高敏C反应蛋白对持续性心房颤动患者射频消融术后复发的预测价值

Predictive Value of hs-CRP Level in Patients With Persistent Atrial Fibrillation Recurrence After Radiofrequency Catheter Ablation

目的：探讨高敏C反应蛋白对持续性心房颤动患者射频消融术后复发的预测价值。方法：筛选出我院以持续性心房颤动为第一诊断,并第一次进行射频消融手术的患者77例,根据随访时是否复发心房颤动分为复发组27例和未复发组50例。统计两组患者临床基线资料,进行Cox风险模型分析,筛选促使心房颤动复发的独立危险因素,并对高敏C反应蛋白水平进行受试者工作曲线（ROC曲线）绘制,评价其对心房颤动复发的预测价值。结果：心房颤动复发与年龄（风险比=1.126,95%可信区间：1.044-1.215,P=0.002）、体重指数（风险比=1.297,95%可信区间：1.077-1.563,P=0.006）、高血压的分级（2级,风险比=4.142,95%可信区间：1.047-16.390,P=0.043;3级,风险比=8.595,95%可信区间：1.913-38.610,P=0.005）、左心房前后径（风险比=1.438,95%可信区间：1.212-1.707,P=0.000）以及高敏C反应蛋白水平（风险比=2.026,95%可信区间：1.010-4.061,P=0.047）相关。高敏C反应蛋白水平ROC曲线下面积为0.693（P=0.005）,界值为0.355 mg/dl。结论：持续性心房颤动消融术后复发与患者术前炎症活动状态相关,积极控制术前基础状态,可能会降低心房颤动复发,改善预后,减少不良心血管事件发生。

Objective： To explore the predictive value of high-sensitivity C-reactive protein（hs-CRP） levels in patients with persistent atrial fibrillation（AF） recurrence after radiofrequency catheter ablation（RFCA）.Methods： A total of 77 patients of persistent AF as the first diagnosis with initial RFCA in our hospital were studied. The patients were divided into 2 groups： Recurrent group, n=27 and Non recurrent group, n=50. Basic clinical conditions were studied by Cox model analysis to screen the risk factors for AF recurrence, receiver operating characteristic（ROC） curve was conducted to assess the predictive value of hs-CRP level on AF recurrence.Results： AF recurrence was related tothe age（HR=1.126, 95% CI 1.044-1.215, P=0.002）, body mass index（HR=1.297, 95% CI 1.077-1.563, P=0.006）, hypertension at stage II（HR=4.142, 95% CI 1.047-16.390, P=0.043）, hypertension at stage III（HR=8.595, 95%CI 1.913-38.610, P=0.005）, left atrial size（HR=1.438, 95% CI 1.212-1.707, P=0.000） and hs-CRP（HR=2.026, 95% CI 1.010-4.061, P=0.047）. The area under ROC curve of hs-CRP level was 0.693, P=0.005 with the cut-off point at 0.355 mg/dl. Conclusion： Persistent AF recurrence after RFCA was related to pre-operative inflammatory status; actively control preoperative condition may reduce AF recurrence, improve prognosis and decrease adverse cardiovascular event in relevant patients.