摘要
目的:比较两种消融手术(冷冻消融和射频消融)治疗心房颤动的临床疗效以及两者对于心肌损伤程度的差异性,并分析消融术后晚期复发的危险因素。方法:回顾性分析2018年3月至2021年6月在贵州医科大学附属医院住院并首次行消融术治疗的275例房颤患者临床资料,术后随访1年,单因素和多因素二分类Logistic回归分析中性粒细胞/淋巴细胞值(NLR)、胱抑素C(CysC)及左心房内径(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,同时比较两种消融手术对心肌损伤程度的影响。结果:冷冻消融组113例,31例复发(27.43%),射频消融组162例,51例复发(31.48%),其术后远期复发率相比(27.43%vs.31.48%)差异无统计学意义(P>0.05)。射频消融组手术时间[(138.21±48.59) min]较冷冻消融组[(115.51±31.28) min]更长(P<0.05)。手术并发症方面射频消融组手术总体并发症为3.7%,冷冻消融组为3.5%,两组差异无统计学意义(P>0.05)。多因素Logistic回归分析结果显示NLR、LAD、CysC是房颤消融术后晚期复发的独立危险因素。NLR、CysC及LAD预测患者术后心房颤动复发的曲线下面积(AUC)为0.736、0.701、0.773,LAD+CysC+NLR联合预测时AUC最大(0.907),预测价值更高。心肌损伤程度方面,两组患者术后cTnT均升高,NT-proBNP均降低,与术前相比差异有统计学意义(P<0.05),与射频组相比,冷冻组术后cTnT显著升高(P<0.05),且两组晚期复发率(22.00%vs. 27.27%,P=0.532)无差异。结论:两种消融手术术后晚期复发率相当;冷冻球囊消融术对心肌细胞的损伤程度大,但对房颤晚期复发率没有影响。NLR、LAD、CysC是房颤消融术后预测晚期复发的独立危险因素,且LAD+CysC+NLR联合预测价值更高。
Objective: To compare the clinical efficacy of cryoablation and radiofrequency ablation in the treating atrial fibrillation and their differences in the degree of myocardial injury, and to analyze the risk factors of late recurrence after ablation. Methods: Clinical data of 275 patients with atrial fibrillation who were admitted to the Affiliated Hospital of Guizhou Medical University from March 2018 to June 2021 and underwent ablation for the first time were retrospectively analyzed. The relationship between neutrophil/lymphocyte ratio(NLR), cystatin C(CysC) and left atrial diameter(LAD) and postoperative atrial fibrillation recurrence was analyzed by univariate and multivariate binary Logistic regression. The predictive value of each indicator was evaluated by receiver operating characteristic(ROC) curve. Meanwhile, the effects of the two ablation procedures on myocardial injury were compared. Results: In the cryoablation group, 31 cases recurred(27.43%) in 113 cases, and in the radiofrequency ablation group 51 cases recurred(31.48%) in 162 cases. There was no significant difference in the late recurrence rate between the two groups(27.43%vs. 31.48%)(P>0.05). The operation time of radiofrequency ablation group[(138.21±48.59) min] was longer than that of cryoablation group[(115.51±31.28) min](P<0.05). In terms of surgical complications, the overall surgical complications were 3.7%in the radiofrequency ablation group and 3.5%in the cryoablation group, with no statistical significance between the two groups(P > 0.05).Multivariate Logistic regression analysis showed that NLR, LAD and CysC were independent risk factors for late recurrence after ablation. The area under curve(AUC) of NLR, CysC and LAD in predicting postoperative atrial fibrillation recurrence were 0.736, 0.701 and 0.773. The AUC of LAD+CysC+NLR combined prediction was the largest(0.907), and the predictive value was higher. In terms of the degree of myocardial injury, cTnT was increased and NT-proBNP was decreased in the two groups after operation, and the difference was statistically significant compared with that before operation(P<0.05). Compared with the radiofrequency group, cTnT was significantly increased after operation in the cryogenic group(P<0.05). There was no difference in the late recurrence rate between the two groups(22.00% vs. 27.27%, P=0.532). Conclusion: Late recurrence rate was similar between the two types of ablation. Cryoballoc ablation greatly damage cardiomyocytes, but has no effect on the late recurrence rate of AF. NLR, LAD and CysC are independent risk factors for late recurrence after atrial fibrillation ablation, and the combination of LAD+CysC+NLR has higher predictive value.
作者
彭茂林
刁晓艳
叶懿萱
刘嘉颖
PENG Maolin;DIAO Xiaoyan;YE Yixuan;LIU Jiaying(School of Clinical Medicine of Guizhou Medical University,Guiyang 550004,China;Department of Cardiovascular Medicine,Affiliated Hospital of Guizhou Medical University,Guiyang 550004,China)
出处
《现代医学》
2023年第1期59-68,共10页
Modern Medical Journal
基金
贵阳市科技计划项目([2019]9-1-15号)
关键词
房颤
冷冻消融
导管消融
复发
危险因素
atrial fibrillation
cryoablation
catheter ablation
recurrence
risk factors
