P波离散度和N端脑钠肽前体预测房颤冷冻球囊导管消融术后复发的价值

doi:10.16150/j.1671-2870.2020.01.008

摘要/Abstract

摘要：

目的：研究P波离散度和N端脑钠肽前体（N-terminal pro-brain natriuretic peptide,NT-proBNP）与房颤冷冻球囊导管消融术后房颤复发间的关系。方法：记录182例首次成功接受冷冻球囊导管消融术的阵发性房颤患者术前和术后1 d、1个月、3个月、6个月窦性心律时的12导联心电图,计算P波离散度,同步测定患者的血浆NT-proBNP水平。随访术后6个月内患者有无房颤发作,同时分析其临床资料、超声心动图检查结果和消融手术资料。结果：术后6个月患者的房颤复发率为21.4%。无房颤复发组患者的年龄小[（47.6±6.1）岁比（60.2±9.5）岁]、孤立性房颤百分比高（69.5%比47.3%）,且其P波离散度无论在术前还是在术后1 d及1、3、6个月均显著小于房颤复发组（P<0.05）;无房颤复发组患者在术后3个月、6个月的P波离散度较术前显著减小（P<0.05）;而房颤复发组患者术后的P波离散度与术前比较,差异无统计学意义（P>0.05）。无房颤复发组患者的NT-proBNP,无论术前还是术后1 d、1个月、3个月、6个月其水平均显著低于同时间点的房颤复发组（P<0.05）,且无房颤复发组患者术后1个月、3个月、6个月的NT-proBNP水平均显著低于术前水平（P<0.05）;而房颤复发组患者术后6个月内的NT-proBNP水平与术前比较,差异均无统计学意义（P>0.05）。此外,无房颤复发组患者术前的左心房内径较房颤复发组小[（41.3±2.7） mm比（46.6±4.4） mm）],并在术后6个月[（38.0±2.0） mm比（41.3±2.7） mm]较术前显著缩小。多变量Logistic回归分析显示,左心房内径(OR=1.3, 95% CI为0.9~1.0, P<0.01）、术前P波离散度（OR=1.2, 95% CI为 1.0~1.1, P=0.04）和术前NT-proBNP水平（OR=2.3, 95% CI为1.3~1.7, P=0.03）是房颤冷冻球囊导管消融术后6个月内房颤复发的独立预测因子。结论：术前P波离散度和NT-proBNP水平可为冷冻球囊导管消融术患者选择及术后预测房颤复发提供一定的参考信息。

关键词: P波离散度, N端脑钠肽前体, 房颤, 冷冻球囊导管消融术, 复发

Abstract:

Objective: To investigate the predictive value of P-wave dispersion and N-terminal pro-brain natriuretic peptide (NT-proBNP) for recurrence of atrial fibrillation (AF) after successful cryoballoon ablation. Methods: A total of 182 patients with paroxysmal AF with successful cryoballoon ablation were enrolled. A 12-lead electrocardiogram (EKG) was used to record the P-wave for calculating P-wave dispersion before ablation and 1 day, 1 month, 3 months and 6 months after ablation, and plasma NT-proBNP was measured at the same time. A 6-month follow-up was carried out for studying the recurrence of AF, and the clinical, EKG and ablation data were analyzed. Results: The recurrence rate of AF within 6 months after successful cryoballoon ablation was 21.4%. Compared with patients with AF recurrence, those without AF recurrence were younger in age [(47.6±6.1) years vs. (60.2±9.5) years], having higher percentage of lone AF（69.5% vs. 47.3%） and smaller P-wave dispersion. P-wave dispersions were decreased at 3, 6 months after ablation in patients without AF recurrence, while in patients with AF recurrence no significant changes were found. Level of NT-proBNP in patients without AF recurrence were lower than those in patients with AF recurrence. Level of NT-proBNP was decreased after ablation in patients without AF recurrence, while no significant change was found in patients with AF recurrence. Meanwhile patients remained free from AF for 6 months had smaller left atrial diameter(LAD) before ablation than those with recurrence of AF[（41.3±2.7） mm vs.( 46.6±4.4) mm], and LAD was further decreased at 6 months [from(41.3±2.7) mm to (38.0±2.0) mm] (P<0.05). Multivariate regression analysis showed that LAD (OR: 1.3, 95% CI: 0.9-1.0, P<0.05), P-wave dispersion (OR: 1.2, 95% CI: 1.0-1.1, P=0.04） and NT-proBNP level(OR: 2.3, 95%CI: 1.3-1.7, P=0.03) before ablation were independent predictors of AF recurrence after ablation. Conclusions: P-wave dispersion and NT-proBNP level may provide reference information for prediction of recurrence of AF after cryoballon ablation.

Key words: P-wave dispersion, NT-proBNP, Atrial fibrillation, Cyroballoon ablation, Recurrence

中图分类号:

R541.75

罗晓颖, 许燕, 张凤如, 吴立群, 戚文航. P波离散度和N端脑钠肽前体预测房颤冷冻球囊导管消融术后复发的价值[J]. 诊断学理论与实践, 2020, 19(1): 32-36.

LUO Xiaoying, XU Yan, ZHANG Fengru, WU Liqun, QI Wenhang. Value of P-wave dispersion, NT-proBNP for prediction of recurrence of atrial fibrillation following cryoballoon ablation[J]. Journal of Diagnostics Concepts & Practice, 2020, 19(1): 32-36.

图/表 4

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参考文献 10

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参数	房颤复发组（n=39）	无房颤复发组（n=143）
年龄（岁）	60.2±9.5^a)	47.6±6.1
男性（%）	48.7	43.4
孤立性房颤（%）	47.3^a)	69.5
房颤史（月）	40.2±27.6	31.3±22.7
体质量指数（kg/m²）	30.4±4.9	28.9±4.1
血肌酐（μmol/L）	83.3±22.6	87.1±19.0
肾小球滤过率[mL/(min·1.73 m²)]	78.3±7.1	80.5±6.4
他汀使用率（%）	27.0	29.3
ACEI和（或）ARB使用率（%）	39.7	44.9
X线曝光时间（min）	15.9±1.7	12.7±1.5

时间点	房颤复发组（n=39）	无房颤复发组（n=143）
术前	75.7±16.4^a)	61.6±18.5
术后1 d	73.4±16.2^a)	60.1±14.5
术后1个月	69.8±15.0^a)	58.4±12.9
术后3个月	68.1±15.8^a)	42.7±9.4^b)
术后6个月	68.2±14.9^a)	39.9±8.8^b)

时间点	房颤复发组（n=39）	无房颤复发组（n=143）
术前	413.6±105.8^a)	157.1±68.4
术后1天	417.5±124.9^a)	178.6±72.2
术后1个月	425.3±97.4^a)	87.3±47.6^b)
术后3个月	404.9 ±96.1^a)	62.5±40.9^b)
术后6个月	391.4 ±88.6^a)	51.5±34.3^b)

参数	房颤复发组（n=39）		无房颤复发组(n=143)
参数	术前	术后6个月	术前	术后个6月
LAD (mm)	46.6±4.4^a)	45.8±4.2^a)	41.3±2.7	38.0±2.0^b)
LVEF（%）	59.4±8.6	58.1±8.7	55.5±8.7	56.6±7.9
E/A	1.1±0.5	1.2±0.4	1.0±0.4	1.2±0.6
E/e'	9.6±3.2	10.1±3.8	10.0±3.7	10.3±4.1

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