环肺静脉射频消融对心房颤动患者抑郁和生活质量的影响

The effect of circumferential pulmonary vein ablation on depression in patients with atrial fibrillation

目的探讨环肺静脉射频消融对心房颤动(简称房颤)患者抑郁和生活质量的影响。方法入选98例行房颤环肺静脉消融治疗的患者(手术组)和102例同期入院未行手术治疗的房颤患者(药物组)。所有患者于纳入研究时和治疗后12个月填写抑郁自评量表(SDS)、生活质量量表(SF-36),采集血常规、肝肾功能、胸部平片、心脏超声、12导同步心电图和24 h动态心电图资料。纳入研究后12个月门诊复查12导同步心电图和24 h动态心电图。对手术组、药物组、手术组术后12个月复发组和未复发组的上述各项指标进行组间和组内比较。对有统计学差异的指标进行多元线性回归分析。结果手术组术后12个月SF-36评分高于术前,SDS粗分和标准分低于术前(P均<0.01)。药物组纳入时和纳入后12个月SDS和SF-36评分无差异。与药物组比较,手术组纳入时的SDS、SF-36无差异,纳入后12个月SDS降低、SF-36增加(P均<0.05)。手术组中复发组和未复发组SDS和SF-36评分有差异(P<0.05)。左房内径[OR=3.28,95%CI(3.07,3.52),P<0.05]和抑郁[OR=2.40,95%CI(2.24,2.85),P<0.05]是房颤环肺静脉射频消融术后复发的独立危险因素。结论环肺静脉射频消融能显著改善房颤患者抑郁状态。左房增大和抑郁状态是房颤射频消融术后复发的独立危险因素。

Objective To investigate whether the circumferential pulmonary vein ablation （CPVA） can improve the depression and quality of life in patients with atrial fibrillation （AF）. Methods Two hundred patients with diagnosis of paroxysmal AF were enrolled in this study. Ninty-eight patients （CPVA group） and 102 patients （medicine group） were treated with CPVA and medicine respectively. Depression symptoms （Self-Rating Depression Scale, SDS） and quality of life （Short- Form life survey-36 items, SF-36） were assessed before and after treatment 12 months in all patients. The baseline clinical parameters of all patients were also evaluated. The relationships of clinical parameters, changes of SAD, SF-36 and the recurrenee of AF in CPVA group were analyzed by univariate and multivariate logistic regression methods. Results There was no significant difference in the baseline between the CPVA and medicine group. Furthermore, the scores of SDS and SF-36 had no improvements in medicine group. The scores of SDS were significant lower and 4 subseales of SF-36 improved after 12 months in CPVA group. Compared to the data of the recurrent patients（n =28）, the score of SDS were significant lower and 3 subseales of SF-36 improved in non recurrent patients in CPVA group after 12 months. Over 12 months follow up, the SDS score was lower and 4 subscales of SF-36 improved in patients of CPVA group than that of medieine group. Univariate and multivariate logistic regression analysis showed that left atrial diameter and SDS score were the independent risk factors of recurrence after CPVA. Conclusions CPVA can ameliorate the depression statue and improve quality of life in patients with oaroxvsmal AF. Deoression statue increases the recurrence risk of Datients with CPAV.