2023 年第 10 期 第 18 卷

血小板体积分布宽度与心房颤动射频消融术后复发关系的研究

Association of platelet distribution width with recurrence of atrial fibrillation after catheter radiofrequency ablation

作者：孔强1史力生1喻荣辉2龙德勇2张钰聪1陈宇嘉1尹春琳1夏经钢1

英文作者：Kong Qiang1 Shi Lisheng1 Yu Ronghui2 Long Deyong2 Zhang Yucong1 Chen Yujia1 Yin Chunlin1 Xia Jinggang1

单位：1首都医科大学宣武医院心脏内科，北京100053；2首都医科大学附属北京安贞医院心脏内科，北京100029

英文单位：1Department of Cardiology Xuanwu Hospital Capital Medical University Beijing 100053 China; 2Department of Cardiology Beijing Anzhen Hospital Capital Medical University Beijing 100029 China

关键词：心房颤动；复发；射频消融；血小板体积分布宽度

英文关键词：Atrialfibrillation;Recurrence;Radiofrequencyablation;Plateletdistributionwidth

• 摘要：

• 目的  探讨血小板体积分布宽度（PDW）与心房颤动射频消融术后复发的关系。方法  回顾性分析2014年1月至2018年12月在首都医科大学宣武医院心内科接受心房颤动射频消融治疗的患者504例。入院常规检测血常规、生化指标、经胸及经食管心脏彩色多普勒超声。所有患者接受肺静脉电隔离治疗，心房颤动未终止或诱发出心房颤动的患者再进一步进行左心房线性消融，若心房颤动仍未终止，进行双相同步电复律转复为窦性心律。术后规范抗凝及抗心律失常治疗，常规随访。分析心房颤动患者射频消融术后复发的危险因素。结果  随访（24±21）个月后，212例患者复发房性心律失常。根据是否复发，将患者分为房性心律失常复发组（AR组，n=212）及窦性心律组（SR组，n=292）。AR组女性、冠状动脉粥样硬化性心脏病、心力衰竭及持续性心房颤动、术中电复律比例高于SR组，手术时间长于SR组（均P＜0.05）。心脏彩色多普勒超声指标中AR组左心房内径(LAD)、舒张期室间隔厚度、二尖瓣血流流速E峰值高于SR组，左心室射血分数低于SR组（均P＜0.05）。入院血常规指标中AR组血小板平均体积及PDW均高于SR组（均P＜0.05）。Cox回归分析结果显示，LAD（风险比=1.049,95%置信区间：1.014～1.086,P=0.006）以及PDW（风险比=0.052,95%置信区间：0.004～0.726,P=0.028）是心房颤动射频消融术后复发的独立危险因素。结论  LAD和PDW是心房颤动射频消融术后复发的独立危险因素。

• Objective  To explore the relationship between platelet distribution width (PDW) and recurrence of atrial fibrillation after radiofrequency ablation. Methods  Totally 504 patients who underwent radiofrequency ablation of atrial fibrillation in Department of Cardiology, Xuanwu Hospital Capital Medical University from January 2014 to December 2018 were retrospectively analyzed. Routine examination of blood routine, biochemical indicators, and transthoracic and transesophageal color Doppler echocardiography upon admission were detected. All patients received pulmonary vein electrical isolation treatment. Patients with atrial fibrillation that did not terminate or induced atrial fibrillation underwent further left atrial linear ablation. If atrial fibrillation did not terminate, biphasic synchronous electrical cardioversion was performed to convert to sinus rhythm. Patients were given standardize anticoagulation and antiarrhythmic treatment after surgery, and routine follow-up. The risk factors for recurrence after radiofrequency ablation in patients with atrial fibrillation were analyzed. Results  After follow-up of (24±21)months, there were 212 patients experienced recurrent atrial arrhythmias, and patients were divided into the recurrent atrial arrhythmias group (AR group, n=212) and the sinus rhythm group (SR group, n=292). The proportions of women, coronary atherosclerotic heart disease, heart failure, persistent atrial fibrillation, and intraoperative electroconversion in the AR group were higher than those in the SR group, and the surgical time was longer than that in the SR group (all P＜0.05). The left atrial diameter (LAD), diastole interventricular septum thickness, mitral valve flow velocity E peak in AR group were higher than those in SR group, and left ventricular ejection fraction was lower than that in SR group (all P＜0.05). The average platelet volume and PDW in the AR group were higher than those in the SR group (both P＜0.05). Cox regression analysis showed that LAD (hazard ratio=1.049, 95% confidence interval: 1.014-1.086, P=0.006) and PDW (hazard ratio=0.052, 95% confidence interval: 0.004-0.726, P=0.028) were independent risk factors for recurrence of atrial fibrillation after radiofrequency ablation. Conclusion  PDW and LAD are the independent predictors for recurrence of atrial fibrillation after radiofrequency ablation.