心电图P波参数联合体质量指数在阵发性房颤患者消融术后复发预测中的应用价值

Application value of electrocardiogram P-wave parameters combined with body mass index for predicting postoperative recurrence in paroxysmal atrial fibrillation patients

目的探讨心电图P波参数联合体质量指数(BMI)在阵发性房颤(PAF)患者射频消融术后复发预测中的应用价值。方法回顾性选取2021年3月—2022年12月新疆医科大学第一附属医院心脏中心收治PAF消融术后患者109例为研究对象,根据术后1年内复发情况分为复发组(n=24)和未复发组(n=85)。109例PAF患者均于术前及术后24 h内行12导联心电图检测。收集患者术前BMI、左心房内径(LAD)等临床资料并采用多因素Logistic回归模型分析PAF患者术后复发的影响因素;采用ROC曲线分析P波参数联合BMI对PAF患者术后复发的预测价值。结果109例PAF患者中术后1年内复发24例,复发率22.02%。复发组房颤病程、高血压占比、LAD、中性粒细胞/淋巴细胞计数比值(NLR)以及BMI均高于未复发组(t/χ^(2)/P=2.559/0.012、5.827/0.016、4.557/<0.001、5.254/<0.001、4.436/<0.001)。复发组术前P波时限(PWD)、最大PWD(Pmax)及P波离散度(Pd)均较未复发组显著升高(t=5.617、4.005、9.078,P均<0.001)。多因素Logistic分析显示,BMI、LAD、NLR、高血压、PWD、Pmax及Pd均为PAF患者术后复发的危险因素[OR(95%CI)=1.163(1.008~1.342)、1.256(1.024~1.540)、1.458(1.106~1.922)、1.435(1.045~1.971)、1.509(1.136~2.005)、1.157(1.005~1.332)、1.714(1.308~2.246)]。四者联合预测PAF患者术后复发的AUC优于PWD、Pmax、BMI各自单独预测效能(Z/P=2.017/0.044、2.476/0.013、2.788/0.005),而与Pd单独预测的AUC比较,差异无统计学意义(Z/P=1.946/0.052)。结论BMI、LAD、NLR、高血压、PWD、Pmax及Pd是PAF患者术后复发的影响因素,术前PWD、Pmax和Pd联合BMI对PAF患者术后复发具有较高预测价值。

Objective To explore the application value of electrocardiogram P-wave parameters combined with body mass index(BMI)for predicting the recurrence of paroxysmal atrial fibrillation(PAF)patients after radiofrequency ablation.Methods A total of 109 patients after PAF ablation admitted to the First Affiliated Hospital of Xinjiang Medical University from March 2021 to December 2022 were retrospectively selected as the study objects,and they were separated into a recurrence group(n=24)and a non-recurrence group(n=85)based on their postoperative recurrence within one year.109 patients with PAF underwent 12-lead electrocardiogram before and within 24 hours after surgery.Clinical data such as preoperative BMI and left atrial diameter(LAD)were collected and a multivariate Logistic regression model was applied to analyze the influencing factors of postoperative recurrence in patients with PAF.ROC curve was used to analyze the predictive value of P wave parameters combined with BMI in postoperative recurrence of PAF patients.Results Among 109 patients with PAF,24 experienced recurrence within one year after surgery,with a recurrence rate of 22.02%.Duration of atrial fibrillation,proportion of hypertension,LAD,ratio of neutrophil/lymphocyte count(NLR)and BMI in the relapsed group were higher than those in the non-relapsed group(t/χ^(2)/P=2.559/0.012,5.827/0.016,4.557/<0.001,5.254/<0.001,4.436/<0.001).The preoperative P-wave duration(PWD),maximum PWD(Pmax),and P-wave dispersion(Pd)in the recurrence group were greatly higher than those in the non-recurrence group(t=5.617,4.005,9.078,all P<0.001).Multivariate Logistic analysis showed that BMI,LAD,NLR,hypertension,PWD,Pmax and Pd were the risk factors for postoperative recurrence in PAF patients[OR(95%CI)=1.163(1.008-1.342),1.256(1.024-1.540),1.458(1.106-1.922),1.435(1.045-1.971),1.509(1.136-2.005),1.157(1.005-1.332),1.714(1.308-2.246)].The combined prediction of AUC in PAF patients was better than PWD,Pmax and BMI(Z/P=2.017/0.044,2.476/0.013,2.788/0.005),and compared with the AUC predicted by Pd alone,the difference was not statistically significant(Z/P=1.946/0.052).Conclusion BMI,LAD,NLR,hypertension,PWD,Pmax,and Pd are influencing factors for postoperative recurrence in patients with PAF.Preoperative PWD,Pmax,and Pd combined with BMI have high predictive value for postoperative recurrence in PAF patients.