单核细胞/高密度脂蛋白胆固醇对持续性心房颤动消融术后复发的预测价值  

The predictive value of monocyte to high-density lipoprotein cholesterol ratio for recurrence of persistent atrial fibrillation after catheter ablation

作　　者：陈晓妍 刘念[2] 邓俊萍 褚婷婷[1] CHEN Xiaoyan;LIU Nian;DENG Junping;CHU Tingting(Shanxi Medical University,Linfen Hospital Affilated to Shanxi Medical University,Linfen 041000,China)

机构地区：[1]山西医科大学、山西医科大学附属临汾医院,041000 [2]首都医科大学附属北京安贞医院-北京市心肺血管疾病研究所心律失常中心

出　　处：《心肺血管病杂志》2025年第3期227-233,共7页Journal of Cardiovascular and Pulmonary Diseases

基　　金：青年科学研究项目(202203021222421)。

摘　　要：目的:探讨单核细胞与HDL-C比值(monocyte to high-density lipoprotein cholesterol ratio,MHR)及DR-FLASH评分系统对持续性心房颤动患者导管消融术后复发的预测价值。方法:选取2018年10月至2023年9月于山西医科大学附属临汾医院心内科住院治疗,并完成第一次导管消融手术的126例持续性心房颤动患者。根据心房颤动是否复发分为复发组(28例)和未复发组(98例)。术前检测患者血常规及血生化指标,并根据单核细胞、HDL-C数值计算MHR水平。根据患者入院情况计算DR-FLASH评分。利用多因素COX回归分析持续性心房颤动患者导管消融术后复发的相关因素。结果:①持续性心房颤动患者行导管消融术后晚期复发率为22.2%,复发组年龄、LAD、DR-FLASH评分、PDW、MHR及早期复发占比高于未复发组,差异有统计学意义(P<0.05)。②多因素COX回归分析显示MHR(HR=3.968,95%CI:1.256~12.535,P=0.019)及DR-FLASH评分(HR=1.586,95%CI:1.102~2.283,P=0.013)是持续性心房颤动导管消融术后晚期复发的危险因素。③ROC曲线分析显示,MHR预测持续性心房颤动导管消融术后晚期复发的AUC为0.663(95%CI:0.573~0.744,P=0.002),DR-FLASH评分预测导管消融术后复发的AUC为0.700(95%CI:0.612~0.778,P<0.001),MHR与DR-FLASH评分相结合对导管消融术后心房颤动复发具有更高的预测价值(AUC=0.753,95%CI:0.669~0.826,P<0.001)。结论:MHR及DR-FLASH评分是持续性心房颤动患者导管消融术后复发的预测因素,将DR-FLASH评分与MHR组合在一起可提高预测价值。Objective:To investigate the value of monocyte to HDL-C ratio(MHR)combined with the DR-FLASH score system(diabetes mellitus,renal dysfunction,persistent form of atrial fibrillation,left atrail diameter>45mm,age>65,female sex,and hypertension,DR-FLASH)in recurrence after catheter ablation in patients with persistent atrial fibrillation(persistent AF).Methods:A total of 126 patients with persistent AF who underwent catheter ablation in Shanxi Medical University Affiliated Linfen People's Hospital Cardiology Department were selected from October 2018 to September 2023.Patients can be divided into relapsed group(n=28)and non-relapsed group(n=98)according to whether they have replased.Before the operation,the patients'blood routine and biochemical indicators were detected,and the MHR level was calculated based on the values of monocytes and HDL-C.The DR-FLASH score was calculated based on the patients'admission conditions.The factors affecting the recurrence of persistent AF after catheter ablation were analyzed using multivariate COX regression analysis.Results:①The recurrence rate of persistent AF patients after catheter ablation was 22.2%.The recurrence group was older,had a larger left atrial diameter,higher DR-FLASH score,higher PDW,higher MHR,and higher rate of early recurrence than the non-recurrence group(P<0.05).②COX multivariate regression Analysis indicated that MHR and DR-FLASH score were independent predictors of late recurrence of persistent AF.③ROC curve analysis showed that the AUC of MHR and DR-FLASH score for predicting late recurrence after catheter ablation of persistent AF were 0.663(95%CI:0.573-0.744,P=0.002),0.700(95%CI:0.612-0.778,P<0.001).The combination of MHR and DR-FLASH score has a higher predictive value for the recurrence of persistent AF after catheter ablation(AUC=0.753,95%CI:0.669-0.826,P<0.001).Conclusions:MHR and DR-FLASH scores are independent predictors of late recurrence after catheter ablation;the prediction efficiency of MHR can be improved by combining DR-FLASH score.

关 键 词：心房颤动 导管消融术 单核细胞 高密度脂蛋白胆固醇 复发 

分 类 号：R54[医药卫生—心血管疾病]