持续性心房颤动患者射频消融术后肾脏功能变化

Changes in renal function after catheter ablation in patients with persistent atrial fibrillation

目的 研究持续性心房颤动（房颤）患者射频消融术后肾脏功能变化及其可能影响因素。方法 2013年1月至2014年12月从首都医科大学附属北京安贞医院房颤中心连续入选146例经单次射频消融术成功复律的持续性房颤患者并长期随访。根据术后是否有房颤复发分为未复发组（68例）和复发组（78例），定期监测血肌酐水平，计算估算的肾小球滤过率（eGFR），肾脏终点事件是eGFR水平较基线时下降率≥25%。用Kaplan-Meier生存曲线比较两组肾脏终点事件生存情况，用Cox回归分析统计持续性房颤患者肾脏终点事件影响因素。结果 本研究随访（16.3±11.8）个月，终点时未复发组较复发组的eGFR [（114.15±18.24）ml·min－1·1.73m－2比（98.64±24.09）ml·min－1·1.73m－2，P〈0.001]和ΔeGFR[（7.42±6.36）ml·min－1·1.73m－2比（-11.40±10.19） ml·min－1·1.73m－2，P〈0.001]水平更好；肾脏终点事件发生率较低（4.41%比16.67%，P〈0.05）；肾脏终点事件生存分析中，未复发组生存预后更好（χ2=5.965, log-rank P=0.015）；多因素Cox回归分析中肾脏终点事件的危险因素有年龄（HR 1.152, P=0.001）、基线eGFR水平（HR 1.086, P=0.001）、房颤复发（HR 13.442, P=0.01）和合并糖尿病（HR 6.076, P=0.025）。结论 持续性房颤射频消融术后房颤未复发者肾功能较复发者更好，房颤复发是射频消融术后肾功能损害的重要危险因素。

Objective The aim of the study was to evaluate the changes and outcome of kidney function after catheter ablation in patients with persistent atrial fibrillation （PAF）.Methods A total of 146 patients with PAF underwent primary atrial fibrillation （AF） ablation were enrolled from January 2013 to December 2014 and followed up. The subjects were divided into the AF recurrence and AF non recurrence groups. The estimated glomerular filtration rate （eGFR） was calculated and serum creatinine levels were detected before ablation and during follow-up. Renal failure was defined as ≥ 25% decline in eGFR. Kaplan-Meier survival curves was applied for the incidence of renal failure. Cox proportional hazards models were conducted to assess the relationship between recurrence of AF and renal failure.Results After （16.3±11.8） months of follow-up, the eGFR in patients with no recurrence of AF was higher than that in patients with recurrence. eGFR and ΔeGFR in patients with no AF recurrence differed significantly from those in patients with recurrence [（114.15±18.24） ml·min-1·1.73m-2 vs. （98.64±24.09） ml·min-1·1.73m-2, and （7.42±6.36） ml·min-1·1.73m-2 vs. （-11.40±10.19） ml·min-1·1.73m-2, all P〈0.001]. The incidence of the renal failure was significantly lower （4.41% vs. 16.67%, P〈0.05） and the survival prognosis was significantly better in patients with no recurrence than those in patients with recurrence （χ2=5.965, log-rank P=0.05）. The multivariate Cox regression analysis revealed that age, baseline eGFR, recurrences of AF and diabetes were independent predictors of the renal failure, with the HR 1.152, 1.086, 13.442 and 6.076, respectively.Conclusions PAF patients with no recurrence after ablation had a better renal function than those with recurrence, and the recurrence of AF is associated with the deterioration of kidney function in patients with PAF.