血浆大内皮素1和白细胞介素17A及左心耳体积与心房颤动经射频消融术后复发的相关性

Correlation of plasma big ET-1and IL-17Aas well as left atrial appendage volume with recurrence of AF after RFCA

目的探讨血浆大内皮素1(big ET-1)、血清白细胞介素17A(IL-17A)、左心耳体积与心房颤动(房颤)经导管射频消融术(RFCA)后复发的相关性及危险因素。方法回顾性分析安徽医科大学第一附属医院和阜阳市第二人民医院经胸超声心动图和肺静脉CT检查之前接受RFCA的房颤患者226例。在RFCA后1、3、6个月进行心电图检查,根据房颤复发将患者分为复发组59例和未复发组167例。术后测左心耳体积、血浆big ET-1、血清IL-17A。结果血浆big ET-1、血清IL-17A、左心耳体积与房颤RFCA后复发呈正相关。复发组左心房容积、左心耳体积、左心耳开口周长、短径、长径均高于未复发组(P<0.01);Cox分析表明,左心房主动射血分数、左心房容积(LAV)max、LAVmin、房颤持续时间、LDL-C是房颤复发的危险因素(P<0.05)。logistic回归分析显示,血小板计数(OR=2.349,95%CI:1.162~4.748,P=0.017)、左心房内径(OR=2.782,95%CI:1.318~5.869,P=0.007)、左心耳体积(OR=2.622,95%CI:1.417~4.852,P=0.002)、IL-17A(OR=2.672,95%CI:1.439~4.965,P=0.002)是持续性房颤患者RFCA后复发的独立危险因素。左心耳体积>9.25 ml预测房颤RFCA后复发的价值最高,曲线下面积为0.81,敏感性为84.9%、特异性为65.8%。结论RFCA后复发患者左心耳体积增大,血清IL-17A、血浆big ET-1升高与复发密切相关,房颤持续时间、LDL-C可能是RFCA后房颤复发的独立危险因素。

Objective To investigate the relationship of plasma big ET-1 and serum IL-17 A levels as well as left atrial appendage volume with recurrence of AF after RFCA.Methods A retrospective study was carried out on 226 AF patients who underwent RFCA before transthoracic echocardiography and pulmonary vein CT scanning in the Departments of Cardiology of the First Affiliated Hospital of Anhui Medical University and Fuyang Second People’s Hospital from December 2019 to December 2021.Electrocardiography were performed at 1,3,and 6 months after RFCA,and according to the results,the patients were divided into recurrence group(n=59)and non-recurrence group(n=167).Left atrial appendage volume,and plasma levels of big ET-1 and serum IL-17 A were measured postoperatively.Results Plasma big ET-1 and serum IL-17 A levels and left atrial appendage volume were positively correlated with AF recurrence after RFCA.The recurrence group had larger left atrial volume,left atrial appendage volume,and circumference and short and long diameters of the mouth of the left atrial appendage than the non-recurrent group(P<0.01).Cox analysis indicated that left atrial active ejection fraction(LAAEF),left atrial maximum volume(LAVmax),left atrial minimum volume(LAVmin),AF durationn,and low-density lipoprotein-cholesterol(LDL-C)were risk factors for AF recurrence(P<0.05).Logistic regression analysis showed that platelet(PLT)count(OR=2.349,95%CI:1.162-4.748,P=0.017),left atrial diameter(OR=2.782,95%CI:1.318-5.869,P=0.007),left atrial appendage volume(OR=2.622,95%CI:1.417-4.852,P=0.002),and IL-17 A level(OR=2.672,95%CI:1.439-4.965,P=0.002)were independent risk factors for recurrence in patients with persistent AF after RFCA.Left atrial appendage volume>9.25 ml had the highest value in predicting AF recurrence after RFCA,with an area under the curve of 0.81,a sensitivity of 84.9%,and a specificity of 65.8%.Conclusion Enlarged left atrial appendage volume and elevated serum IL-17 A and plasma big ET-1 levles are closely associated with recurrence in AF patients after RFCA.AF duration and LDL-C level are independent risk factors for AF recurrence after RFCA.