血清BNP水平与冠状动脉旁路移植术术后并发房颤的关系

Relationship between serum BNP level and atrial fibrillation after coronary artery bypass grafting

目的 探讨血清B型利钠肽（BNP）水平与冠状动脉旁路移植术后并发房颤的关系.方法 选择2016年3月至2017年9月我院收治的98例行冠状动脉旁路移植手术的患者为研究对象,根据术后是否并发房颤将其分为房颤组（n=37）和窦律组（n=61）.收集患者的临床病历资料,包括人口学资料、疾病史、心功能检查、实验室检查等,采用多因素Logistic回归分析血清BNP与房颤的关系.结果 房颤组患者年龄、术后24 h LVEF大于窦律组,术后24h血清BNP、hs-CRP水平高于窦律组,差异均有统计学意义（P＜0.05）.多因素Logistic回归结果显示,高龄、术后24h LVEF、术后24 h BNP、术后24 h hs-CRP为冠状动脉旁路移植术后并发房颤的独立危险因素,OR分别为1.868、1.285、1.784、1.436,差异均有统计学意义（P＜0.05）.术后24 h血清BNP对冠状动脉旁路移植术后并发房颤预测的ROC曲线下面积为0.855 （95％CI0.794～0.915）,血清BNP最佳临界值为107.28 pg/ml,灵敏度、特异度分别为76.35％、82.11％,准确度为75.29％.结论 血清BNP水平是冠状动脉旁路移植术后并发房颤的独立危险因素,术后24h内及时检测可作为预测房颤的重要指标.

Objective To explore the relationship between serum B-type natriuretic peptide （BNP） and atrial fibrillation after coronary artery bypass grafting.Methods A total of 98 patients underwent coronary artery bypass grafting in our hospital from March 2016 to September 2017 were enrolled in this study,which were divided into atrial fibrillation group （n=37） and sinus rhythm group （n=61） according to whether the patients were atrial fibrillation.The clinical records of patients were collected such as demographic data,disease history,csrdiac function examination,laboratory tests.The relationship between serum BNP and atrial fibrillation was analyzed by the multivariate logistic regression.Results The age,LVEF at 24 h after operation of atrial fibrillation group were more than those of sinus rhythm group,and the serum BNP,hs-CRP levels at 24 h after operation were higher than those of sinus rhythm group,the difference was statistically significant （P〈0.05）.Multivariate logistic regression analysis showed that age,LVEF and BNP at 24 h after operative,hs-CRP at 24 h after operative were independent risk factors for atrial fibrillation after coronary artery bypass grafting,with OR of 1.868,1.285,1.784,1.436,the difference was statistically significant （P〈0.05）.The area under the ROC curve of serum BNP at 24 h for predicting atrial fibrillation after coronary artery bypass grafting was 0.855（95%CI 0.794-0.915）,the best critical value of serum BNP was 107.28 pg/ml,the sensitivity,specificity was 76.35%,82.11% respectively,and the accuracy of 75.29%.Conclusion Serum BNP is an independent risk factor of atrial fibrillation after coronary bypass grafting,and timely detection with 24 h after operation can be used as an important index to predict atrial fibrillation.