2021 年第 9 期 第 16 卷

炎症相关因子及左心房内径对阵发性心房颤动患者射频消融术后复发的预测价值

Predictive value of inflammation-related factors and left atrial diameter in recurrence of paroxysmal atrial fibrillation after radiofrequency ablation

作者：赵志浩张凤云杨煜

英文作者：Zhao Zhihao Zhang Fengyun Yang Yu

单位：徐州医科大学附属医院心内科221006

英文单位：Department of Cardiology the Affiliated Hospital of Xuzhou Medical University Xuzhou 221006 China

关键词：心房颤动；射频消融术；中性粒细胞与淋巴细胞比值；淋巴细胞与单核细胞比值；左心房内径

英文关键词：Atrialfibrillation；Radiofrequencyablation；Neutrophiltolymphocyteratio；Lymphocytetomonocyteratio；Leftatrialdiameter

• 摘要：

• 目的 探讨炎症相关因子及左心房内径（LAD）对阵发性心房颤动患者射频消融术后复发的预测价值。方法 选取2018年5月至2020年3月于徐州医科大学附属医院心内科行首次射频消融术的阵发性心房颤动患者165例，所有患者在CARTO3系统引导下均完成环肺静脉隔离，并且成功恢复窦性心律，术后定期随访，观察患者是否有心房颤动复发。根据术后随访的结果，将患者分为复发组和非复发组，单因素和多因素二分类Logistic回归分析方法分析炎症相关因子及LAD与患者术后心房颤动复发的关系，采用受试者工作特征（ROC）曲线评价各指标的预测价值。结果 所有患者射频消融术后随访到2020年10月，随访(18±11)个月，术后阵发性心房颤动复发46例，未复发119例。复发组LAD、心房颤动病程、中性粒细胞计数、单核细胞计数、中性粒细胞与淋巴细胞比值（NLR）水平明显高于未复发组，淋巴细胞计数、白蛋白和淋巴细胞与单核细胞比值（LMR）水平明显低于未复发组，差异均有统计学意义(均P＜0.05)。Logistic回归分析结果显示，LAD和NLR是患者术后心房颤动复发的独立危险因素，LMR是患者术后心房颤动复发的独立保护因素(均P＜0.05)。NLR、LMR预测患者术后心房颤动复发的曲线下面积（AUC）为0.749、0.752，LAD预测的AUC为0.673。LAD+LMR+NLR联合预测时AUC最大（0.811），预测价值更高。结论 NLR、LMR和LAD可作为阵发性心房颤动患者射频消融术后复发的独立预测因素。当NLR≥2.485或LMR≤4.375或LAD≥41.5 mm时，阵发性心房颤动射频消融术后复发的概率明显增加，且LAD+LMR+NLR联合预测价值更高。

• Objective To discuss the predictive value of inflammation-related factors and left atrial diameter （LAD） in recurrence of paroxysmal atrial fibrillation (AF) after radiofrequency ablation. Methods From May 2018 to March 2020, 165 patients with paroxysmal AF undergone the first radiofrequency ablation in Department of Cardiology, the Affiliated Hospital of Xuzhou Medical University were enrolled. All patients received pulmonary vein isolation (PVI) and successfully recovered sinus rhythm under the guidance of CARTO3 system. The patients were followed-up regularly after operation to observe whether there were AF recurrence. According to the results of postoperative follow-up, the patients were divided into recurrence group and non-recurrence group. The relationship between inflammation-related factors, LAD and paroxysmal AF recurrence after operation was analyzed by univariate and multivariate binary Logistic regression analysis, and the predictive value of each index was assessed by receiver operating characteristic(ROC) curve. Results The patients were followed-up until October 2020, (18±11) months after radiofrequency ablation, and there were 46 cases of paroxysmal AF recurrence and 119 cases of non-recurrence. LAD, duration of AF, neutrophil count, monocyte count, and neutrophil to lymphocyte ratio (NLR) levels in recurrence group were significantly higher than those in non-recurrence group, while lymphocyte count, albumin, and lymphocyte to monocyte ratio (LMR) levels in recurrence group were significantly lower than those in non-recurrence group (all P＜0.05). Logistic regression analysis showed that LAD and NLR were independent risk factors for postoperative recurrence of AF, and LMR was an independent protective factor for postoperative recurrence of AF (all P＜0.05). The area under the curve (AUC) of NLR and LMR for predicting postoperative recurrence of AF were 0.749 and 0.752, and the AUC for LAD prediction was 0.673. When LAD，LMR and NLR were combined, the AUC was the largest (0.811) and the predictive value was higher. Conclusions NLR, LMR and LAD are identified as independent predictors of recurrence after radiofrequency ablation in patients with paroxysmal AF. When NLR≥2.485 or LMR≤4.375 or LAD≥41.5 mm, the probability of recurrence markedly increases, and the predictive value is higher when LAD, LMR and NLR are combined for prediction.