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山东大学学报 (医学版) ›› 2019, Vol. 57 ›› Issue (3): 49-57.doi: 10.6040/j.issn.1671-7554.0.2018.179

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预测心房颤动患者射频消融术后复发的危险因素

陈琳琳1,衣少雷2,王蔚宗1,李展1,张勇1,张玉娇1,任满意1,解新星3,刘同宝2,侯应龙1   

  1. 1.山东大学附属千佛山医院心内科, 山东 济南 250014;〓2.山东大学附属省立医院心内科, 山东 济南 250021;〓3.日照心脏病医院心内科, 山东 日照 276800
  • 发布日期:2022-09-27
  • 通讯作者: 侯应龙. E-mail:houyinglong2010@hotmail.com刘同宝. E-mail:liutongbao@medmail.com.cn
  • 基金资助:
    山东省科技发展计划(2014GSF118180);国家自然科学基金(81770334);山东省自然科学基金(ZR2017LH003);泰山学者岗位建设基金(ts201511104)

Risk factors of recurrent atrial fibrillation after radiofrequency catheter ablation

CHEN Linlin1, YI Shaolei2, WANG Weizong1, LI Zhan1, ZHANG Yong1, ZHANG Yujiao1,REN Manyi1, XIE Xinxing3, LIU Tongbao2, HOU Yinglong1   

  1. 1. Department of Cardiology, Qianfoshan Hospital Affiliated to Shandong University, Jinan 250014, Shandong, China;
    2. Department of Cardiology, Provincial Hospital Affiliated to Shandong University, Jinan 250021, Shandong, China;
    3. Department of Cardiology, Rizhao International Hospital, Rizhao 276800, Shandong, China
  • Published:2022-09-27

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摘要： 目的 探讨心房颤动(房颤)导管射频消融术后复发的相关危险因素。 方法 选取行房颤射频消融术患者270例(房颤组),同时选取健康查体者100例(对照组)。收集两组临床基线资料和外周静脉血,检测生化学标志物和miRNA;术后随访12个月,根据房颤复发情况分为房颤术后复发组和术后未复发组,并进一步按照阵发性房颤和持续性房颤分为复发与未复发亚组进行分析。应用单因素分析及Logistic回归分析,筛选房颤术后复发相关的危险因素。比较房颤亚组中危险因素的ROC曲线下面积,判断预测因素准确性。 结果 单因素分析显示:与对照组相比,房颤组血浆miRNA-21、miRNA-133、 miRNA-150、 miRNA-206、 miRNA-328表达量差异均有统计学意义(P<0.05);与术后未复发组相比,房颤术后复发组房颤类型、术中电复律、病程时间、CHADS2评分、左房前后径(LAD)、左室射血分数、尿酸、血浆miRNA-21表达量差异有统计学意义(P<0.05)。Logistic回归分析显示:阵发性房颤中LAD(OR=1.187,P=0.031)、血浆miRNA-21表达量(OR=1.226,P=0.012)在复发与未复发亚组间差异有统计学意义;而在持续性房颤中,LAD(OR=1.125,P=0.035)、病程时间(OR=1.023,P=0.019)、血浆miRNA-21表达量(OR=1.177,P=0.032)在复发与未复发亚组间差异有统计学意义。阵发性房颤中以LAD为指标计算ROC曲线下面积(AUC)为0.750,综合血浆中miRNA-21表达量后AUC=0.844;持续性房颤中,综合LAD、病程时间及血浆miRNA-21表达量测得AUC亦具有一定的参考价值。 结论 LAD及血浆中miRNA-21表达量是预测阵发性与持续性房颤患者射频消融术后复发的独立危险因素,而病程时间是预测持续性房颤射频消融术后复发的独立危险因素。

关键词: 心房颤动, 射频消融术, 房颤复发, miRNA, 危险因素

Abstract: Objective To evaluate recurrence-related risk factors of atrial fibrillation(AF)after radiofrequency catheter 山 东 大 学 学 报 (医 学 版)57卷3期 -陈琳琳,等.预测心房颤动患者射频消融术后复发的危险因素 \=-ablation(RFCA). Methods A total of 270 patients who underwent RFCA were enrolled as the AF group, and 100 healthy subjects as the control group. Clinical baseline information and peripheral venous blood of the two groups were collected. Biochemical markers and miRNA expressions were detected. During the follow-up of 12 months, the patients were divided into the recurrence group and non-recurrence group, and further divided into paroxysmal AF and persistent AF subgroups. Univariate analysis and Logistic regression analysis were used to screen out relevant hazards after RFCA. The area under the receiver operating characteristic(ROC)curve(AUC)in the AF subgroups was analyzed to judge the accuracy of predictive factors. Results The univariate analysis showed statistical differences in the expressions of miRNA-21, miRNA-133, miRNA-150, miRNA-206 and miRNA-328 between the control group and AF group(P<0.05), and statistical differences in the AF type, electric conversion, duration of disease, CHADS2 scoring, left atrial diameter(LAD), left ventricular ejection fraction(LVEF), uric acid and miRNA-21 expression between the recurrence group and non-recurrence group(P<0.05). Logistic regression analysis revealed that LAD(OR=1.187, P=0.031)and miRNA-21 expression(OR=1.226, P=0.012)in the paroxysmal AF subgroup had statistical significance. LAD(OR=1.125, P=0.035), course of disease(OR=1.023, P=0.019), and miRNA-21 expression(OR=1.177, P=0.032)in the persistent AF subgroup had statistical significance. In the paroxysmal AF subgroup, LAD was used as the index to calculate AUC, and the result was 0.750. When miRNA-21 expression and LAD together served as the comprehensive index, AUC=0.844 was derived. AUC measured by the combination of LAD, course of disease and miRNA-21 expression in the persistent AF group also had reference value. Conclusion LAD and miRNA-21 expression are independent recurrence-related risk factors after RFCA in patients with paroxysmal AF, while LAD, miRNA-21 expression and duration of disease are independent recurrence-related risk factors for persistent AF.

Key words: Atrial fibrillation, Radiofrequency catheter ablation, Atrial fibrillation recurrence, miRNA, Risk factors

中图分类号: 

  • R541.7+5
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