血浆NT-proBNP水平对持续性房颤患者射频消融术后预后的预测价值

Predictive value of plasma NT-proBNP level in prognosis of patients with persistent atrial fibrillation after radiofrequency ablation

目的研究血浆后氨基末端脑钠肽前体(NT-proBNP)水平对持续性房颤(简称房颤)患者射频消融术后预后的预测价值。方法将四川大学华西医院2014年1月至2017年1月间收治的130例房颤患者纳为研究对象,同时纳入50例健康体检者为健康对照组,根据患者房颤类型将其分为持续性房颤组(n=77)与阵发性房颤组(n=53),比较3组血浆NT-proBNP水平;所有持续性房颤患者(n=77)行射频消融治疗,根据其术后是否转复窦性心律将其分为转复窦律组(n=27)与未转复窦律组(n=50),随访1年,根据患者手术效果将其分为手术成功组(n=30)与手术失败组(n=47),分析术后转复窦律与手术效果的相关性;比较术后转复窦律组与未转复窦律组的血浆NT-proBNP水平;比较手术失败组与成功组的血浆NT-proBNP水平;分析血浆NT-proBNP水平与患者预后的关系。结果健康对照组、阵发性房颤组、持续性房颤组患者的血浆NT-proBNP水平呈依次上升趋势,组间差异显著(P<0.05);术后是否转复窦律与手术效果存在相关性(r=0.716,P<0.05);术后转复窦律组的血浆NT-proBNP水平显著低于未转复窦律组(P<0.05);手术成功组术前及术后24 h血浆NT-proBNP浓度均显著低于失败组(P<0.05);相关性分析提示,血浆NT-proBNP水平与持续性房颤患者射频消融术后复发呈正相关(r=0.367,P<0.05)。结论血浆NT-proBNP浓度在持续性房颤射频消融患者预后中具有良好的应用价值。

Objective To investigate the predictive value of plasma N-terminal pro-brain natriuretic peptide(NT-proBNP)level in patients with persistent atrial fibrillation(AF)after radiofrequency ablation. Methods 130 cases of patients with atrial fibrillation admitted to West China Hospital of Sichuan University from January 2014 to January 2017 were included in the study. At the same time,50 healthy examiners were included in healthy control group. According to the types of atrial fibrillation,they were divided into persistent atrial fibrillation group(n=77)and paroxysmal atrial fibrillation group(n=53). The plasma levels of NT-proBNP in the 3 groups were compared. All patients with persistent atrial fibrillation(n=77)were given radiofrequency ablation,and were divided into sinus rhythm cardioversion group(n=27)and sinus rhythm non-cardioversion group(n=50)according to whether there was sinus rhythm cardioversion after operation. After 1 year of follow-up,the patients were divided into surgery success group(n=30)and surgery failure group(n=47)according to the surgical results,and the correlation between the postoperative sinus rhythm cardioversion and surgical outcomes was analyzed. The plasma NT-proBNP levels were compared between sinus rhythm cardioversion group and sinus rhythm non-cardioversion group or failure group and surgery success group. The relationship between plasma NT-proBNP level and prognosis was analyzed.Results The levels of plasma NT-proBNP in control group,paroxysmal atrial fibrillation group and persistent atrial fibrillation group were increased in turn(P<0.05). There was a correlation between the presence or absence of sinus rhythm cardioversion and surgical outcomes(r = 0.716,P<0.05). The level of plasma NT-proBNP in sinus rhythm cardioversion group was significantly lower than that in sinus rhythm noncardioversion group(P<0.05). The plasma NT-proBNP concentrations before operation and at 24 h after operation in surgery successful group were significantly lower than those in surgery failure group(P<0.05).Correlation analysis showed that plasma NT-proBNP level was positively correlated with preoperative recurrence after radiofrequency ablation in patients with persistent atrial fibrillation(r = 0.367,P<0.05).Conclusion Plasma NT-proBNP concentration has a good application value in the prognosis of patients with persistent atrial fibrillation after radiofrequency ablation.