Abstract: Background The occurrence of atrial fibrillation is believed to be closely related to atrial remodeling, inflammation, and oxidative stress，among which atrial remodeling is the pathogenesis. Studies have shown that MOTS-c is a novel mitochondrial-derived peptide with anti-inflammatory, protective oxidative stress and cardiac remodeling effects. However, the expression and role of MOTS-c in AF has not been evaluated.Objective To explore the expression of MOTS-c in the serum of atrial fibrillation (AF) patients and its correlation with atrial remodeling in AF,and to analyze the value of MOTS-c in predicting AF.Methods A total of 142 patients with AF who were admitted to the Department of Vasculardiology，The Affiliated Changsha Hospital of Xiangya School of Medcine，Central South University from September 2023 to March 2024 were selected as the AF group. According to the situation of AF, they were divided into paroxysmal AF group (n=49), persistent AF group (n=48), and permanent AF group (n=45). Another 48 patients without AF history admitted during the same period were selected as the control group. The serum MOTS-c levels were detected by using ELISA in each group, and the cardiac ultrasound indicators were measured by cardiac color Doppler echocardiography.The serum MOTS-c levels in groups were compared. The correlation of MOTS-c levels with the cardiac ultrasound indicators in AF patients was identified. Multivariate Logistic regression analysis was used to identify whether serum MOTS-c was an independent risk factor for AF. The optimal cut-off value of serum MOTS-c in predicting AF was determined by the receiver operating characteristic（ROC）curves.Results Serum MOTS-c expression levels were lower in the AF group than in the control group(P<0.001) .MOTS-c expression was lower in the permanent AF group than in the paroxysmal and persistent AF groups(P<0.01). The serum MOTS-c levels in the persistent AF group were lower than those in the paroxysmal AF group, but there was no significant difference(P > 0.05) .Partial correlation analysis showed a negative correlation between MOTS-c expression and LAD changes in AF group（r= -0.317，P<0.001）. Multivariate Logistic regression analysis showed that LAD （OR=1.481，95%CI：1.262~1.738，P＜0.001）and MOTS-c （OR=0.970，95%CI：0.958~0.982，P＜0.001）were independently associated with AF. Receiver operating characteristic curve analysis showed that an area under the curve of serum MOTS-c expression was 0.859( 95% confidence interval, 0.794~0.923；P<0.001). Conclusion The levels of MOTS-c in serum were significantly decreased in patients with AF, these are negatively correlated with LAD.MOTS-c may be involved in the process of atrial remodeling in patients with AF.Lowered serum MOTS-c levels may be an independent risk factor for the occurrence of AF and have predictive diagnostic value for AF.

Key words: MOTS-c, atrial fibrillation, atrial remodeling

摘要： 背景 心房颤动（简称房颤）的发生与心房重构、炎症、氧化应激等密切相关，其中心房重构是其主要发病机制。研究显示MOTS-c是一种新型线粒体衍生肽，具有抗炎、保护氧化应激和防止心脏重塑等作用。但MOTS-c在房颤患者中的表达及作用尚未明确。目的 探讨MOTS-c在房颤患者血清中的表达，其与房颤心房重构的相关性，以及MOTS-c预测房颤的价值。方法 选择2023年9月至2024年3月在中南大学湘雅医学院附属长沙医院心血管内科住院的房颤病人142例为研究对象，作为房颤组。再依据房颤的发作情况，49例为阵发性房颤组、48例为持续性房颤组、45例为永久性房颤组；并选择48例无房颤病史的患者48例作为对照组。通过酶联免疫吸附法（ELISA法）检测各组血清MOTS-c水平，心脏彩色多普勒超声检查测量心脏超声指标。比较各组MOTS-c的差异；分析MOTS-c与心脏超声指标的相关性，Logistic回归分析MOTS-c是否为房颤的独立危险因素，ROC曲线分析MOTS-c对房颤的预测价值。结果 房颤组血清MOTS-c水平显著低于对照组（P<0.001），且永久性房颤组血清MOTS-c水平低于阵发性房颤组和持续性房颤组（P<0.01）。持续性房颤组血清MOTS-c水平低于阵发性房颤组，但无统计学差异（P >0.05）。房颤组血清MOTS-c水平与左心房内径（LAD）呈负相关关系（r= -0.317，P<0.001）。多因素Logistic回归分析结果显示，LAD（OR=1.481，95%CI：1.262~1.738，P＜0.001）和MOTS-c（OR=0.970，95%CI：0.958~0.982，P＜0.001）与房颤独立相关。受试者操作特征（ROC）曲线分析显示，血清MOTS-c的曲线下面积为0.859，95%置信区间为0.794~0.923（P<0.001）。结论 房颤患者血清MOTS-c水平显著降低，并与LAD呈负相关，提示房颤可能参与房颤患者的心房重构过程。血清MOTS-c降低可能是房颤发生的独立危险因素，并对房颤有预测诊断价值。

关键词: MOTS-c, 心房颤动, 心房重构