心房颤动首次导管射频消融术后晚期复发的中西医影响因素分析及预测模型构建  

Influencing factors of TCM and western medicine and prediction model construction for late recurrence of atrial fibrillation after first radiofrequency catheter ablation

作　　者：冯丽亚 董玉江 高红梅[2] 张梦贺[2] 孙聪[2] Feng Liya;Dong Yujiang;Gao Hongmei;Zhang Menghe;Sun Cong(Department of First Clinical Medical School,Shandong University of Traditional Chinese Medicine,Shandong Province,Jinan 250355,China;不详)

机构地区：[1]山东中医药大学第一临床医学院,济南250355 [2]山东中医药大学第二附属医院心血管内科,济南250001

出　　处：《疑难病杂志》2024年第12期1431-1438,共8页Chinese Journal of Difficult and Complicated Cases

基　　金：国家自然科学基金资助项目(82104844);山东省卫健委基金资助项目(202203011031)。

摘　　要：目的探讨心房颤动(房颤)患者首次行导管射频消融术(RFCA)后晚期复发的中西医影响因素,并构建临床预测模型。方法回顾性选取2018年1月—2022年12月山东中医药大学第二附属医院心血管内科收治的首次行RFCA房颤患者342例为研究对象。根据术后是否晚期复发,将患者分为复发组(n=105)和未复发组(n=237)。多因素Logistic回归分析房颤患者首次行RFCA后晚期复发的影响因素;绘制预测房颤患者首次行RFCA后晚期复发的列线图模型;使用受试者工作特征(ROC)曲线评估列线图模型的预测效能,Hosmer-Lemeshow检验及校准曲线评估列线图模型的拟合能力和校准度。结果复发组房颤患者气虚证比例、阴虚证比例、左心房内径(LAD)、左心室内径(LVD)、中性粒细胞/淋巴细胞计数比值(NLR)高于未复发组,使用Ⅲ类抗心律失常药物、他汀类降血脂药物、益气养阴类中药注射剂比例低于未复发组(t/χ^(2)/P=6.355/0.012、7.149/0.007、5.445/<0.001、3.063/0.002、3.499/0.001、10.542/0.001、12.122/<0.001、6.362/0.012)。多因素Logistic回归分析结果显示,非阵发性房颤、早期复发、气虚证、阴虚证、LAD大、NLR大为房颤患者首次行RFCA后晚期复发的独立危险因素[OR(95%CI)=2.103(1.071~4.127)、9.837(4.981~19.428)、2.414(1.265~4.603)、2.460(1.317~4.596)、1.117(1.047~1.192)、1.377(1.077~1.761)],使用他汀类降血脂药、益气养阴类中药注射剂是独立保护因素[OR(95%CI)=0.208(0.104~0.413)、0.416(0.211~0.820)]。构建列线图模型,其预测房颤患者首次行RFCA后晚期复发的ROC曲线下面积(AUC)为0.863(95%CI=0.823~0.904),Hosmer-Lemeshow检验提示模型拟合效果较好。结论非阵发性房颤、早期复发、LAD、NLR、气虚证、阴虚证、使用他汀类降血脂药、使用益气养阴类中药注射剂是房颤患者首次行RFCA后晚期复发的独立影响因素。基于上述独立影响因素构建的预测模型具有较高的预测效能Objective To investigate the independent influencing factors of TCM and Western medicine of late recurrence after the first radiofrequency catheter ablation(RFCA)in patients with atrial fibrillation(AF),and construct a clinical prediction model.Methods Three hundred and fourty-two patients with AF who underwent RFCA for the first time in the Cardiovascular Department of Second Affiliated Hospital of Shandong University of Traditional Chinese Medicine from January 2018 to December 2022 were retrospectively selected as the study subjects.According to the occurrence of late recurrence,the included cases were divided into recurrence group(n=105)and non-recurrence group(n=237).Multivariate logistic regression analysis was used to analyze the influencing factors of late recurrence after the first RFCA in AF;A nomogram model was constructed to predict the late recurrence after the first RFCA in AF.The predictive effectiveness of the nomogram model was assessed by receiver operating characteristic(ROC)curve.The fit ability and calibration of the nomogram model was assessed by Hosmer-Lemeshow inspection and calibration curves.Results The proportion of Qi deficiency pattern,Yin deficiency pattern,left atrial diameter(LAD),left ventricle diameter(LVD),and neutrophil to lymphocyte ratio(NLR)of patients with AF in the recurrence group were higher than those in the non-recurrence group,and the proportion of class III antiarrhythmics,statins,and Yiqi-Yangyin TCM injections in the recurrence group were lower than those in the recurrence group(t/χ^(2)/P=6.355/0.012,7.149/0.007,5.445/<0.001,3.063/0.002,3.499/0.001,10.542/0.001,12.122/<0.001,6.362/0.012).Multiple regression analysis identified that non-paroxysmal AF,early recurrence,Qi deficiency pattern,Yin deficiency pattern,large LAD and large NLR were independent risk factors for late recurrence after the first RFCA in AF[OR(95%CI)=2.103(1.071-4.127),9.837(4.981-19.428),2.414(1.265-4.603),2.460(1.317-4.596),1.117(1.047-1.192),1.377(1.077-1.761)],and the use of statins and Yiqi

关 键 词：心房颤动 导管射频消融术 晚期复发 列线图 预测 

分 类 号：R541.75[医药卫生—心血管疾病]