| Objective To investigate the levels of molecular markers of plasma C-reactive protein(CRP),D-dimmer(D-D), Brain natriuretic peptide (BNP) in patients with atrial fibrillation(AF)and its predictive value of the risk of thrombotic events (including left atrialthrombus,stroke and other arterial thromboembolic complications)Methods60patients with AF were divided into2groups: Paroxysmal atrial fibrillation(PAF) group (n=27) and Non-Paroxysmal atrial fibrillation(NPAF)group(n=33);30patientswith structural heart diseases without atrial fibrillation were selected as control group.Afteradmission,all patients immediately underwent fluorescence immunoassay to detect theplasma D-D and BNP,the plasma CRP was assayed with ELISA,left atrial diameter(LAD）size was detected by the echocardiography. According to with or without thromboticevents,the patients were divided into thrombotic events positive group (n=26)andthrombotic events negative group (n=34).Results1. The comparison of the levels of molecular markers of plasma CRP, D-D,BNP and basic information including age,gender,smoking,hypertension, coronaryheart disease, diabetes mellitus in patients with different AF: There was no significantdifference in basic information between the three groups; The levels of CRP [(3.91±0.20)mg/l vs (2.78±0.29) mg/l、(1.09±0.46)mg/l，P<0.05,respectively] and D-D [(720.85±97.44)μg/l vs (501.26±104.61) μg/l、(249.07±48.14)μg/l，P<0.05,respectively] in NPAF groupwere significantly higher than PAF group and control group; The levels of CRP[(2.78±0.29) mg/l vs(1.09±0.46)mg/l，P<0.05]and D-D[(501.26±104.61) μg/l vs (249.07±48.14)μg/l，P<0.05] in PAF group were significantly higher than control group;The levels of BNP[(324.27±82.52)pg/ml vs (149.12±70.25)pg/ml、(116.91±52.99)pg/ml,P<0.05, respectively]in NPAF group were significantly higher than PAF and control group;and the comparisonbetween the control group and PAF group,the difference was no statisticallysignificant(P>0.05).2.The comparison of LAD size in patients with different AF: TheLAD size[(42.33±2.09) mm vs (37.37±2.81)mm、(34.77±1.87)mm,P<0.05,respectively] inNPAF group was significantly higher than PAF group and control group; PAF group[(37.37±2.81)mm vs (34.77±1.87)mm,P<0.05] was significantly higher than controlgroup.3.The comparison in basic information including gender, age, smoking,hypertension, coronary heart disease, diabetes mellitus between the thromboticevents positive group and thrombotic events negative group: There was no significantdifference in gender and smoking between the two groups; Thrombotic events positivegroup was higher than thrombotic event negative group in age[(65±4)years old vs(58±5)years old,P<0.05];The proportion of accompanying diseases including hypertension,coronary heart disease, diabetes mellitus in positive group[50%vs18%、77%vs18%、35%vs6%，P<0.05，respectively] was higher than negative group.4. The comparison of LADsize and the levels of molecular markers of plasma CRP,D-D and BNP betweenthrombotic events positive group and thrombotic events negative group:The LADsize[(42.65±2.30)mm vs (38.15±2.91)mm, P<0.05]and the levels of CRP[(3.61±0.57) mg/lvs(3.24±0.62)mg/l，P<0.05], D-D[(715.88±119.17)μg/l vs (550.26±128.54) μg/l，P<0.05],BNP[(314.13±100.07)pg/ml vs (192.94±100.76)pg/ml,P<0.05]were significantly increasedin Positive group patients compared with the negative group patients.5. The multivariatelogistic regression analysis of thrombotic events in patients with AF: Multivariateregression analysis showed that the LAD(OR=2.034，95%CI=1.662~3.324， p=0.022)，the levels of D-D(OR=3.77，95%CI=2.665~5.221，p=0.012)，BNP(OR=1.879，95%CI=0.022~3.365，p=0.015) and CRP (OR=3.624，95%CI=1.156~5.368，p=0.009) wereindependently associated with thrombotic events.6.The evaluation of diagnostic value forthe independent risk factors of thrombotic events in patients with AF:ROC curveshowed:BNP P<0.01,and the area under the curve>0.7, there was a predictive value as the risk assessment of thrombotic events in patients with atrial fibrillation; D-D P<0.01,and thearea under the curve>0.9, there was a higher predictive value;when the Youden,sindex[r=(sensitivity+specificity)-1] was maximum,the best critical points of BNP and D-Dwere400pg/ml,0.9μg/l; the LAD P>0.05，the area under the curve <0.7, did not show thevalue of the risk assessment of thrombotic events in patients with atrial fibrillationwith,and CRP P<0.05,but the area under the curve <0.7,the diagnostic value waslower.7.The risk assessment of the thrombotic events in patients with AF:Amongsingle risk factor, the sensitivity, negative predictive value,specificity and positivepredictive value of BNP to predict thrombotic events were86.9%,69.5%,72.2%,61.3%,ofCRP were65.4%,68.7%,75%,68.7%,of D-D were63.2%,64.9%,88.7%,64.2%.Thespecificity (92.9%) and positive predictive value (83.7%)with the BNP and CRP werehigher than single risk factor,but the sensitivity (46.2%)and negative predictive value(61%)were lower；The specificity (92.9%) and positive predictive value (85.7%)with BNP andD-D were higher than single risk factors,but the sensitivity (38.5%)and negative predictivevalue(58%)were lower；The diagnostic specificity (96.4%) and positive predictive value(91.7%)with CRP and D-D were higher than single risk factors,but sensitivity (42.3%) andnegative predictive value(55.3%)were lower;The specificity(100%) and positive predictivevalue(100%) with the D-D,CRP and BNP were higher than two risk factors, but sensitivity(23.1%) and negative predictive value (51.7%) were lower.Conclusion1.The levels of Plasma CRP,D-D and BNP in NPAF were higher thanPAF;The LAD size in NPAF patients were higher than PAF patients.2.The levels ofplasma CRP,D-D,BNP and the LAD size in thrombotic events positive patients werehigher than thrombotic events negative patients; The proportion of accompanying diseasesincluding hypertension, coronary heart disease, diabetes mellitus in thrombotic eventspositive patients were higher than negative patients.3. The LAD size, the levels of plasmaCRP,D-D,BNP were independently associated with thrombotic events;Among single riskfactor，the sensitivity and the negative predictive value of the BNP to predict thromboticevents were the highest,and the specificity and positive predictive value of D-D were thehighest; Along with more independent risk factors，the specificity and positive predictivevalue to predict thrombotic events in patients with AF were higher,but the sensitivity and negative predictive value were lower.Considering combined more risk factors,thespecificity and positive predictive value to predict thrombotic events were higher,and therisk assessment of thrombotic events was more reliable. |
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