血清S100β水平对心房颤动导管消融术后复发的预测价值  

Predictive value of serum S100βlevel on recurrence of atrial fibrillation after catheter ablation

作　　者：刘旨浩 段首鹏 王钧 郭辅定 孙吉 邓强 李旭俊 徐赛婷 谢梦洁 宋凌鹏 王怡竣 周丽平[1] 王悦怡 江洪[1] 余锂镭[1] Liu Zhihao;Duan Shoupeng;Wang Jun;Guo Fuding;Sun Ji;Deng Qiang;Li Xujun;Xu Saiting;Xie Mengjie;Song Lingpeng;Wang Yijun;Zhou Liping;Wang Yueyi;Jiang Hong;Yu Lilei(Department of Cardiology,Renmin Hospital of Wuhan University,Cardiac Autonomic Nervous System Research Center of Wuhan University,Cardiovascular Research Institute of Wuhan University,Hubei Key Laboratory of Cardiology,Wuhan 430060,China)

机构地区：[1]武汉大学人民医院心内科、武汉大学心脏自主神经研究中心、武汉大学心血管病研究所、心血管病湖北省重点实验室,430060

出　　处：《中国心血管杂志》2023年第1期23-28,共6页Chinese Journal of Cardiovascular Medicine

基　　金：国家自然科学基金(81871486、81970287)。

摘　　要：目的探讨血清S100β水平对心房颤动(房颤)患者导管消融术后复发的预测价值。方法回顾性观察性研究,连续纳入2020年6月至2021年3月于武汉大学人民医院首次行三维标测指导下环肺静脉电隔离术的阵发性房颤患者。术前通过ELISA法检测血清S100β水平。导管消融术3个月后(3个月内为空白期)如出现持续时间超过30 s的快速型房性心律失常则定义为复发。通过绘制受试者工作特征(ROC)曲线分析血清S100β水平预测房颤复发的最佳截断值,应用多因素Cox回归分析S100β对行导管消融治疗的房颤患者术后复发的影响。结果(1)共纳入102例患者,平均随访(10.96±2.16)个月,其中25例(24.5%)患者房颤复发。根据ROC曲线确定血清S100β水平预测导管消融术后房颤复发的最佳截断值为13.45 ng/ml,据此将患者分为S100β低水平组(S100β<13.45 ng/ml)46例和S100β高水平组(S100β≥13.45 ng/ml)56例。(2)S100β高水平组和低水平组的临床基线特征、实验室检查结果和CHA2DS2-VASc评分等比较,差异均无统计学意义(均为P>0.05);而S100β高水平组的房颤复发率显著高于S100β低水平组(37.5%比8.7%,χ^(2)=11.325,P=0.001)。(3)Kaplan-Meier生存曲线分析显示,S100β高水平组患者的累积无房颤复发率显著低于S100β低水平组(χ^(2)=10.946,Log-rank P<0.001)。(4)多因素Cox回归分析显示,血清S100β水平升高是导管消融术后房颤复发的独立预测因子(HR:6.890,95%CI:2.065~22.983,P=0.002)。(5)ROC曲线分析结果显示,血清S100β水平预测导管消融术后房颤复发的ROC曲线下面积(AUC)为0.682(95%CI:0.562~0.803,P=0.006),敏感度为84.0%,特异度为54.5%;S100β联合CHA2DS2-VASc评分可提高对导管消融术后房颤复发的预测准确性(AUC=0.801,敏感度为88.0%,特异度为64.9%,P<0.001)。结论血清S100β水平升高是房颤患者导管消融术后复发的独立危险因素,S100β联合CHA2DS2-VASc评分可提高其预测价值。Objective To explore the predictive value of serum S100βlevel on recurrence of atrial fibrillation(AF)after catheter ablation in patients with paroxysmal AF.Methods This was a singlecenter retrospective observational study.Paroxysmal AF patients who underwent pulmonary vein isolation for the first time under the guidance of three-dimensional mapping in Renmin Hospital of Wuhan University were consecutively enrolled from June 2020 to March 2021.Serum S100βlevels were detected by ELISA.AF recurrence was defined as a documented episode of any atrial arrhythmias(AF,atrial flutter and atrial tachycardia)lasting≥30 s during the follow-up period after a blanking period of 3 months.The optimal cut-off value of the parameters in predicting the AF recurrence was identified using receiver operating characteristic(ROC)curve analysis.The predictive efficacies of serum S100βlevels were evaluated with multivariate Cox regression analysis.Results(1)A total of 102 patients were included in this study,and followed up for an average of(10.96±2.16)months,of which 25(24.5%)patients had AF recurrence.According to the S100βcut-off value,patients were divided into low-level S100βgroup(S100β<13.45 ng/ml,n=46)and high-level S100βgroup(S100β≥13.45 ng/ml,n=56).(2)There were no significant differences in the clinical baseline characteristics,laboratory parameters and CHA2DS2-VASc score between the high-level and low-level S100βgroup(all P>0.05).The recurrence rate of AF was significantly higher in the high-level S100βgroup than that in the low-level S100βgroup(37.5%vs.8.7%,χ^(2)=11.325,P=0.001).(3)Kaplan-Meier survival curve analysis showed that the cumulative recurrence-free rate of high-level S100βgroup was significantly lower than that of low-level S100βgroup(χ^(2)=10.946,Log-rank P<0.001).(4)Multivariate Cox regression showed that high S100βlevel was an independent predictor of AF recurrence after catheter ablation in paroxysmal AF patients(HR:6.890,95%CI:2.065-22.983,P=0.002).(5)ROC analyses showed that the area und

关 键 词：S100Β 心房颤动 导管消融术 复发 

分 类 号：R541.75[医药卫生—心血管疾病]