氢化可的松对射频消融治疗后房颤复发的影响

Effect of hydrocortisone on the recurrence of atrial fibrillation after radiofrequency ablation

目的评价氢化可的松预防对射频消融（RFCA）治疗房颤（AF）后AF复发的疗效。方法将256例经RFCA治疗后AF患者随机分为氢化可的松组与对照组（每组n=128）。氢化可的松组患者在RFCA治疗术后应用100mg氢化可的松注射液溶解于100mL5％葡萄糖注射液中，静脉滴注，每天1次，连续应用3—6d；对照组患者未注射氢化可的松。监测并比较氢化可的松治疗后两组患者的体温（BT）、血C-反应蛋白（CRP）、血白细胞计数（WBC）与心包炎发病比例。对患者进行1年随访，比较两组患者AF复发率，采用多因素Cox回归分析评价与AF复发相关的独立预测因子。结果两组患者WBC、CRP、BT及心包炎发生比率比较差异无统计学意义（均P〉0．05）；氢化可的松组即刻复发[8（6．7％）V8．19（14．8％），P=0．01]与早期AF复发[5（3．9％）VS．14（10．9％），P：0．03]的患者比例显著低于对照组，氢化可的松组与对照组中期复发的患者比例与12个月内AF复发的患者比例比较差异无统计学意义（均P〉0．05）；两组患者维持窦性心律百分比比较差异无统计学意义（P=0．58）。多因素Cox回归分析表明，持续性AF是AF复发的独立预测因子（OR=2．88，95％CI 1．34～6．21，P〈0．01）。结论AF患者RFCA治疗术后单独应用氢化可的松预防AF复发，患者的即刻AF复发率与早期AF复发率显著降低，中期AF复发率未有显著改善。

Objective To evaluate the efficacy of hydrocortisone in the prevention of recurrence of atrial fibrillation （AF） after radiofrequency catheter ablation （RFCA）. Methods A total of 256 RFCA patients were randomly divided into hydrocortisone group and control group, each group consisted of 128 patients. Patients in the hydrocortisone group were treated with 100 mg hydrocortisone injection in 100 mL 5% glucose injection after RFCA, intravenous infusion once a day for 3 - 6 days. Patients in the control group were not injected with corticosteroids. Body temperature （BT）, C- reactive protein （CRP）, white blood cell count （WBC） and the incidence of pericarditis in two groups after treatment with hydrocortisone were observed and compared. The patients were followed up for one year, and AF recurrence rates were compared between the two groups. Multivariate Cox regression analysis was used to evaluate independent prognostic factors associated with AF recurrence. Results There was no significant difference in WBC, CRP, BT and the incidence of pericarditis between the hydrocortisone group and the control group （all P 〉 0.05）. The immediate recurrence [ 8 （6.7%） vs. 19 （14.8%）, P = 0.01 ] and early recurrence [ （5 （3.9%） vs. 14 （10.9%）, P = 0.031 of hydrocortisone group were lower than those in the control group. There was no significant difference in the proportion of patients with intermediate recurrence and AF recurrence with- in 12 months in hydrocortisone group and control group （all P 〉 0.05）. There was no significant difference between the two groups in maintaining sinus rhythm （P= 0.58）. Multivariate Cox regression analysis showed that persistent AF was an independent predictor of AF recurrence （OR = 2.88, 95% CI 1.34 6.21, P 〈 0.01）. Conclusion The use of hydrocortisone alone in patients with atrial fibrillation after RF- CA to prevent recurrence of atrial fibrillation is associated with a significantly lower rate of early AF recur- rence, but the intermediate recurrence rate of AF does not improve significantly.