心房颤动患者循环脂多糖与抗氧化状态受损。来自动脉粥样硬化与心房颤动（ATHERO-AF）研究的数据。
Circulating Lipopolysaccharides and Impaired Antioxidant Status in Patients With Atrial Fibrillation. Data From the ATHERO-AF Study.
作者信息
Menichelli Danilo, Carnevale Roberto, Nocella Cristina, Cammisotto Vittoria, Castellani Valentina, Bartimoccia Simona, Frati Giacomo, Pignatelli Pasquale, Pastori Daniele
机构信息
Department of Clinical, Internal, Anesthesiological and Cardiovascular Sciences, Sapienza University of Rome, Rome, Italy.
Department of Medical-Surgical Sciences and Biotechnologies, Sapienza University of Rome, Latina, Italy.
出版信息
Front Cardiovasc Med. 2021 Nov 17;8:779503. doi: 10.3389/fcvm.2021.779503. eCollection 2021.
Atrial fibrillation (AF) is characterized by an oxidative imbalance, which is associated with an increased risk of cardiovascular events (CVEs). It is unclear whether low grade endotoxemia may contribute to the impaired antioxidant status in AF patients. We investigated the relationship between circulating lipopolysaccharides (LPS) and antioxidant status in AF patients. analysis from the ongoing prospective observational cohort ATHERO-AF study including 907 patients. Antioxidant status was evaluated by the activity of glutathione peroxidase 3 (GPx3) and superoxide dismutase (SOD). Patients were divided into two groups to evaluate the risk of CVEs: (1) LPS below median and GPx3 above median ( = 254); (2) LPS above median and GPx3 below median ( = 263). The mean age was 73.5 ± 8.3 years, and 43.1% were women. Median LPS and GPx3 were 50.0 pg/ml [interquartile range (IQR) 15-108] and 20.0 U/ml (IQR 10.0-34.0), respectively. Patients of Groups 2 were older, with a higher prevalence of heart failure. LPS above the median was associated with reduced GPx3 [Odds Ratio for LPS 1.752, 95% Confidence Interval (CI) 1.344-2.285, < 0.001] and SOD (OR 0.525, 95%CI 0.403-0.683) activity after adjustment for CHADSVASc score. In a mean follow-up of 54.0 ± 36.8 months, 118 CVEs occurred, 42 in Group 1 and 76 in Group 2 (Log-Rank test = 0.001). At multivariable Cox regression analysis, Group 2 was associated with a higher risk of CVEs [Hazard Ratio (HR) 1.644, 95%CI 1.117-2,421, = 0.012], along with age ≥ 75 years (HR 2.035, 95%CI 1.394-2.972, < 0.001), diabetes (HR 1.927, 95%CI 1.280-2.900, = 0.002), and previous cerebrovascular disease (HR 1.895, 95%CI 1.251-2.870, = 0.003) and previous cardiovascular disease (HR 1.708, 95%CI 1.149-2.538, = 0.008). Our study indicates that circulating LPS may contribute to impaired antioxidant status in patients with AF. Patients with coincidentally high LPS and reduced GPx3 activity showed the highest risk of CVEs.
心房颤动（AF）的特征是氧化失衡，这与心血管事件（CVE）风险增加相关。尚不清楚低度内毒素血症是否可能导致AF患者抗氧化状态受损。我们研究了AF患者循环脂多糖（LPS）与抗氧化状态之间的关系。对正在进行的前瞻性观察队列ATHERO-AF研究中的907例患者进行分析。通过谷胱甘肽过氧化物酶3（GPx3）和超氧化物歧化酶（SOD）的活性评估抗氧化状态。患者分为两组以评估CVE风险：（1）LPS低于中位数且GPx3高于中位数（n = 254）；（2）LPS高于中位数且GPx3低于中位数（n = 263）。平均年龄为73.5±8.3岁，女性占43.1%。LPS和GPx3的中位数分别为50.0 pg/ml[四分位间距（IQR）15 - 108]和20.0 U/ml（IQR 10.0 - 34.0）。第2组患者年龄更大，心力衰竭患病率更高。在校正CHADSVASc评分后，LPS高于中位数与GPx3活性降低[LPS的比值比为1.752，95%置信区间（CI）1.344 - 2.285，P < 0.001]和SOD活性降低（比值比0.525，95%CI 0.403 - 0.683）相关。在平均54.0±36.8个月的随访中，发生了118例CVE，第1组42例，第2组76例（对数秩检验P = 0.001）。在多变量Cox回归分析中，第2组与CVE风险更高相关[风险比（HR）1.644，95%CI 1.117 - 2.421，P = 0.012]，同时还与年龄≥75岁（HR 2.035，95%CI 1.394 - 2.972，P < 0.001）、糖尿病（HR 1.927，95%CI 1.280 - 2.900，P = 0.002）、既往脑血管疾病（HR 1.895，95%CI 1.251 - 2.870，P = 0.003）和既往心血管疾病（HR 1.708，95%CI 1.149 - 2.538，P = 0.008）相关。我们的研究表明，循环LPS可能导致AF患者抗氧化状态受损。LPS同时升高且GPx3活性降低的患者CVE风险最高。
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