative stress [Derivatives of reactive oxygen metabolites (DROMs) and isoprostanes (IsoPs)] were measured. Twenty subjects were categorized as 0 (no risk), 24 as 1 (intermediate risk) and 20 as 2 (severe risk) based on their CHADS-2 scores. High sensitivity-CRP (CHADS-2 0=40.0%, 1=70.0%, 2=90.0%; p=0.003) and DROMs (CHADS-2 0=45%, 1=78%, 2=80%; p=0.04) were positively associated with the CHADS-2 risk score. Subjects with intermediate to severe CHADS-2 risk retained significant associations with abnormal hs-CRP (OR: 5.3, 95%CI: 1.1–25.0) and DROMs (adjusted OR: 6.7, 95%CI: 1.2–38.8) after adjusting for gender and hypertension. In a multiple logistic interaction model, there was no significant interaction between hs-CRP and DROMs in their association with CHADS-2 risk categories (p=0.64). A biomarker risk-model, combining hs-CRP and DROMs, correlated well with the CHADS-2 risk categories (r= 0.49, p<0.001). A biomarker risk-model using a combination of hs-CRP and DROMs correlates well with CHADS-2 risk scores in chronic AF. Either or both of these markers may add predictive power to future stroke risk prediction models.