阵发性心房颤动患者射频消融术后复发的预测因素分析  

Predictor Analysis in Patients of Paroxysmal Atrial Fibrillation Recurrence After Radiofrequency Ablation

作　　者：徐海霞[1] 陆齐[1] 黄荫浩[1] 顾周山[1] 陈子微 牟建军[2] 

机构地区：[1]南通大学附属医院心内科,江苏省南通市226001 [2]西安交通大学医学院第一附属医院心内科

出　　处：《中国循环杂志》2017年第12期1203-1207,共5页Chinese Circulation Journal

基　　金：南通市科技项目基金(MS32015030;MS32016019)

摘　　要：目的:探讨与阵发性心房颤动(AF)患者导管射频消融术后心律失常复发相关的预测因素。方法:收集2013-03至2016-03接受导管射频消融的阵发性AF患者142例,分为复发组(n=46)和未复发组(n=96),比较两组临床资料差异。采用单因素及多因素Logistic回归分析阵发性AF消融术后复发相关的因素。根据尿酸水平(单位:μmol/L)的四分位数,分为Q1组(<259,n=33)、Q2组(259~320,n=37)、Q3组(321~380,n=37)、Q4组(>380,n=35),组间采用Kruskal-Wallis检验分析。受试者工作特征(ROC)曲线分析尿酸及尿酸联合代谢综合征(MS)在AF术后复发预测中的价值。结果:复发组与未复发组临床资料比较,体重指数、糖尿病、MS、AF病程、CHADS_2评分、肌酐、尿酸、B型利钠肽、左心室射血分数等,差异均有统计学意义(P均<0.05)。Logistic回归分析,AF病程(OR=1.02,95%CI:1.01~1.03,P=0.002)、尿酸水平(OR=1.01,95%CI:1.00~1.01,P=0.046)、MS(OR=4.73,95%CI:1.36~16.45,P=0.014)是AF复发的独立预测因子。根据尿酸四分位数分组临床资料比较提示性别、体重指数、MS、肌酐、左心室射血分数及AF复发等,差异均有统计学意义(P均<0.05)。ROC曲线分析提示,尿酸+MS在预测AF消融术后复发中的敏感性为80.4%,特异性为74.1%(AUC:0.79±0.04,95%CI:0.71~0.89,P=0.0001),而尿酸在预测AF术后复发中的敏感性为73.9%,特异性为57.2%(AUC:0.66,95%CI:0.56~0.76,P=0.02),尿酸+MS在AF消融术后复发中比尿酸更有预测价值,差异有统计学意义(P<0.05)。结论:尿酸及MS与阵发性AF消融术后复发相关,高尿酸合并MS对AF消融术后复发有一定的预测价值。Objective： To explore the predictors in patients of paroxysmal atrial fibrillation （AF） recurrence after radiofrequency catheter ablation （RFCA）. Methods： A total of 142 PAF patients received RFCA in our hospital from 2013-03 to 2016-03 were studied. The patients were divided into 2 groups： Recurrence group, n=46 and Non-recurrence group, n=96. Clinical data was compared between 2 groups and AF recurrent predictors were studied by single and multivariate Logistic regression analysis. Based on quartiles of uric acid （UA） level, the patients were categorized in another set of 4 groups： Q1 group, UA〈259 μmol/L, n=33, Q2 group, UA 259-320 μmol/L, n=37, Q3 group, UA 321-380 μmol/L, n=37 and Q4 group, UA〉380 μmol/L, n=35. The influence of UA on AF recurrence was measured by Kaplan-Meier test, the predictive value of UA combining metabolic syndrome （UA＋MS） on AF recurrence was studied by ROC curve analysis. Results： The BMI, diabetes, MS, AF duration, CHADS2 score, creatinine, UA and BNP were different between Recurrence group and Non-recurrence group, all P〈0.05. Logistic regression analysis indicated that AF duration （OR=1.02,95% CI 1.01-1.03, P=0.002）, UA level （OR=1.01, 95% CI 1.00-1.01, P=0.046） and MS （OR=4.73, 95% CI 1.36-16.45, P=0.014） were the independent predictors for AF recurrence. UA quartile analysis indicated that gender, BMI, MS, creatinine, LVEF and the incidence of AF recurrence had signifcant discrepancy by different UA levels, all P〈0.05. ROC curve showed that the predictive values for UA＋MS in AF recurrence had the sensitivity at 80.4%, specificity at 74.1% （AUC 0.79±0.04, 95% CI 0.71-0.89, P=0.0001）, for UA in AF recurrence had the sensitivity at 73.9%, specificity at 57.2% （AUC 0.66, 95% CI 0.56-0.76, P=0.02）; UA＋MS had the higher predictive value than UA alone, P〈0.05. Conclusion： Both UA and MS were related to AF recurrence, high UA level combining MS had certain predictive value for AF recurrence in PAF patients after RFCA.

关 键 词：心房颤动 导管消融术 危险性评估 

分 类 号：R54[医药卫生—心血管疾病]