阵发房颤患者复律前后血脑钠肽水平及临床意义

Changes of plasma brain natriuretic peptide in patients with paroxysmal atrial fibrillation and its clinical significance

目的:观察阵发房颤(AF)患者在复律前后脑钠肽(BNP)水平的变化,探讨BNP在AF发生和复发中的临床意义。方法:选择120例心功能正常患者,其中40例为窦性心律对照组,阵发AF患者依据复律结果分复律组35例,复发组35例,失败组10例;测定对照组以及阵发AF 3组复律前后BNP水平和左房内径(LAD)。结果:(1)阵发AF组LAD和BNP水平明显高于对照组(P<0.01)。(2)在复律前,复律组BNP水平和LAD明显低于复发组和失败组(P<0.01);复发组BNP水平和LAD低于失败组,但无统计学意义。(3)复律后2 h内,复律组与复发组BNP水平明显下降,均明显低于复律前(P<0.01),复发组BNP水平高于复律组,但无统计学意义。(4)复律后2周,复律组LAD和BNP水平明显低于复律后2 h(P<0.01),复发组在AF复发后BNP再度升高,明显高于复律后2 h(P<0.01)。(5)二项Lo-gistic分析显示,LAD和BNP是AF复发的独立影响因素和预测指标。结论:BNP水平对阵发AF患者预测和评估复律后AF复发有着重要的临床价值。

Objective: To study the changes of plasma brain natriuretic peptide(BNP)levels before and after cardioversion in paroxysmal atrial fibrillation(AF) patients,and explore the clinical significance of BNP in paroxysmal AF patients in the occurrence and reccurrence.Methods: 120 AF patients with normal 1eft ventricle function were divided into four groups:the sinusrhythm group /the contrast group(40 patients),the cardioversion group(35 patients),the recurrence group(35 patients) and the failure group(10 patients).The latter three groups of patients were put together according to the result of cardioversion.Plasma BNP levels and left atrium(LAD) were measured in all the 120 patients,while the plasma BNP levels after cardioversion were measured in the cardioversion group and the recurrence group.Results:(1).The plasma BNP levels and LAD of patients in the groups with AF were significantly higher than those in the sinusrhythm group(P<0.01).(2)Before cardioversion,the plasma BNP levels and LAD of the cardioversion group were remarkably lower than those of the recurrence group and of the failure group(P<0.01);The plasma BNP levels and LAD of the cardioversion group were slightly lower than those of the failure group but with little statistical significance(P>0.05).(3) Two hours after successful cardioversion,the plasma BNP levels were decreased significantly in the cardioversion group and in the recurrence group than before the cardioversion(P<0.01).The plasma BNP levels of the recurrence group were higher than those of the cardioversion group,but the difference was of little significance.(4)Two weeks after the cardioversion,LAD and BNP levels of the cardioversion group were significantly lower than those at two hours after the conversion(P<0.01),while the BNP of the recurrence group rose again after the AF recurrence,and were significantly higher than those after the conversion(P<0.01).(5) The binary logistic analysis revealed that LAD and BNP were independent causes and predictors of AF recurrence.Conclusion:The plasma BNP levels could be used to predict the occurrence and recurrence after cardioversion.In paroxysmal AF patients,BNP level may have predictive value of AF recurrence after successful cardioversion.