炎症联合凝血生物标志物谱动态监测对心房颤动合并冠心病患者预后的预测价值

Dynamic monitoring of inflammatory-coagulation biomarker profiles and its predictive value of prognosis in patients with atrial fibrillation complicated with coronary heart disease

摘要:

目的]探讨炎症-凝血生物标志物谱动态监测对心房颤动合并冠心病患者预后的预测价值,构建多标志物风险预测模型并建立优化的风险分层系统。 [方法]前瞻性纳入2021年6月—2024年6月收治的心房颤动合并冠心病患者130例,分别于基线、1个月、3个月、6个月和12个月检测多项炎症及凝血生物标志物,并进行动态随访,随访主要终点为12个月主要不良心血管事件(MACE)。采用LASSO回归筛选预测变量,构建炎症-凝血联合指数(ICSI),通过Cox回归分析评估预后价值。 [结果]随访12个月,38例(29.2%)患者发生MACE。炎症-凝血标志物基线水平与SYNTAX评分呈正相关,高危组高敏C反应蛋白(hs-CRP)和D-二聚体水平分别是低危组的3.2倍和2.8倍(P＜0.001)。事件组标志物在随访期间持续高水平,无事件组呈下降趋势；3个月时hs-CRP下降＜30%、D-二聚体下降＜25%的患者MACE风险分别增加3.23倍和3.67倍。多标志物预测模型[纳入hs-CRP、白细胞介素6(IL-6)、肿瘤坏死因子α(TNF-α)、D-二聚体、纤维蛋白原、N末端B型脑钠肽前体(NT-proBNP)]的ROC曲线下面积(AUC)为0.802,显著优于CHA₂DS₂-VASc评分(AUC=0.658)和HAS-BLED评分(AUC=0.612)。基于ICSI风险分层系统在CHA₂DS₂-VASc＜4分的患者中,重新识别出23例中高危患者,其MACE发生率达39.1%。 [结论]炎症-凝血生物标志物谱动态监测能准确预测心房颤动合并冠心病患者的预后,基于多标志物的风险分层系统优于传统评分,可识别传统方法遗漏的高危患者。

Abstract:

Aim To investigate the prognostic value of dynamic monitoring of inflammatory-coagulation biomarker profiles in patients with atrial fibrillation (AF) complicated with coronary heart disease (CHD), and to establish a multi-biomarker risk predictive model and develop an optimized risk stratification system. Methods A total of 130 patients with AF and CHD admitted from June 2021 to June 2024 were prospectively enrolled. Multiple inflammatory and coagulation biomarkers were measured at baseline, 1,3, 6, and 12 months, and dynamic follow-up was performed. The primary endpoint was major adverse cardiovascular events (MACE) during the 12-month follow-up period. LASSO regression was used to select predictive variables and construct an inflammation-coagulation score index (ICSI). Cox regression analysis was used to evaluate its prognostic value. Results During 12-month follow-up, 38 patients (29.2%) experienced MACE. The baseline levels of inflammatory-coagulation biomarkers were positively correlated with the SYNTAX score, and the levels of hs-CRP and D-dimer in the high-risk group were significantly 3.2-fold and 2.8-fold those in the low-risk group, respectively (P＜0.001). The biomarkers in the event group persistently remained at high levels during the follow-up period, while those in the non-event group showed a downward trend. Patients with ＜30% hs-CRP reduction or ＜25% D-dimer reduction at 3 months had 3.23-fold and 3.67-fold increased risk of MACE, respectively. The multi-biomarker model (incorporating,high-sensitivity C-reactive protein (hs-CRP), interleukin-6 (IL-6), tumor necrosis factor-alpha (TNF-α), D-dimer, fibrinogen, N-terminal pro-B-type natriuretic peptide (NT-proBNP) achieved an area under the curve (AUC) of 0.802, superior to CHA₂DS₂-VASc score (AUC=0.658) and HAS-BLED score (AUC=0.612). The risk stratification system based on ICSI identified 23 intermediate-to-high-risk patients among those with CHA₂DS₂-VASc＜4, with a MACE incidence rate of 39.1%. Conclusion Dynamic monitoring of inflammatory-coagulation biomarker profiles accurately predicts prognosis of AF patients complicated with CHD.