术前血清可溶性ST2水平对心房颤动射频消融术后复发的预测价值研究  

Value of Preoperative Serum Soluble ST2 Level in Predicting Recurrence of Atrial Fibrillation after Radiofrequency Ablation

作　　者：温旭涛[1] 杨希立[1] 舒建坤 许兆延[1] 李炜杰 WEN Xu-tao;YANG Xi-li;SHU Jian-kun;XU Zhao-yan;LI Wei-jie(Department of Cardiology,the First People’s Hospital of Foshan,Guangdong Foshan 528000,China)

机构地区：[1]佛山市第一人民医院心血管内科,广东佛山528000

出　　处：《现代检验医学杂志》2022年第3期191-197,共7页Journal of Modern Laboratory Medicine

基　　金：佛山市医学类科技攻关项目(编号:1920001001068)。

摘　　要：目的探究术前可溶性生长刺激表达基因2(soluble growth stimulation expressed gene 2,sST2)蛋白对心房颤动射频消融术后复发的预测价值。方法选择2019年12月~2021年9月于佛山市第一人民医院行射频消融术治疗的心房颤动患者作为研究对象,根据术后复发情况,将患者分为复发组(41例)和非复发组(79例)。比较两组患者的一般资料、心脏彩超检查指标及血液生化指标,多因素Logistic回归分析影响患者术后复发的因素;受试者工作特征曲线(ROC)评价术前sST2对患者术后复发的预测价值并获得最佳临界值,根据临界值将患者分为sST2低表达组和高表达组,Kaplan-Meier法绘制生存曲线比较两组患者的术后复发情况;Pearson检验分析术前sST2与其它危险因素的相关性;构建反向传播(back propagation,BP)神经网络模型,评价其预测效能。结果左房内径(left artrial diameter,LAD)增加、血清尿酸(uric acid,UA)升高、氨基末端脑钠肽前体(N-terminal pro-brain natriuretic peptide,NT-proBNP)升高、超敏C反应蛋白(high-sensitivity C-reactive protein,hs-CRP)升高、白介素(interleukin,IL)-6升高、sST2升高是导致心房颤动患者射频消融术后复发的独立危险因素(OR=3.372,3.728,3.183,3.645,3.473,2.906,均P<0.05);sST2预测患者术后复发的ROC曲线下面积为0.796(95%CI:0.726~0.842,P<0.001),最佳临界值为151.46 ng/ml,sST2低表达组术后未复发率(78.16%)明显高于sST2高表达组(33.33%),差异有统计学意义(Log-Rankχ^(2)=21.374,P<0.001);sST2与LAD,UA,NT-proBNP,hs-CRP和IL-6均呈明显正相关(r=0.732,0.565,0.683,0.501,0.469,均P<0.05);BP神经网络模型预测患者术后复发的准确性和有效性较好。结论术前高水平sST2与心房颤动患者射频消融术后复发有关,对患者术后复发有一定的预测价值。Objective To explore the predictive value of preoperative soluble growth stimulation expressed gene 2(sST2)protein for recurrence after radiofrequency ablation of atrial fibrillation.Methods Patients with atrial fibrillation who underwent radiofrequency ablation in the First People’s Hospital of Foshan from December 2019 to September 2021 were selected.According to the postoperative recurrence,the patients were divided into recurrent group(n=41)and non-recurrent group(n=79).The general data,cardiac color Doppler ultrasound examination indexes and blood biochemical indexes were compared between the two groups of patients.Multivariate Logistic regression analysis was used to analyze the factors affecting postoperative recurrence of patients.The receiver operating characteristic(ROC)curve evaluated the predictive value of preoperative sST2 for postoperative recurrence and obtained the best critical value.According to the critical value,the patients were divided into sST2 low expression group and high expression group.Kaplan-Meier method was used to draw survival curve to compare the postoperative recurrence of the two groups of patients.Pearson test analyzed preoperative sST2 and other risks correlation of factors,and constructed a back propagation(BP)neural network model to evaluate its predictive effectiveness.Results Increased left atrial diameter(LAD)and all increased serum uric acid(UA),N-terminal pro-brain natriuretic peptide(NTproBNP),high-sensitivity C-reactive protein(hs-CRP),interleukin(IL)-6 and sST2 were independent risk factors for recurrence after radiofrequency ablation in patients with atrial fibrillation(OR=3.372,3.728,3.183,3.645,3.473,2.906,all P<0.05).The area under the ROC curve for sST2 to predict postoperative recurrence in patients was 0.796(95%CI:0.726~0.842,P<0.001),and the best cut-off value was 151.46 ng/ml,the postoperative non-recurrence rate(78.16%)of the sST2 low expression group was significantly higher than that of the sST2 high expression group(33.33%),the difference was statisti

关 键 词：可溶性生长刺激表达基因2蛋白 心房颤动 射频消融术 反向传播神经网络模型 

分 类 号：R541.75[医药卫生—心血管疾病] R392.11[医药卫生—内科学]