Division of Cardiology, Emory University School of Medicine, Emory Clinical Cardiovascular Research Institute, Atlanta, Georgia.
Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia.
Heart Rhythm. 2017 Dec;14(12):1849-1855. doi: 10.1016/j.hrthm.2017.07.028. Epub 2017 Jul 27.
Oxidative stress (OS) may be a key mechanism underlying the development of atrial fibrillation (AF) in experimental studies, but data in humans remain limited.
Systemic OS can be estimated by measurements of circulating levels of the aminothiols including glutathione, cysteine, and their oxidized products. We tested the hypothesis that the redox potentials of glutathione (EGSH) and cysteine will be associated with prevalent and incident AF.
Plasma levels of aminothiols were measured in 1439 patients undergoing coronary angiography, of whom 148 (10.3%) had a diagnosis of AF. After a median follow-up of 6.3 years, 104 of 917 patients (11.5%) developed incident AF. Multivariate logistic regression and Cox regression models were used to determine whether OS markers were independent predictors of prevalent and incident AF after adjustment for traditional risk factors, heart failure, coronary artery disease, and high-sensitivity C-reactive protein level.
For each 10% increase in EGSH, the odds of prevalent AF was 30% higher (odds ratio [OR] 1.3; 95% confidence interval [CI] 1.1-1.7; P = .02) and 90% higher (OR 1.9; 95% CI 1.3-2.7; P = .004) when the median was used as a cutoff. The EGSH level above the median was more predictive of chronic AF (OR 4.0; 95% CI 1.3-12.9; P = .01) than of paroxysmal AF (OR 1.7; 95% CI 1.1-2.7; P = .03). Each 10% increase in EGSH level was associated with a 40% increase in the risk of incident AF (hazard ratio 1.4; 95% CI 1.1-1.7; P = .01).
Increased OS measured by the redox potentials of glutathione is associated with prevalent and incident AF. Therapies that modulate OS need to be investigated to treat and prevent AF.
氧化应激（OS）可能是实验研究中心房颤动（AF）发展的关键机制，但人体数据仍然有限。
循环中含巯基的氨基酸（包括谷胱甘肽、半胱氨酸及其氧化产物）水平的测量可以评估全身 OS。我们检验了这样一个假设，即谷胱甘肽的氧化还原电位（EGSH）和半胱氨酸与现患和新发房颤（AF）相关。
对 1439 例接受冠状动脉造影的患者进行了含巯基氨基酸的血浆水平检测，其中 148 例（10.3%）诊断为 AF。中位随访 6.3 年后，917 例患者中有 104 例（11.5%）发生新发 AF。采用多变量 logistic 回归和 Cox 回归模型，在调整传统危险因素、心力衰竭、冠心病和高敏 C 反应蛋白水平后，确定 OS 标志物是否为现患和新发 AF 的独立预测因子。
EGSH 每增加 10%，现患 AF 的几率增加 30%（比值比 [OR] 1.3；95%置信区间 [CI] 1.1-1.7；P =.02），以中位数为界时，几率增加 90%（OR 1.9；95% CI 1.3-2.7；P =.004）。中位数以上的 EGSH 水平对慢性 AF 的预测性更强（OR 4.0；95% CI 1.3-12.9；P =.01），而非阵发性 AF（OR 1.7；95% CI 1.1-2.7；P =.03）。EGSH 水平每增加 10%，新发 AF 的风险增加 40%（风险比 1.4；95% CI 1.1-1.7；P =.01）。
谷胱甘肽氧化还原电位测量的 OS 增加与现患和新发 AF 相关。需要研究调节 OS 的治疗方法，以治疗和预防 AF。
