持续性心房颤动的左房肺静脉解剖特点  

Anatomical characteristics of left atrium and pulmonary veins in persistent atrial fibrillation

作　　者：张海洋 苗浩[1] 鲍伟 胡晓芹 葛力萁 李菲 张超群 谢丽响 李承宗 ZHANG Hai-yang;MIAO Hao;BAO Wei;HU Xiao-qin;GE Li-qi;LI Fei;ZHANG Chao-qun;XIE Li-xiang;LI Cheng-zong(Department of Cardiovascular Medicine,Affiliated Hospital of Xuzhou Medical University,Xuzhou 221000,Jiangsu,China;Department of Cardiovascular Medicine,Suixi County Hospital,Huaibei 235100,Anhui,China;Department of Imaging,Affiliated Hospital of Xuzhou Medical University,Xuzhou 221000,Jiangsu,China)

机构地区：[1]徐州医科大学附属医院心血管内科,江苏徐州221000 [2]濉溪县医院心血管内科,安徽淮北235100 [3]徐州医科大学附属医院影像科,江苏徐州221000

出　　处：《中国心脏起搏与心电生理杂志》2024年第3期165-170,共6页Chinese Journal of Cardiac Pacing and Electrophysiology

摘　　要：目的探讨持续性心房颤动(PeAF)患者的临床特点和左房肺静脉解剖特点。方法回顾性入选2020年1月至2021年12月徐州医科大学附属医院心血管内科的非瓣膜性心房颤动患者,分为阵发性心房颤动(PAF)组和PeAF组。所有患者术前均行左房肺静脉计算机断层扫描血管造影(CTA)检查,通过Siemens Syngo.via工作站软件分析测量解剖参数包括左右肺静脉开口直径、与水平面所成角度、左房体积、左房球形度。比较两组患者的临床特征及左房肺静脉CTA解剖参数的差异。结果共入选347例患者,其中PeAF组122例,PAF组225例。与PAF组比较,PeAF组脑梗死比例(18.0%vs8.9%)、饮酒史比例(28.7%vs16.4%)、氨基末端脑钠肽前体[819.80(469.00,1829.62)pg/mLvs428.70(207.82,993.93)pg/mL]、胺碘酮应用比例(45.9%vs31.6%)均较高(P均<0.05)。PeAF的左上肺静脉开口前后径[(1.68±0.41)cmvs(1.50±0.34)cm,P<0.01]、左上肺静脉开口上下径[(2.24±0.44)cmvs(2.04±0.37)cm,P<0.01]、右上肺静脉开口前后径[(1.70±0.37)cm vs(1.62±0.34)cm,P=0.041]、左下肺静脉开口上下径[(1.52±0.26)cm vs(1.45±0.30)cm,P=0.034]、左房体积[(94.50±30.93)cm^(3)vs(72.50±28.63)cm^(3),P<0.01]、左房球形度[(80.95±5.51)%vs(78.77±5.97)%,P=0.001]均较PAF高,而左下肺静脉与水平面所成角度[15.00°(0°,25.00°)vs22.00°(0°,10.00°),P=0.034]较PAF低(P均<0.05)。多因素回归分析显示,饮酒(HR=2.447;95%CI:1.204~4.974;P=0.013)、左下肺静脉与水平面所成角度(HR=1.024;95%CI:1.002~1.046;P=0.029)、左房体积(HR=1.013;95%CI:1.001~1.024;P=0.001)和左房球形度(HR=1.055;95%CI:1.002~1.110;P=0.040)是PeAF相关的独立危险因素。结论PeAF组与PAF组比较,临床危险因素较少,左房肺静脉CTA显示了更多的解剖危险因素。饮酒、左下肺静脉与水平面所成角度、左房体积和左房球形度与PeAF独立相关。Objective Explore the clinical characteristics and left atrial pulmonary vein anatomy of patients with persistent atrial fibrillation(PeAF).Methods Retrospective selection of non valvular atrial fibrillation(AF)patients from Xuzhou Medical University Affiliated Hospital from January 2020 to December 2021,divided into paroxysmal atrial fibrillation(PAF)group and PeAF group.All patients underwent left atrial pulmonary vein computed tomography angiography(CTA)examination before surgery.Anatomical parameters including left and right pulmonary vein opening diameter,angle to horizontal plane,left atrial volume,and left atrial sphericity were analyzed and measured using(Siemens Syngo.via)workstation software.Compare the clinical characteristics and differences in left atrial pulmonary vein CTA anatomical parameters between two groups of patients.Results A total of 347patients were selected,including 122in the PeAF group and 225in the PAF group.Compared with the PAF group,the proportion of cerebral infarction(18.0%vs 8.9%,P=0.013),history of alcohol consumption(28.7%vs16.4%,P=0.007),NT-proBNP[819.80(469.00,1829.62)pg/mL vs 428.70(207.82,993.93)pg/mL,P<0.01],and the proportion of amiodarone use(45.9%vs 31.6%,P=0.008)were all higher(P<0.05).When comparing the anatomical parameters of left atrial pulmonary vein CTA,the anterior and posterior diameters of the left upper pulmonary vein opening[(1.68±0.41)cm vs(1.50±0.34)cm,P<0.01],the upper and lower diameters of the left upper pulmonary vein opening[(2.24±0.44)cm vs(2.04±0.37)cm,P<0.01],the anterior and posterior diameters of the right upper pulmonary vein opening[(1.70±0.37)cm vs(1.62±0.34)cm,P=0.041],left lower pulmonary vein opening upper and lower diameter[(1.52±0.26)cm vs(1.45±0.30)cm,P=0.034],the left atrial volume[(94.50±30.93)cm^(3) vs(72.50±28.63)cm^(3),P<0.01],and the left atrial sphericity[(80.95±5.51)%vs(78.77±5.97)%,P=0.001]were all higher,the angle between the left lower pulmonary vein and the horizontal plane[15.00°(0°,25.00°)vs 22.00°(0°,10.0

关 键 词：心血管病学 非瓣膜病心房颤动 持续性心房颤动 阵发性心房颤动 左房肺静脉CTA 射频导管消融 

分 类 号：R541.75[医药卫生—心血管疾病] R454.1[医药卫生—内科学]