Abstract: Background The occurrence of atrial fibrillation（AF）is closely related to atrial remodeling，inflammation， oxidative stress and other factors，among which atrial remodeling is the main 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 have not been evaluated. Objective To explore the expression of MOTS-c in the serum of 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. They were divided into paroxysmal AF group（n=49）and non-permanent AF group（n=93）. 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 The serum MOTS-c levels in the control group and the AF group were（230.31±51.93）μg/L and（158.75±38.69）μg/L respectively；the serum MOTS-c levels in the AF group wre lower than that in the control group（t=10.111，P<0.001）. The serum MOTS-c levels in patients with paroxysmal AF and non-paroxysmal AF were（175.38±42.03） μg/L and（149.98±33.89）μg/L respectively；the serum MOTS-c levels in the non-paroxysmal AF group were lower than that in the paroxysmal AF group，and the difference was statistically significant（t=3.900，P<0.001）.Serum MOTS-c was negatively correlated with left atrial diameter（LAD）in the 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 independent influencing factors for AF.Receiver operating characteristic curve analysis showed that an area under the curve of serum MOTS-c expression was 0.859（95%CI=0.794-0.923），the optimal cut-off value was 188.5μg/L，the sensitivity was 0.88，and the specificity was 0.73. Conclusion The serum MOTS-c levels 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: Atrial fibrillation, MOTS-c, Atrial remodeling, Root cause analysis, Forecasting

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不明确。目的 探讨MOTS-c在房颤患者血清中的表达情况，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 连续选取2023年9月—2024年3月在中南大学湘雅医学院附属长沙医院心内科住院的非瓣膜性房颤患者142例（作为房颤组）。49例患者为阵发性房颤，93例患者为非阵发性房颤。并选取同期在本院行健康体检且无房颤病史的受试者48例为对照组。通过酶联免疫吸附法（ELISA法）检测不同人群血清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，并采用多因素Logistic回归分析探究MOTS-c是否为房颤的独立危险因素，受试者工作特征曲线（ROC曲线）分析MOTS-c对房颤的预测价值。结果 对照组、房颤组血清MOTS-c水平分别为（230.31±51.93）μg/L和（158.75±38.69）μg/L；房颤组患者血清MOTS-c水平低于对照组（t=10.111，P<0.001）。阵发性房颤患者、非阵发性房颤患者血清MOTS-c水平分别为（175.38±42.03）μg/L和（149.98±33.89）μg/L；非阵发性房颤组患者MOTS-c水平低于阵发性房颤组，差异有统计学意义（t=3.900，P<0.001）。房颤组中MOTS-c与左心房内径（LAD）呈负相关（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）、MOTS-c（OR=0.970，95%CI=0.958~0.982，P<0.001）是房颤的独立影响因素。血清MOTS-c预测房颤的ROC曲线下面积为0.859（95%CI=0.794~0.923），最佳截断值为188.5μg/L，灵敏度为0.88，特异度为0.73。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: 心房颤动, MOTS-c, 心房重构, 影响因素分析, 预测