外周血端粒长度对房颤射频消融术后复发的预测价值初探

Predictive value of telomere length in peripheral blood for recurrence of atrial fibrillation after radiofrequency ablation

目的 探讨端粒长度对射频消融术成功率的影响.方法 选择急诊接诊后转至心内科行射频消融术的157例房颤患者进行随访,通过实时定量PCR(RT-PCR)法测定其在急诊就诊时白细胞端粒相对长度(表达为t/s比值),通过二元Logistic回归分析及受试者工作特征曲线(ROC曲线)分析,观察其与射频消融术后复发的相关性.结果 41例患者在术后平均(14.21±5.05)个月的随访期间复发房颤.二元Logistic回归分析提示,t/s比值减小及术前房颤诊断时间到射频消融术时间(DTAT)为房颤复发的独立危险因素.进一步的ROC曲线分析结果显示,二者对房颤复发有一定的诊断价值,其曲线下面积(AUC)分别为0.685(P<0.001,敏感度63.4%,特异度62.9%)、0.673(P<0.001,敏感度56.1%,特异度69.8%).结论 端粒长度缩短与房颤的复发存现显著相关性,可作为预测射频消融术后复发的生物标志物.早期恢复房颤患者的窦性节律可能有助于减少射频消融术复发率.

Objective Radiofrequency ablation is an important method for cardioversion in patients with atrial fibrillation,but its success is influenced by many clinical factors.We attempt to explore a biomarker that is easy to quantify to help detennine the success rate of radiofrequency ablation.Telomere length can reflect biological age,and age is the main risk factor for atrial fibrillation.Therefore,we intend to explore the impact of telomere length on the success rate of radiofrequency ablation.Methods We followed up 157 patients with atrial fibrillation who were transferred to cardiology department for radiofrequency ablation after emergency treatment.Leukocyte telomere length(expressed as t/s)was measured by RT-PCR in emergency patients.The correlation between telomere length and recurrence after radiofrequency ablation was observed by binaryl^ogistic regression analysis and subject curve analysis.Results Forty-one patients had recurrence of atrial fibrillation during an average follow-up period of(14.21±5.05)months.BinaryLogistic regression analysis showed that t/s ratio reduction and DATA were independent risk factors for recurrence of atrial fibrillation.Further ROC analysis showed that the area under curve(AUC)was 0.685(P<0.001,sensitivity 63.4%,specificity 62.9%)and AUC was 0.673(P<0.001,sensitivity 56.I%,specificity 69.8%).Conclusion We found a significant correlation between telomere shortening and recurrence of atrial fibrillation,which may serve as a biomarker for predicting recurrence after radiofrequency ablation.Early recovery of sinus rhythm in patients with atrial fibrillation can help reduce the recurrence rate of radiofrequency ablation.