射频导管消融术对血栓前状态的影响及阿司匹林的作用

Influence of radiofequency catheter ablation and effect of aspirin on prethrombotic state.

目的探讨射频导管消融术(RFCA)对血栓前状态的影响,评价阿司匹林(Asp)的干预作用。方法选择58例行RFCA的阵发性室上性心动过速患者将其随机分成两组:Asp组(n=28):术前3天口服Asp;对照组(n=30):术前不用药。分别于术前(T0)、电生理检查(EPS)后(T1)、射频放电后即刻(T2)、术后24 h(T3)测定血浆血管性假血友病因子(VWF)、内皮素(ET)、血小板α颗粒膜糖蛋白140(GMP-140)和D-二聚体(DD),比较两组内不同时间点各项指标的变化及两组间的差异。并作RFCA的程序变量与血栓前状态的分子标志物变化的相关性分析。结果①两组患者VWF和ET在不同时间点较术前无显著差异(P>0.05);②对照组GMP-140和DD在T1时刻即有显著升高(P<0.05),T2时刻进一步升高达峰值,T3较T0有所下降,但仍明显高于术前(P(0.05);Asp组GMP-140在T1、T2、T3时刻与T0时刻比较无明显升高(P>0.05),而DD仍有显著升高(P<0.05或P<0.01),但与对照组同一时间点比较升高的幅度明显降低(P<0.05);④GMP-140和DD升高的幅度与手术持续时间呈正相关(r=0.48,r=0.41,P<0.05)。结论尽管术中应用肝素RFCA仍可导致血栓前状态。RFCA致血栓前状态与手术持续时间呈正相关。Asp可减轻RFCA引起的血栓前状态。

Objective To detect the influence of radiofequency catheter ablation （RFCA） and evaluate the effect of pretreatment with aspirin on prethrombotic state. Methods Fifty-eight patients with superaventricular tachycardia undergoing RFCA were randomized to control group without aspirin （n = 30） before RFCA and pretreatment group with aspirin（ n = 28 ） for 3 days prior to RFCA. VWF, ET, GMP-140 and D-dimer levels of plasma were measured at four different time points： before RFCA （T0）, after the electrophysiologic studys（EPS） （T1 ）, immediately after the last RFCA（T2） and at 24 hours after RFCA（T3 ）. The changes within groups at different time points and the differences between groups at same time points was compared. Results ①There were no remarkable difference at different time points in both groups for the levels of plasma VWF and ET before RFCA （P 〉0.05）. ②In control group, GMP-140 and DD levels of plasma increased significantly （P 〈 0.05;P 〈 0. 001 ）after EPS, further rose to peak values immediately after RFCA（ P 〈 0. 0001 ）, and slightly decreased at 24h after RFCA, which were still high ter than the values before RFCA （P 〈 0.05;P 〈 0.01 ）. ③In Asp group, there were no remarkable elevation in the levels of plasma GMP-140 at different time points, compared with the values before RFCA （P〉0.05 ）. However, DD still elevated （ P 〈0. 05 ; P 〈 0. 01 ）, compared with the values before RFCA, which were much lower than the values at same time points in control group （P 〈0. 05 ）. ④ Procedure duration was the only variable that correlated with the relative increase in GMP-140 and DD（ r = 0.48;r =0. 41, P 〈0.05）. Conclusion Although intravenous heparin is administered during the operation, the prethrombotic state can be introducted by RFCA. Prethrombotic state caused by RFCA is related to procedure duration. Pretreatment with aspirin can prevent prethrombotic state.