Ichihara Noboru, Miyamura Masatoshi, Maeda Daichi, Fujisaka Tomohiro, Fujita Shu-Ichi, Morita Hideaki, Takeda Yoshihiro, Ito Takahide, Sohmiya Koichi, Hoshiga Masaaki, Ishizaka Nobukazu
Department of Cardiology, Osaka Medical College, Osaka, Japan.
J Arrhythm. 2017 Oct;33(5):469-474. doi: 10.1016/j.joa.2017.05.003. Epub 2017 May 30.
Circulating soluble urokinase-type plasminogen activator receptor (suPAR), which can reflect immune activation and low-grade inflammation, may be a novel biomarker of cardiovascular disease.
We investigated the potential association between suPAR and the prevalence of atrial fibrillation (AF) by analyzing patients with either sinus rhythm, paroxysmal atrial fibrillation (PAF), or non-paroxysmal atrial fibrillation (NPAF), which indicates either permanent or persistent AF.
Among 426 patients enrolled (mean age 71.4±9.2 years; 110 (25.8%) female), 310, 62, and 54 were diagnosed with sinus rhythm, PAF, and NPAF, respectively. NPAF was >10-fold more prevalent in the highest suPAR quartile (>3534 pg/mL; 32 (30.2%) of 106 patients) than in the lowest suPAR quartile (<1802 pg/mL; 3 (2.8%) of 107 patients). Logistic regression analysis showed that, as compared with the lowest suPAR quartile, the highest suPAR quartile was associated with NPAF with an odds ratio of 6.48 (95% confidence interval, 1.71-24.5) after adjustment for sex, age, log(eGFR), C-reactive protein, and systolic blood pressure. In multivariate receiver operating characteristic analysis to predict NPAF, the area under the curve (AUC) for the combination of age, sex, log(eGFR), and C-reactive protein was 0.777 (standard error [SE], 0.036); the addition of log(suPAR) slightly improved the prediction (AUC, 0.812; SE, 0.034, P=0.084).
Serum suPAR was associated with AF, particularly NPAF, as demonstrated by multivariate logistic regression analysis. Whether suPAR promotes or maintains AF should be investigated in further studies.
循环可溶性尿激酶型纤溶酶原激活物受体（suPAR）可反映免疫激活和低度炎症，可能是心血管疾病的一种新型生物标志物。
我们通过分析窦性心律、阵发性心房颤动（PAF）或非阵发性心房颤动（NPAF，即永久性或持续性心房颤动）患者，研究suPAR与心房颤动（AF）患病率之间的潜在关联。
在纳入的426例患者中（平均年龄71.4±9.2岁；110例（25.8%）为女性），分别有310例、62例和54例被诊断为窦性心律、PAF和NPAF。在suPAR最高四分位数组（>3534 pg/mL；106例患者中的32例（30.2%））中，NPAF的患病率比suPAR最低四分位数组（<1802 pg/mL；107例患者中的3例（2.8%））高10倍以上。逻辑回归分析显示，与suPAR最低四分位数组相比，在对性别、年龄、log（估算肾小球滤过率[eGFR]）、C反应蛋白和收缩压进行调整后，suPAR最高四分位数组与NPAF相关，比值比为6.48（95%置信区间，1.71 - 24.5）。在预测NPAF的多变量受试者工作特征分析中，年龄、性别、log（eGFR）和C反应蛋白联合检测的曲线下面积（AUC）为0.777（标准误[SE]，0.036）；加入log（suPAR）后预测略有改善（AUC，0.812；SE，0.034，P = 0.084）。
多变量逻辑回归分析表明，血清suPAR与心房颤动相关，尤其是与NPAF相关。suPAR是否促进或维持心房颤动有待进一步研究。
