阵发性心房颤动导管消融术后早期复发的临床研究  

Clinical study on early recurrence of paroxysmal atrial fibrillation after catheter ablation

作　　者：张立臻 吴小朋 刘淑珍[2] 宋恒良[1] 李保银 万大国[1] ZHANG Lizhen;WU Xiaopeng;LIU Shuzhen;SONG Hengliang;LI Baoyin;WAN Daguo(Department of Cardiology,The second Affiliated Hospital,Zhengzhou University,Zhengzhou 450014,China)

机构地区：[1]郑州大学第二附属医院心血管内科,郑州450014 [2]郑州大学第二附属医院急诊科,郑州450014 [3]首都医科大学附属北京朝阳医院心血管内科,北京100020

出　　处：《实用医学杂志》2019年第24期3798-3802,共5页The Journal of Practical Medicine

基　　金：河南省科技攻关项目(编号：162102310143)

摘　　要：目的探讨与阵发性心房颤动(paroxysmal atrial fibrillation,PAF)患者接受射频消融术后早期复发相关的预测因素。方法纳入166例行导管消融术的PAF患者。根据术后3个月是否复发分为早期复发组和非复发组,检测患者术前及术后3个月血浆尿酸、高敏C反应蛋白(hsCRP)水平,分析术后早期复发相关的影响因素并评估其预测价值。结果与非复发组相比,早期复发组患者年龄、房颤病程、左心房前后径(LAD)、尿酸、hsCRP差异均存在统计学意义(P<0.05)。多因素Logistic回归分析显示,术前尿酸、hsCRP和LAD是PAF消融术后早期复发的独立影响因素。ROC曲线显示,术前尿酸水平预测PAF消融术后早期复发的敏感性为0.667,特异性为0.617(AUC:0.685,95%CI:0.600~0.769,P<0.001),而术前尿酸联合hsCRP预测PAF消融术后早期复发的敏感性为0.706,特异性为0.809(AUC:0.799,95%CI:0.721~0.877,P<0.001)。术前尿酸联合hsCRP预测PAF消融术后早期复发比尿酸有更好的价值,差异有统计学意义(P<0.05)。结论术前尿酸、hsCRP和LAD是PAF消融术后早期复发的独立影响因素,术前尿酸联合hsCRP对PAF患者术后早期复发有一定的预测价值。Objective To explore the predictive factors associated with early recurrence of radiofrequency catheter ablation(RFCA)in patients with paroxysmal atrial fibrillation(PAF). Methods PAF patients undergoing catheter ablation were enrolled. According to whether with recurrence 3 months after the operation,the patients were divided into early recurrence group and non-recurrence group. The plasma uric acid(UA)and high sensitivity C-reactive protein(hsCRP)levels were determined before and 3 months after the operation,and the influencing factors of early recurrence were analyzed and their predictive value was evaluated. Results Compared with non-recurrence group,there was significant difference in age,duration of atrial fibrillation,LAD,UA,and hsCRP in the early recurrence group(P < 0.05). Multivariate logistic regression analysis showed that preoperative UA,hsCRP and LAD were independent factors for early recurrence in patients with PAF after RFCA. ROC curve showed that the sensitivity of predictive values for preoperative UA in early recurrence of PAF patients was 66.7%and specificity 61.7%(AUC:0.685,95%CI:0.600~0.769,P < 0.001),while UA + hsCRP in early recurrence had the sensitivity of 70.6%,and specificity of 80.9%(AUC:0.799,95%CI:0.721~0.877,P < 0.001). Preoperative UA combined with hsCRP was more valuable than UA alone in predicting early recurrence and the difference was statistically significant(P < 0.05). Conclusion Preoperative UA,hsCRP and LAD are independent factors for early recurrence in patients with PAF after RFCA. Preoperative UA combined with hsCRP has a predictive value for early recurrence.

关 键 词：阵发性心房颤动 导管消融 早期复发 

分 类 号：R54[医药卫生—心血管疾病]