多指标联合对心房颤动患者射频消融术后复发的预测价值

Predictive Value of Combined Multi-indicators for Recurrence after Radiofrequency Ablation in Patients with Atrial Fibrillation

目的探讨术前多指标联合对心房颤动(房颤)患者射频消融术后复发的预测价值。方法回顾性分析2018年1月—2021年1月于贵州医科大学附属医院及贵州医科大学附属乌当医院房颤行射频消融术治疗的169例患者,随访12个月,根据房颤是否复发分为复发组(48例),未复发组(121例)。收集患者的一般临床资料、血生化资料、超声心动图资料、口服药物、既往病史等资料。采用单因素和多因素Logistic回归分析筛查房颤复发的危险因素,再通过受试者工作特性(ROC)曲线和曲线下面积(AUC)评估LAD、TG及联合预测指标对房颤术后复发的预测效能。结果两组患者左房前后径(LAD)、三酰甘油(TG)、脑钠肽(BNP)、房颤类型比较,差异有统计学意义(P<0.05)。单因素分析发现,LAD、TG、房颤类型差异有统计学意义(P<0.05);Logsitic多因素回归分析发现LAD(OR=1.068、95%CI 1.006~1.133,P=0.030);TG(OR=0.540、95%CI 0.317~0.918,P=0.023),持续性房颤(OR=2.228、95%CI 1.036~4.793,P=0.040),是房颤射频术后复发的独立危险因素。TG、LAD及联合预测指标预测房颤射频术后复发的AUC分别为0.613、0.644和0.734,差异有统计学意义(P<0.05)。结论LAD、TG和持续房颤是房颤射频消融术后复发的独立危险因素,联合预测指标对房颤射频消融术后复发风险的评估效能高于任何单一指标,其对复发的预测更可靠。

Objective To investigate the predictive value of the combined preoperative multi-indicators on recurrence after radiofrequency ablation in patients with atrial fibrillation(AF).Methods A retrospective analysis was made of 169 patients with atrial fibrillation treated by radiofrequency ablation in the Affiliated Hospital of Guizhou Medical University and Wudang Hospital of Guizhou Medical University from January 2018 to January 2021.They were followed up for 12 months and were divided into recurrent group(48 cases)and non-recurrent group(121 cases)according to whether the atrial fibrillation recurred.Collect general clinical data,blood biochemical data,echocardiographic data,oral drugs,past medical history and other data of patients.The risk factors of recurrence of atrial fibrillation were screened by univariate and multivariate logistic regression analysis,and the predictive efficacy of LAD,TG and combined predictive indicators on recurrence of atrial fibrillation was evaluated by the subject working characteristic(ROC)curve and area under curve(AUC).Results There were statistically significant differences in left atrial anteroposterior diameter(LAD),triglyceride(TG),brain natriuretic peptide(BNP)and atrial fibrillation type between the two groups(P<0.05).Univariate analysis showed that there were statistically significant differences in LAD,TG and AF types(P<0.05);Logistic multivariate regression analysis found LAD(OR=1.068,95%CI 1.006~1.133,P=0.030);TG(OR=0.540,95%CI 0.317~0.918,P=0.023)and persistent atrial fibrillation(OR=2.228,95%CI 1.036~4.793,P=0.040)were independent risk factors for recurrence of atrial fibrillation after radiofrequency surgery.The AUC of TG,LAD and combined predictors predicting recurrence of atrial fibrillation after radiofrequency surgery were 0.613,0.644 and 0.734,respectively,the difference was statistically significant(P<0.05).Conclusion This study showed that LAD,TG and sustained AF were independent risk factors for recurrence after RF ablation of AF,and the combined predictors were more effective in assessing the risk of recurrence after RF ablation of AF than any single index,and their prediction of recurrence was more reliable.