心电图P波参数联合血清脂联素和内脏脂肪素预测心房颤动射频消融术后复发的价值

Value of ECG P-wave parameterscombined withserum adiponectin and VFin predictingrecurrenceof AFafterradiofrequencyablation

目的 探究心电图P波参数联合血清脂联素、内脏脂肪素(visfatin, VF)预测心房颤动(atrial fibrillation, AF)射频消融术后复发的价值。方法 回顾性选取2021年3月至2023年3月扬州大学附属医院收治的AF患者120例为AF组,根据术后情况分为复发组39例和未复发组81例。另选取同期健康体检者120例为对照组。所有入选者进行心电图检查;酶联免疫吸附法检测脂联素、VF水平;采用logistic回归分析AF患者术后复发的影响因素。绘制ROC曲线分析心电图P波参数联合血清脂联素、VF对AF患者术后复发的预测价值。其中P波参数包括P波时限(P-wave duration, PWD)、最大PWD(maximum PWD,Pmax)、最小PWD、P波离散度(P-wave dispersion, Pd)。结果 AF组术后PWD、Pmax和Pd明显低于术前,差异有统计学意义(P<0.01)。AF组血清脂联素水平明显低于对照组[(6.15±1.58)μg/L vs(11.43±2.26)μg/L],VF水平明显高于对照组[(12.05±2.30)μg/L vs(6.23±1.02)μg/L],差异有统计学意义(P<0.01)。复发组术前PWD、Pmax和Pd明显高于未复发组,差异有统计学意义(P<0.01)。复发组血清脂联素水平明显低于未复发组,VF水平明显高于未复发组,差异有统计学意义(P<0.01)。多因素logistic回归分析显示,PWD、Pmax、Pd、VF为AF患者术后复发的危险因素,脂联素为保护因素(P<0.05,P<0.01)。ROC曲线分析显示,PWD、Pmax、Pd、脂联素、VF联合检测AF患者术后复发的曲线下面积为0.972,各指标联合检测优于PWD、Pmax、Pd、脂联素、VF单独检测(Z=2.574,Z=2.567,Z=2.543,Z=2.554,Z=2.586,P<0.05)。结论 心电图P波参数以及血清VF升高、脂联素降低为AF患者术后复发的影响因素,联合检测可提高术后复发的预测价值。

Objective To investigate the value of electrocardiogra(ECG)P-wave parameters com-bined with serum adiponectin and visfatin(VF)in predicting recurrence of atrial fibrillation(AF)after radiofrequency ablation.Methods A total of 120 AF patients(AF group)admitted to our.hospital from March 2021 to March 2023 were enrolled,and divided into a recurrence group(39 cases)and a non-recurrence group(81 cases)according to the postoperative condition.Another 120 healthy individuals who took physical examination in the same period were enrolled and served as control group.All subjects underwent ECG.ELISA was used to detect adiponectin and VF levels.Logistic regression analysis was used to identify the influencing factors of postoperative recur-rence in AF patients.ROC curve was plotted to analyze the predictive value of P wave parameters combined with serum adiponectin and VF for postoperative recurrence in AF patients.The P-wave parameters included P-wave duration(PWD),maximum PWD(Pmax),minimum PWD,and.P-wave dispersion(Pd).Results PWD,Pmax and Pd were significantly decreased in AF patients after operation(P<0.01).Serum adiponectin level was obviously lower and that of VF was nota-bly higher in the AF group than the control group(6.15±1.58μg/L Us 11.43±2.26 μg/L,12.05±2.30μg/L vs 6.23±1.02μg/L,P<0.01).The recurrence group had remarkably higher preopera-tive PWD,Pmax and Pd,and lower adiponectin and higher VF levels than the non-recurrence group(P<0.01).Multivariate logistic regression analysis showed that PWD,Pmax,Pd,and VF were risk factors,and adiponectin was a protective factor for postoperative recurrence in AF pa-tients(P<0.05,P<0.01).ROC curve analysis indicated that PWD,Pmax,Pd,adiponectin and VF combined together to detect postoperative recurrence in AF patients had an AUC value of 0.972,which was higher than that of above indicators alone(Z=2.574,Z=2.567,Z=2.543,Z-2554.Z=2.586,P<0.05).Conclusion ECG P-wave parameters as well as elevated serum VF and re-duced serum adiponectin are influencing factors for postoperative recurrence in AF patients,and their combined detection may promote the predictive value for postoperative recurrence in them.