术前血清肌酸激酶同工酶、骨形态发生蛋白浓度对起搏器置入术后患者新发心房颤动的预测价值

Predictive Value of Preoperative Serum Concentrations of MB Isoenzyme of Creatine Kinase and Bone Morphogenetic Protein 10 for New-Onset Atrial Fi⁃brillation in Patients after Pacemaker Implantation

目的探讨术前血清心肌型肌酸激酶同工酶(MB isoenzyme of creatine kinase,CK-MB)、骨形态发生蛋白(bone morphogenetic protein 10,BMP10)浓度对起搏器置入术后患者新发心房颤动(房颤)的预测价值。方法回顾性分析2021年3月至2023年3月于上海市第四康复医院收治的行起搏器置入术的患者189例的临床资料。根据观察终点出现房颤情况将受试者分为非房颤组(n=111)和房颤组(n=78)。对2组患者的临床资料行单因素分析及多因素Logistic回归分析。基于筛选的危险因素构建列线图模型,并对模型进行验证。相关性采用双变量Pearson线性相关性分析法进行分析。采用受试者工作特征曲线(receiver operating characteristic curve,ROC)分析术前血清CK-MB、BMP10浓度对患者起搏器置入术后新发房颤的预测价值。结果白细胞计数(whit blood cell count,WBC)≤8.52×10^(9)/L、乳酸脱氢酶(lactate dehy drogenase,LDH)≥1523.65 IU/L、脑钠肽(brain natriuretic peptide,BNP)≥4013.65 pg/mL、左心房内径(left atrial diameter,LAD)≥43.64 mm、血管紧张素转化酶(angiotensin converting enzyme,ACE)≥35.61 U/L、超敏C反应蛋白(hypersensitive C-reactive protein,hs-CRP)≥2.69 mg/L、CK-MB≥81.26 U/L、BMP10≤119.55 ng/mL是导致患者起搏器置入术后新发房颤的独立危险因素(P<0.05)。两模型的曲线下面积分别为0.802(95%CI:0.796~0.821)、0.831(95%CI:0.803~0.858)。结论较高的LAD及血清LDH、BNP、ACE、hs-CRP、CK-MB浓度、较低的BMP10浓度和WBC是患者起搏器置入术后新发房颤的影响因素,其中术前血清CK-MB、BMP10浓度对患者起搏器置入术后新发房颤具有较高的预测价值。

Objectives To investigate the predictive value of preoperative serum concentrations of cardiac MB isoenzyme of creatine kinase(CK-MB)and bone morphogenetic protein 10(BMP10)for new-onset atrial fibrillation(AF)in patients after pacemaker implantation.Methods A total of 189 patients who underwent pacemaker implantation in Shanghai Fourth Rehabilitation Hospital from March 2021 to March 2023 were retrospectively collected.The subjects were divided into non-AF group(n=111)and AF group(n=78)according to the occurrence of AF at the observation end point.The general data of the two groups were compared by univariate analysis and multivariate Logistic regression analysis.A nomogram model was constructed based on the screened risk factors,and the model was validated.Correlations were analyzed using bivariate Pearson linear correlation analysis.Receiver operating characteristic curve(ROC)was used to analyzed the predictive value of preoperative serum concentrations of CK-MB and BMP10 in patients with new-onset AF after pacemaker implantation.Results Whit blood cell count(WBC)≤8.52×10^(9)/L,lactate dehy drogenase(LDH)≥1523.65 IU/L,brain natriuretic peptide(BNP)≥4013.65 pg/mL,left atrial diameter(LAD)≥43.64 mm,angiotensin converting enzyme(ACE)≥35.61 U/L,hypersensitive C-reactive protein(hs-CRP)≥2.69 mg/L,CK-MB≥81.26 U/L and BMP10≤119.55 ng/mL were independent risk factors for postoperative new-onset AF in patients after pacemaker implantation(P<0.05).The area under the curve(AUC)of the two nomograph models were 0.802(95%CI:0.796-0.821),0.831(95%CI:0.803-0.858).Conclusions Higher LAD and high concentrations of LDH,BNP,ACE,hs-CRP,CK-MB,lower concentration of BMP10 and lower WBC are the influencing factors of new-onset AF in patients after pacemaker implantation.Secrum concentrations of CK-MB,BMP10 have high predictive value for new-onset AF in patients after pacemaker implantation.