Huang Jiaqi, Wu Na, Xiang Ying, Wu Long, Li Chengying, Yuan Zhiquan, Jia Xiaoyue, Zhang Zhihui, Zhong Li, Li Yafei
Department of Epidemiology, College of Preventive Medicine, Army Medical University (Third Military Medical University), Chongqing 400038, People's Republic of China; Evidence-based Medicine and Clinical Epidemiology Center, Army Medical University (Third Military Medical University), Chongqing 400038, People's Republic of China.
Department of Cardiology, Southwest Hospital, Army Medical University (Third Military Medical University), Chongqing 400038, People's Republic of China.
Int J Cardiol. 2020 Dec 1;320:83-89. doi: 10.1016/j.ijcard.2020.06.030. Epub 2020 Jun 27.
Chemokines play an important role in inflammation and atherosclerosis. However, little is known about the relationship between chemokines and the prognosis of atrial fibrillation (AF). This "real-world" cohort study was designed to observe the prognostic value of plasma CC motif chemokine ligand (CCL) 18, CCL23, CCL28, CXC motif chemokine ligand (CXCL) 14, CXCL16 in newly diagnosed AF patients.
Baseline plasma levels of chemokines were measured in a cohort with 299 AF patients using Bio-plex Pro™ xMAP arrays. A Cox proportional hazard model was used to evaluate the associations of chemokines with AF outcomes. Net reclassification improvement (NRI) and integrated discrimination improvement (IDI) were calculated to evaluate the improvement of chemokines to CHADS-VASc score.
High CCL18 (hazard ratio [HR] 2.65, 95% confidence interval [CI] 1.18-5.98, P = 0.019) and CCL23 levels (HR 2.78, 95%CI 1.07-7.22, P = 0.036) were associated with stroke in AF patient. Patients with low CXCL14 (HR 0.39, 95%CI 0.15-0.97, P = 0.042) and high CXCL16 levels (HR 3.02, 95%CI 1.39-6.58, P = 0.005) have increased risk of all-cause mortality. High CCL16 levels (HR 5.41, 95%CI 2.32-12.63, P < 0.001) were associated with cardiovascular death. However, CCL28 had no significant association with outcomes. Adding chemokines to CHADS-VASc score increased the reclassification and clinical net benefit.
Plasma levels of CCL18, CCL23, CXCL14, and CXCL16 were independently associated with AF outcomes. Chemokines added to CHADS-VASc score significantly enhanced risk assessment for the outcomes. Incorporation of chemokines into clinical decisions may help the management of AF treatment.
趋化因子在炎症和动脉粥样硬化中起重要作用。然而，关于趋化因子与心房颤动（AF）预后之间的关系知之甚少。这项“真实世界”队列研究旨在观察血浆CC基序趋化因子配体（CCL）18、CCL23、CCL28、CXC基序趋化因子配体（CXCL）14、CXCL16在新诊断AF患者中的预后价值。
使用Bio-plex Pro™ xMAP阵列在一个包含299例AF患者的队列中测量趋化因子的基线血浆水平。采用Cox比例风险模型评估趋化因子与AF结局的关联。计算净重新分类改善（NRI）和综合判别改善（IDI）以评估趋化因子对CHADS-VASc评分的改善情况。
高CCL18水平（风险比[HR] 2.65，95%置信区间[CI] 1.18 - 5.98，P = 0.019）和CCL23水平（HR 2.78，95%CI 1.07 - 7.22，P = 0.036）与AF患者的卒中相关。低CXCL14水平（HR 0.39，95%CI 0.15 - 0.97，P = 0.042）和高CXCL16水平（HR 3.02，95%CI 1.39 - 6.58，P = 0.005）的患者全因死亡风险增加。高CCL16水平（HR 5.41，95%CI 2.32 - 12.63，P < 0.001）与心血管死亡相关。然而，CCL28与结局无显著关联。将趋化因子加入CHADS-VASc评分可增加重新分类和临床净获益。
血浆CCL18、CCL23、CXCL14和CXCL16水平与AF结局独立相关。将趋化因子加入CHADS-VASc评分可显著增强对结局的风险评估。将趋化因子纳入临床决策可能有助于AF治疗的管理。
