高敏C反应蛋白能预测环肺静脉射频消融治疗后的心房颤动复发

High-sensitive C-reactive protein as a predictor of atrial fibrillation recurrence after circumferential pulmonary vein ablation

目的探讨环肺静脉射频消融（CPVA）治疗心房颤动（房颤）患者消融术前血浆高敏C反应蛋白（hsCRP）浓度能否预测术后房颤复发。方法121例房颤患者接受单一术者进行的单次CPVA术，其中阵发性房颤77例，持续性房颤44例。房颤复发定义为随访期内心电图和／或24h动态心电图证实房颤发作持续时间≥30s。应用酶联免疫法测定血浆hsCRP浓度。结果在5～44（28±12）个月的随访中，单次CPVA术后房颤复发率为29．75％（36／121），其中阵发性房颤为24．68％（19／77），持续性房颤为38．6％（17／44）。房颤复发患者无论是阵发性房颤[（2．16±1．51）mg／L对（1．27±1．19）mg／L，P=0．028]，还是持续性房颤[（2．59±1．52）mg／L对（1．45±1．32）mg／L，P=0．005]，消融术前血浆hsCRP浓度均较高[（2．36±1．51）mg／L对（1．33±1．23）mg／L，P〈0．001]。多因素Logistic回归分析显示，血浆hsCRP浓度升高与消融术后房颤复发有关，能独立预测房颤复发（P〈0．001）。结论CPVA术前血浆hsCRP浓度升高与术后房颤复发有关，可能是术后房颤复发的独立预测因素。

Objective The goal of this study was to investigate whether the plasma high-sensitive C-reactive protein（ hsCRP） concentrations before circumferential pulmonary vein ablation（CPVA） can be used as a predictor for atrial fibrillation（ AF） recurrence after CPVA. Methods One hundred and twenty-one patients who underwent CPVA by single operator for symptomatic and/or drug-refractory paroxysmal/persistent AF were included in the study. AF recurrence,which detected by 12-lead electrocardiogram and 24 h-ambulatory electrocardiography,was defined as recurrence of AF attack lasting for ≥ 30 s beyond 3 months after ablation. The plasma hsCRP concentrations were determined by the use of a commercially available enzyme-linked immunosorbent assay. Results The AF recurrence rate after the CPVA was 29. 75% （ 36/121 ） in means 5 - 44 （ 28 ± 12 ） months follow-up ,24. 68% （19/77） for paroxysmal AF ,38.64% （17/44） for persistent AF. Plasma concentration of hsCRP before CPVA was significantly higher in the recurrence group compared with the non-recurrence group [ （2. 36 -± 1.51 ）mg/L vs（ 1.33 ± 1.23） mg/L,P 〈0. 001 ] ,whatever paroxysmal AF[ （2. 16 ± 1.51 ）mg/L vs（ 1.27 ± 1.19） mg/L ,P = 0. 028 ] and persistent AF[ （ 2. 59 ± 1.52 ） mg/L vs （ 1.45 ± 1.32 ） mg/L, P = 0. 005]. Multiple logistic regression analyses showed that higher levels of plasma hsCRP was a signifieant prognostic predictors of AF recurrence in follow-up （ P 〈 0. 001 ）, whatever in paroxysmal AF （ P = 0. 014 ） or in persistent AF （ P = 0. 002 ）. Conclusion Our findings suggest that the plasma hsCRP concentration before CPVA are related with AF recurrence after single ablation,whatever paroxysmal AF or persistent AF,it could be a crucial predictor of AF recurrence in follow-up ≥3 months after CPVA.