Relationship between homocysteine,platelet microparticles and lipoprotein(a)and intra-atrial thrombosis in patients with atrial fibrillation complicated with pulmonary infection

ZHANG Min; WANG Jian-qiao; YUAN Zhen-xing; LIU Hua-chang

doi:10.3969/j.issn.1672-5301.2024.09.006

Abstract：Objective To investigate the relationship between homocysteine(Hcy),platelet microparticles(PMP)and lipoprotein(a)[Lp(a)]and intra-atrial thrombosis(AT)in patients with atrial fibrillation complicated with pulmonary infection.Methods A total of 228 patients with atrial fibrillation admitted to Langfang People's Hospital from September 2021 to June 2023 were selected and divided into the thrombus group and no-thrombus group according to whether they had AT.The baseline data,Hcy,PMP and Lp(a)of the two groups were compared,and the effects of whether accompanied by lung infection on AT,Hcy,PMP,Lp(a)were compared.Spearman correlation and partial correlation analysis were performed to analyze the relationship between Hey,PMP and Lp(a)and AT patients with and without lung infection.Receiver operating characteristic curve(ROC)was used to asses the value of different schemes in predicting AT in patients with atrial fibrillation with pulmonary infection,and DeLong test was used to compare the predictive value of different schemes.Results The CHA2DS2-VASc score in the thrombus group was higher than that in the non-thrombus group(P＜0.05).The levels of Hcy,PMP and Lp(a)in the thrombus group were higher than those in the non-thrombus group[(20.5±6.14)μmol/L vs.(16.25±5.38)µmol/L,(4.18±1.25)×105/ml vs.(3.36±1.01)× 105/ml,(21.23±7.00)mg/dL vs.(15.51±5.25)mg/dL,P＜0.05].The scores of Hcy,PMP,Lp(a)and CHA2DS2-VASc in the thrombus group were higher than those in the non-thrombus group(P＜0.05).The Hcy,PMP and Lp(a)of the pulmonary infection group were higher than those of the group without pulmonary infection thrombosis;the Hcy,PMP and Lp(a)of the group with pulmonary infection thrombosis were higher than those of the group without pulmonary infection thrombosis(P＜0.05).Spearman correlation analysis showed that Hcy,PMP and Lp(a)were positively correlated with AT regardless of the presence of pulmonary infection(P＜0.05);and the correlation coefficient r value of each index in patients with pulmonary infection was higher than that in patients without pulmonary infection.Partial correlation analysis showed that Hcy,PMP and Lp(a)were still correlated with AT(P＜0.05).Without pulmonary infection,the combined AUC was higher than that of Hcy,PMP and Lp(a)(Z=4.182,4.203,3.677,all P＜0.05),alone.There was no significant difference between the combined AUC and the CHA2DS2-VASc score(Z=1.434,P=0.152＞0.05).With pulmonary infection,the combined AUC was higher than that of Hcy,PMP,Lp(a)(Z=3.677,3.676,3.089,all P＜0.05),alone;and the combined AUC was greater than the CHA2DS2-VASc score(Z=2.291,P＜0.05).Conclusion Pulmonary infection can further increase Hey,PMP and Lp(a)in patients with atrial fibrillation,and increase the risk of AT.The combined detection of Hey,PMP and Lp(a)for early warning AT in people without pulmonary infection is similar to the CHA2DS2-VASc score,and the combination of the three is better than the CHA2DS2-VASc score in patients with pulmonary infection,which can provide a complementary means for personalized prevention and treatment of atrial fibrillation AT,anticoagulation management,and thrombosis risk classification.