B型利钠肽与孤立性心房颤动

Blood B-Type Natriuretic Peptide Changes in Patients With Lone Atrial Fibrillation

目的:探讨B型利钠肽(BNP)与孤立性心房颤动(AF)的血栓事件发生、复律及再发之间的关系。方法:103例孤立性AF患者行食道超声(经食道超声心动图)、头颅计算机断层摄影术或磁共振(CT／MRI)检查及血BNP测定。探讨BNP在AF血栓事件及其相关因素中的作用。根据血栓事件将患者分为有血栓事件组(n=15)和无血栓事件组(n=88)。对于有复律指征的患者,根据AF复律及再发情况分为复律不成功患者(复律失败或随访期内再发,n=16)和复律成功患者(复律成功并随访期内维持窦性心律,n=7),分别进行对比研究。结果:服药后无血栓事件组BNP降低幅度优于血栓事件组,有显著性显异(P<0．05)。复律成功患者较复律不成功患者BNP水平低[(60±32)ng／L比(178±70)ng／L,P<0．05]、病程短[(3．0±1．9)个月比(7．6±2．5)个月,P< 0．05]和左心房内径小[(42．3±3．4)mm比(48．6±5．1)mm,P<0．05],均有显著性差异。多因素Logistic回归分析: BNP是预测孤立性AF血栓事件的独立因素(P<0．05);BNP、左心房内径和AF病程是预测AF复律及再发的独立因素(P均<0．05)。结论:BNP可作为预测孤立性AF血栓事件和AF复律与再发的临床指标。

Objective：To assess relationship plasma BNP levels with risks for thromboembolism cardioversion or maintenance sinus rhythm in patients with lone atrial fibrillation （AF）. Methods： Plasma BNP were measured and TEE and CT/MRI were performed in 103 consecutive patients with lone AF. Fifiteen patients with a history of thromboembolism or echocardiographic evidence of thrombus （ A ^＋ group） were compared with 88 AF patients without complications （A group） and sinus rhythm were excluded. ）. Sixteen AF patients with failed cardioversion or recurrence of AF （B ^＋ group） were compared with 7 patients with successful cardioversion, maintenance sinus rhythm （B group）. Results ： The A ^＋ group patients desmonstrated higher plasma BNP levels than A group patients （ P 〈 0. 05 ）. The B ^＋ group patients desmonstrated higher plasma BNP levels, longer duration of AF and greater left atrial diameter than B group patients （178 ±70 versus 160±32 ng/L, 7.6±2.5 versus 3±1.9 m, 48.6± 5. 1 versus 42. 3 ±3.4 mm;all P 〈0. 05）. Overall analysis of continuous variables with multiple logistic regression analysis revealed that BNP was a significant predictor of thromboembolism （ P 〈 0.05 ）. BNP, LAD and a history of AF were independent predictor of failed cardioversion and recurrence AF （all P 〈0. 05）. Conclusion： BNP levels may be a useful noninvasive measure to detect risks of thromboembolic complications and to decide who should undergo cardioversion for lone AF.