内关穴针灸联合胺碘酮治疗对持续性心房颤动环肺静脉电隔离术后早期复发的影响

Effect of acupuncture at Neiguan point combined with amiodarone therapy on early recurrence after circumferential pulmonary vein electrical isolation in patients with persistent atrial fibrillation

目的:探讨内关穴针灸联合胺碘酮治疗对持续性心房颤动(房颤)环肺静脉电隔离术(CPVI)后早期复发的影响。方法:本研究连续纳入2017年8月至2018年10月在武汉大学人民医院心内科住院且接受首次射频消融治疗的85例持续性房颤患者,随机数表法分为针灸组( n=40)和对照组( n=45)。对照组从术后第1天起连续口服胺碘酮直至3个月,针灸组从术后第1天起每天双侧内关穴针灸20 min,连续1周,胺碘酮用法与对照组相同。分析两组术后及3个月随访时心率变化以及针灸组针灸过程中心率的变化、两组术后血清中炎性因子水平及术后3个月内两组房颤复发率。 结果:消融术后和随访3个月时两组心率差异无统计学意义( P>0.05),但针灸组心率在针灸结束后较针灸前明显降低( P<0.05)。两组术前血清中肿瘤坏死因子α(TNF-α)、白细胞介素6(IL-6)、C反应蛋白(CRP)、转化生长因子β1(TGF-β1)等炎性因子水平差异无统计学意义( P>0.05),术后血清目标炎性因子水平较术前都有较明显升高,但针灸组要明显低于对照组。术后随访3个月,针灸组的房颤复发率明显低于对照组(12.5%对33.3%, P<0.05)。多因素Logistic回归分析提示内关穴针灸是环肺静脉电隔离术后早期房颤复发的独立相关因素,其可以降低消融术后房颤的早期复发( OR=0.17;95% CI 0.05~0.63;P=0.008)。 结论:内关穴针灸联合胺碘酮治疗在降低持续性房颤导管消融术后早期复发方面优于单独的胺碘酮治疗,这一效应与内关穴针灸能降低射频消融术后患者血清中炎性因子水平有关。

Objective To explore the effect of acupuncture at Neiguan point combined with amiodarone therapy on early recurrence after circumferential pulmonary vein electrical isolation(CPVI)in patients with persistent atrial fibrillation.Methods Eighty-five patients were enrolled in succession due to persistent atrial fibrillation from August 2017 to October 2018 in the Department of Cardiology,Renmin Hospital of Wuhan University and received CPVI therapy for the first time.All patients were randomized divided into acupuncture group(n=40)and control group(n=45)on the first day of hospitalization.In the control group,amiodarone was orally taken continuously from the first day after operation until 3 months.In the acupuncture group,patients were treated with sterile single-use needles in the bilateral Neiguan Points,each patient was performed Neiguan Point acupuncture for 20 min per day and lasting 1 week,and amiodarone was prescribed as same as the control group.The heart rate change on the first day after operation and 3 months later in the two groups were analyzed.The heart rate change during the acupuncture process in the acupuncture group was analyzed as well.The serum levels of inflammatory factors in the two groups before and one week after the operation as well as 3 months later were analyzed.The recurrence rate of atrial fibrillation between the two groups were finally evaluated.Results There was no difference in heart rate between the two groups on the first day after operation and 3 months later(P>0.05).But the heart rate in the acupuncture group was significantly slowed after acupuncture than that before acupuncture(P<0.05).There was no statistically significant difference in serum levels of tumor necrosis factor-α(TNF-α)、interleukin-6(IL-6)、C-reactive protein(CRP)、transforming growth factor-β1(TGF-β1)between the two groups before operation(P>0.05).After operation,the serum levels of target inflammatory factors were significantly higher than before operation in the two groups,but the acupuncture group has a lower level of inflammatory factors than that control group.After 3 months’follow-up after operation,the recurrence rate of atrial fibrillation in the acupuncture group was significantly lower than that in the control group(12.5%vs.33.3%,P<0.05).In a multivariate logistic regression analysis,acupuncture was an independent factor associated with a lower rate of early recurrences during the blanking period(odds ratio,0.17;95%confdence interval,0.05-0.63;P=0.008).Conclusion Neiguan point acupuncture combined with amiodarone is superior to amiodarone alone in reducing early recurrence of patients with persistent atrial fibrillation after catheter ablation.This effect is related to the fact that Neiguan Point acupuncture can reduce the level of inflammatory factors in serum of patients after radiofrequency ablation.