红细胞分布宽度与N末端脑利钠肽前体对OPCAB术后患者阵发性心房颤动的预测价值  

The predictive value of red blood cell distribution and NT-pro-BNP for paroxysmal atrial fibrillation in patients with OPCAB

作　　者：李晓密[1] 韩宏光[1] 王辉山[1] 孟庆涛[1] 杨忠路[1] 韩劲松[1] 刘宇[1] 张晓慧[1] LI Xiao-mi HAN Hong-guang WANG Hui-shan et al(Department of Cardiovascular Surgery, General Hospital of Shenyang Military Region, Shenyang 110016, China)

机构地区：[1]沈阳军区总医院心外科,辽宁省沈阳市110016

出　　处：《中国心血管病研究》2016年第9期812-818,862,共8页Chinese Journal of Cardiovascular Research

摘　　要：目的 探讨红细胞分布宽度（RDW）与N末端脑利钠肽前体（NT-pro-BNP）对非体外循环下冠状动脉旁路移植术（OPCAB）后患者阵发性心房颤动（AF）的预测价值.方法 选取2015年1～12月沈阳军区总医院心血管外科OPCAB后阵发性房颤患者247例为试验组,选择年龄、性别、合并疾病等一般情况相匹配的术后非房颤患者247例作为对照组.记录两组患者年龄、性别、合并疾病、实验室指标、超声心动图结果,并比较两组各项指标的差异.结果 两组患者术前基本情况、术前超声结果、实验室指标等比较未见统计学差异.OPCAB术后阵发性心房颤动组RDW（t=3.261,13.67±0.81,12.59± 1.02,P=0.001）、NT-pro-BNP（t=2.424,619.39±789.56,296.39±309.36,P=0.019）均高于对照组.与对照组相比,阵发性心房颤动组患者左心房直径增大（t=5.913,40.4±8.7,37.3±7.5,P=0.000）,左心室射血分数下降（t=-4.216,54.3±7.9,61.6±7.1,P=0.000）.应用多变量Logistic回归分析显示,LAD、RDW、NT-pro-BNP是OPCAB术后阵发性心房颤动的独立预测因素（P＜0.05）.RDW的ROC曲线下面积为0.659（95％CI 0.550～0.767,P=0.000）,Youden指数最大的切点是12.75,其敏感度为70.0％、特异度为45.3％.NT-pro-BNP的ROC曲线下面积为0.710（95％CI 0.611～0.810,P=0.007）,Youden指数最大的切点是156.80,其敏感度为82.5％、特异度为57.4％.结论 非体外循环下冠状动脉旁路移植术后阵发性心房颤动患者RDW、NT-pro-BNP水平明显升高,可能是OPCAB术后房颤发生的独立预测因素.Objective To investigate the predictive value of red blood cell distribution and NT-pro-BNP for paroxysmal atrial fibrillation in patients with OPCAB. Methods From January 2015 to December 2015, retro- spective analysis patients undergone off-pump coronary artery bypass （OPCAB） in Department of Cardiovascular Surgery, General Hospital of Shenyang Military Region 247 cases with paroxysmal AF, and 247 subjects as control matched for sex, age and atherosclerotic risk factors. Sex, age, previous medical history, laboratory parameters and echocardiography were analyzed between the patients with AF and controls. Results There were no significant dif- ferences in previous medical history, laboratory parameters and eehocardiography between the two groups（P〈0.05）. The level of RDW （t=3.261, 13.67±0.81, 12.59±1.02, P=0.001） and NT-pro-BNP （t=2.424, 619.39±789.56, 296.39±309.36, P=0.019） in AF group was significantly higher than that in control group. Compared with the control group, left atrial diameter（LAD） was increasedand（t=5.913, 40.4±8.7, 37.3±7.5, P=0.000）, left ventricular ejection fraction（LVEF） was decreased （t=-4.216, 54.3±7.9, 61.6±7.1, P=0.000） in AF group. Multivariate logistic regression analysis showed that LAD, RDW, NT-pro-BNP were independent predictors for paroxysmal AF. The PDW area under the ROC curve=0.659 （95%CI 0.550-0.767, P=0.000）, the critical point of RDW was 15.50. At this point,the sensitivity of RDW was 70.0%, the specificity was 45.3%. The NT-pro-BNP area under the ROC curve=0.710 （95%CI 0.611-0.810, P=0.007）, the critical point of NT-pro-BNP was 156.80. At this point, the sensitivity of NT-pro-BNP was 82.5%, the specificity was 57.4%. Conclusion Paroxysmal AF has higher level of RDW and NT-pro-BNP compared with controls, RDW and NT-pro-BNP are independent predic- tors for paroxysmal atrial fibrillation in patients with OPCAB.

关 键 词：红细胞分布宽度 N末端脑利钠肽前体 非体外循环下冠状动脉旁路移植术 心房颤动 

分 类 号：R654.2[医药卫生—外科学]