血清PDGF联合BNP预测非体外循环冠状动脉搭桥术患者术后新发心房颤动的临床价值  

Clinical value of platelet derived growth factor combined with brain natriuretic peptide in predicting new-onset atrial fibrillation after off-pump coronary artery bypass grafting

作　　者：姜丽杰[1] 刘兆汛 张新花 赵竞余[1] Jiang Lijie;Liu Zhaoxun;Zhang Xinhua;Zhao Jingyu(Department of Cardiovascular Surgery,Handan Central Hospital,Handan 056002,China;不详)

机构地区：[1]邯郸市中心医院心血管外科,邯郸056002

出　　处：《中国循证心血管医学杂志》2024年第5期564-568,共5页Chinese Journal of Evidence-Based Cardiovascular Medicine

基　　金：河北省邯郸市科学技术研究与发展计划项目(1823208048ZC)。

摘　　要：目的探讨血小板源性生长因子(PDGF)联合血清脑钠肽(BNP)预测非体外循环冠状动脉搭桥术(OPCABG)患者术后新发心房颤动(房颤)的临床价值。方法选取2021年1月至2023年1月于邯郸市中心医院心血管外科收治的197例择期行OPCABG术的患者作为研究对象。所有患者于术前检测血清PDGF水平(酶联免疫吸附法)和血清BNP水平(放射免疫法)。根据患者术后住院期间是否发生房颤分为新发房颤组(n=37)和非新发房颤组(n=160)。采用受试者工作特性(ROC)曲线评估血清PDGF、BNP对OPCABG患者术后是否新发房颤的预测价值;采用多因素Logistic回归分析探讨OPCABG患者术后新发房颤的影响因素。结果新发房颤组血清BNP、PDGF水平高于非新发房颤组(P<0.05)。新发房颤组患者年龄、右冠状动脉狭窄率、术后主动脉内球囊反搏(IABP)辅助比例、机械通气时间、空腹血糖(FPG)、左心房容积指数(LAVI)均高于非新发房颤组,左室射血分数(LVEF)低于非新发房颤组(P<0.05)。多因素Logistic回归分析显示,右冠状动脉近段狭窄≥75%(OR=2.090,95%CI:1.495~2.922)、BNP≥287.64 pg/ml(OR=2.746,95%CI:1.798~4.193)、PDGF≥398.57μg/L(OR=2.601,95%CI:1.765~3.835)是OPCABG患者术后发生房颤的影响因素(P<0.05)。血清BNP、PDGF预测OPCABG患者术后新发房颤的AUC(95%CI)分别为0.781(0.756~0.818)、0.825(0.797~0.861),两者联合预测的AUC(95%CI)为0.901(0.874~0.935)。结论OPCABG术后新发房颤患者血清PDGF、BNP水平均升高,二者可作为OPCABG患者术后新发房颤的预测指标,且联合检测预测效能更高,可为临床早期治疗提供依据。Objective To investigate the clinical value of platelet derived growth factor(PDGF)combined with brain natriuretic peptide(BNP)in predicting new-onset atrial fibrillation(AF)in patients undergone off-pump coronary artery bypass grafting(OPCABG).Methods The patients(n=197)undergone OPCABG were chosen from Department of Cardiovascular Surgery in Handan Central Hospital from Jan.2021 to Jan.2023.The levels of serum PDGF(enzyme-linked immunosorbent assay)and BNP(radioimmunoassay)were detected in all patients before the operation.The patients were divided,according to whether they had AF or not during hospitalization,into newonset AF group(n=37)and non-new-onset AF group(n=160).The predictive value of PDGF and BNP to newonset AF was reviewed by using ROC curve analysis in patients after OPCABG.The influence factors of newonset AF were discussed by using multi-factor Logistic regression analysis in patients after OPCABG.Results The levels of serum BNP and PDGF were higher in new-onset AF group than those in non-new-onset AF group(P<0.05).Age,right coronary artery stenosis rate,assisted ratio of postoperative intra-aortic balloon pumps(IABP),mechanical ventilation(MV)time,fasting plasma glucose(FPG)and left atrial volume index(LAVI)were higher,and left ventricular ejection fraction(LVEF)was lower in new-onset AF group than those in non-new-onset AF group(P<0.05).The results of multi-factor Logistic regression analysis showed that proximal right coronary artery stenosis≥75%(OR=2.090,95%CI:1.495~2.922),BNP≥287.64 pg/ml(OR=2.746,95%CI:1.798~4.193)and PDGF≥398.57μg/L(OR=2.601,95%CI:1.765~3.835)were influence factors of postoperative new-onset AF after OPCABG.The AUC of BNP was 0.781(95%CI:0.756~0.818),AUC of PDGF was 0.825(95%CI:0.797~0.861)and AUC of BNPcombined with PDGF was 0.901(95%CI:0.874~0.935)in predicting postoperative new-onset AF after OPCABG.Conclusion The levels of serum PDGF and BNP increase in patients with new-onset AF after OPCABG,and they can be taken as the predictive indicators for new-onset AF af

关 键 词：血小板源性生长因子 脑钠肽 非体外循环冠状动脉搭桥术 心房颤动 预测价值 

分 类 号：R541.75[医药卫生—心血管疾病]