阵发性心房颤动患者环肺静脉射频消融术后复发的预测因素研究  

Predictors of recurrence in patients with paroxysmal atrial fibrillation after circumferential pulmonary vein radiofrequency ablation

作　　者：徐敏[1] 刘飞[1] 葛志翔 缪羽霞 孟军[1] 杨珍妮 Xu Min;Liu Fei;Ge Zhixiang;Miao Yuxia;Meng Jun;Yang Zhenni(Echocardiogram Room of Changzhou First People's Hospital,the Third Affiliated Hospital of Suzhou University,Changzhou 213003,China)

机构地区：[1]苏州大学附属第三医院常州市第一人民医院心超室,213003

出　　处：《中华医学超声杂志（电子版）》2020年第12期1220-1226,共7页Chinese Journal of Medical Ultrasound(Electronic Edition)

基　　金：国家自然科学青年基金项目(81701734);常州市卫健委指导项目(WZ201804);常州市科技局应用基础研究(CJ20190086)。

摘　　要：目的探讨阵发性心房颤动(PAF)患者左心房功能联合B型脑钠肽(BNP)预测环肺静脉射频消融术(CPVA)后复发的意义。方法选取2017年1月至2018年12月在常州市第一人民医院住院的拟行第一次CPVA术的PAF患者201例。CPVA术前测定患者血液BNP水平;实时三维超声心动图(RT-3DE)获取左心房时间-容积曲线;根据术后3个月动态心电图结果,将PAF患者分为窦性心律组和复发组。应用多因素Logistic回归分析影响CPVA术后PAF复发的独立危险因素;对获得的独立危险因素行预测PAF复发的ROC曲线,比较不同指标的效能。结果201例PAF患者完成CPVA术,随访中36例(17.9%)复发,复发组BNP高于窦性心律组(P<0.05)。2组间左心房最大容积指数(LAVImax)、左心房最小容积指数(LAVImin)差异有统计学意义(均P<0.05);2组间膨胀指数(EI)、舒张期射血指数(DEI)、被动射血指数(PEI)、主动射血指数(AEI)差异均有统计学意义(均P<0.05)。多因素Logistic回归分析表明:术前BNP、DEI及PAF病史是PAF复发的独立预测因素(均P<0.05)。ROC曲线显示:DEI及联合指标(DEI+BNP)预测CPVA术后复发的效能均优于LAVImin(AUC:0.881 vs 0.686、0.901 vs 0.686,均P<0.05);联合诊断的特异性优于DEI及BNP(89.7%vs 79.4%、89.7%vs 72.7%,均P<0.05)。结论CPVA术治疗的PAF患者中,左心房存储功能受损及BNP增高均是CPVA术后PAF复发的独立预测因素,两者联合可提高预测复发的特异度。Objective To observe the significance of left atrial(LA)function combined with Btype natriuretic peptide(BNP)in predicting the recurrence of paroxysmal atrial fibrillation(PAF)after cardiopulmonary vein ablation(CPVA).Methods A total of 201 PAF patients from Changzhou NO.1 People's Hospital who planned to receive the first CPVA operation were selected.According to the results of dynamic electrocardiogram 3 months after CPVA,AF patients were divided into either a sinus rhythm group or a recurrence group.Multivariate logistic regression analysis was performed to analyze the independent factors influencing the recurrence of PAF after CPVA.Receiver operating characteristic(ROC)curve analysis was used to compare the diagnostic efficiency of each index.Results Of the 201 AF patients who underwent CPVA,36(17.9%)experienced recurrent AF during follow-up.BNP in the recurrence group was significantly higher than that of the sinus rhythm group(P<0.05).There were significant differences in LA minimum volume index(LAVImin),LA maximum volume index(LAVImax),expansion index(EI),diastolic ejection index(DEI),passive ejection index(PEI),and active ejection index(AEI)between the two groups (P<0.05 for all).Multivariate logistic regression analysis showed that BNP,DEI,and history of PAF were independent predictors of AF recurrence(P<0.05).ROC curve analysis showed that the areas under the ROC curves(AUCs)of DEI and combination index(DEI+BNP)were both better than LAVImin(AUC:0.881 vs 0.686,0.901 vs 0.686,P<0.05 for both),and the specificity of the combination index(DEI+BNP)was better than either of them alone(89.7%vs 79.4%,89.7%vs 72.7%,P<0.05 for both).Conclusions In patients with PAF treated by CPVA,impaired LA storage function and increased BNP are independent predictors of AF recurrence after CPVA.The combination of the two can improve the specificity of diagnosis.

关 键 词：心房颤动 B型脑钠肽 环肺静脉射频消融术 复发 超声心动描记术 

分 类 号：R541.75[医药卫生—心血管疾病]