阵发性心房颤动患者肺静脉电隔离术前后血浆N端脑钠素前体水平的变化

Changes of NT-ProBNP before and after pulmonary vein isolation in patients with paroxysmal atrial fibrillation

目的:探讨阵发性心房颤动(房颤)患者肺静脉电隔离术前后血浆心钠素(ANP)、N端脑钠素前体(NT-ProBNP)和超敏C反应蛋白(hs-CRP)变化的临床意义,以及与房颤复发的关系。方法:33例阵发性房颤患者和30例正常对照者入选,分别用放射免疫法、电化学发光免疫法、免疫比浊法测定术前、术后24h和术后3个月的ANP、NT-ProBNP和hs-CRP水平。结果:①房颤组基线血浆NT-ProBNP水平与对照组相比显著升高[(296.79±272.13):(80.81±69.13)μg/L,P=0.000],而血浆ANP和hs-CRP水平正常。术后房颤复发组的基线血浆NT-ProBNP水平较维持窦律组显著升高[(572.72±234.21):(176.82±188.73)μg/L,P=0.000]。②对13个变量如年龄、房颤史、超声参数、血浆ANP、NT-ProBNP和hs-CRP水平等进行Cox多元逐步回归,结果显示仅高的血浆NT-ProBNP水平是阵发性房颤患者肺静脉电隔离术后房颤复发的独立预测因子(χ2=20.986,P=0.000)。通过Kaplan-Meier分析,血浆NT-ProBNP水平≥423.20μg/L是房颤复发的重要危险因子(P=0.002)。结论:阵发性房颤患者血浆NT-ProBNP水平显著升高,升高的NT-ProBNP水平不仅可预测发生房颤的风险,还是早期预测房颤复发的生物标记物。

Objective：To study the clinical significance of clinical significance of changes of plasma hs CRP, ANP and NT ProBNP levels before and after pulmonary vein isolation （PVI）, and the relationship atrial fibrillation recurrence in patients with paroxysmal atrial fibrillation （PAf）. Method：Thirty-three patients with PAf and thirty control subjects were enrolled in this study. Before the PVI procedure, 24 hours and 3 months after successful PVI, the plasma ANP, NT-ProBNP and hs-CRP levels were measured separately by radioimmunoassay, dectrochemiluminescence immunoassay and immunoturbidimetric assay. Result： （1）The baseline level of NT-ProBNP was significantly elevated in patients with PAf when compared with control subjects （[296.79 ± 272.13] vs [80.81± 69. 13]ug/L, P=0. 000）; but the level of plasma ANP and hs-CRP was normal the baseline level plas ma NT-ProBNP in patients with AF recurrence were markedly higher than that in patients with non-A recurrence （[572.72±234. 21] vs [176.82±188. 73ug/L, P=0. 000）, （2）Cox Stepwise multivariate analysis demonstrated that only elevated NT ProBNP at baesline was an independent predictor of Af recurrence（P=0. 000） after PVI a mong 13 variables such as age, history of Af, echocardiographic parameters, hs-CRP, ANP and NT ProBNP. A cutoff value of NT-ProBNP≥423.20 ug/L was a significant risk factor for Af recurrence by Kaplan-Meier analysis （log-rank test, P=0. 002）. Conclusion： The baseline level of NT-ProBNP was significantly elevated in patients with PAf. The elevated NT ProBNP level not only can predict the risk of Af, but also was a more sensitive marker for early prediction of Af recurrence.