| 一站式术后心房颤动患者心功能变化及晚期复发危险因素的预测 |
| 投稿时间：2025-05-12 修订日期：2025-05-28 点此下载全文 |
| 引用本文：贾志清,朱王亮,乔鑫,都哇拉.一站式术后心房颤动患者心功能变化及晚期复发危险因素的预测[J].医学研究杂志,2025,54(10):79-83, 88 |
| DOI：
10.11969/j.issn.1673-548X.2025.10.014 |
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| 基金项目:内蒙古自治区科技计划项目(2021GG0118) |
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| 中文摘要:目的 探讨导管消融术(catheter ablation,CA)联合左心耳封堵术(一站式手术)对心房颤动(atrial fibrillation,AF)患者心功能的影响,并分析一站式手术术后AF晚期复发的危险因素。方法 选取2020年1月～2023年12月因AF就诊于内蒙古自治区人民医院的患者225例,根据手术方式分为一站式手术组(n=93)和CA组(n=132),采用倾向评分匹配方法,按照1∶1的比例各自筛选出55例在临床基线特征上相匹配的患者,即CA组(n=55)和一站式手术组(n=55),比较两组患者术前与术后1年的心功能变化。采用多因素Logistic回归分析和受试者工作特征(receiver operating characteristic,ROC)曲线评估一站式手术术后AF晚期复发的危险因素及其预测价值。结果 术后1年,两组患者的N末端B型利钠肽原(N-terminal B-type natriuretic peptide,NT-proBNP)、左心房内径(left atrial internal diameter,LAD)、左心室舒张末期内径(left ventricular end-diastolic diameter,LVEDD)较术前均明显降低(P<0.05),左心室射血分数(left ventricular ejection fraction,LVEF)较术前明显升高(P<0.05),但术后1年两组患者的心功能改善程度比较,差异无统计学意义(P>0.05)。单因素分析结果显示,一站式手术术后晚期复发组在NT-proBNP、LAD、左心室收缩末期内径(left ventricular end-systolic diameter,LVESD)与晚期未复发组比较,差异均有统计学意义(P<0.05)；多因素Logistic回归分析结果显示,术前NT-proBNP(OR=1.075,95%CI:1.029～1.124,P=0.001)和术前LAD(OR=1.222,95%CI:1.094～1.365,P<0.001)是一站式手术术后AF晚期复发的危险因素。ROC曲线分析结果显示,NT-proBNP、LAD以及两者联合应用预测一站式手术术后AF晚期复发的曲线下面积(area under the curve,AUC)分别为0.788、0.772、0.846,敏感度分别为84.4%、68.8%、87.5%,特异性分别为68.9%、78.7%、77.0%。结论 一站式手术与CA均可显著改善AF患者的心功能,且效果相当。术前LAD增大及NT-proBNP升高是一站式手术术后AF晚期复发的独立危险因素,两者联合应用可有效提升AF复发风险评估效能。 |
| 中文关键词:心房颤动 一站式手术 心功能 复发 危险因素 |
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| Changes in Cardiac Function and Prediction of Late Recurrence Risk Factors in Atrial Fibrillation Patients undergoing One-stop Procedure. |
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| Abstract:Objective To investigate the impact of catheter ablation (CA) combined with left atrial appendage closure (one-stop procedure) on cardiac function in atrial fibrillation (AF) patients, and analyze the risk factors for late AF recurrence after one-stop procedure. Methods A total of 225 patients who visited the Inner Mongolia Autonomous Region People′s Hospital for AF from January 2020 to December 2023 were included, and they were divided into the one-stop procedure group (n=93) and the CA group (n=132) according to the procedure, and 55 patients with matching clinical baseline characteristics were respectively screened out at a ratio of 1:1 by the method of propensity score matching, namely the CA group (n=55) and the one-stop procedure group (n=55), and the changes in cardiac function between the two groups were compared between preoperative and 1-year postoperative periods. Risk factors for late postoperative recurrence of AF and their predictive value in the one-stop procedure group were assessed using multivariate Logistic regression analysis and receiver operating characteristic (ROC) curve. Results At 1 year postoperatively, N-terminal B-type natriuretic peptide (NT-proBNP), left atrial internal diameter (LAD), and left ventricular end-diastolic diameter (LVEDD) were significantly lower and left ventricular ejection fraction (LVEF) was significantly higher in both groups compared with the preoperative period (P<0.05), but there was no statistically significant difference in the improvement degree of cardiac function between the two groups at 1 year postoperatively (P>0.05). The results of the univariate analysis showed that there were statistically significant differences in NT-proBNP, LAD, and left ventricular end-systolic diameter (LVESD) in the one-stop procedure late postoperative recurrence group compared with late postoperative non-recurrence group (P<0.05), and the results of multivariate Logistic regression analysis showed that the preoperative NT-proBNP (OR=1.075,95%CI:1.029-1.124, P=0.001) and preoperative LAD (OR=1.222,95% CI:1.094-1.365, P<0.001) were the risk factors for late recurrence of AF after one-stop procedure. The results of the ROC curve analysis showed that the area under the curve (AUC) of NT-proBNP, LAD, and the combination of the two in predicting late recurrence of AF after one-stop procedure were 0.788,0.772 and 0.846, respectively, with a sensitivity of 84.4%, 68.8% and 87.5%, and a specificity of 68.9%, 78.7% and 77.0%, respectively. Conclusion Both one-stop procedure and CA can significantly improved cardiac function in patients with AF with comparable results. Preoperative LAD enlargement and NT-proBNP elevation are independent risk factors for late recurrence of AF after one-stop procedure, and the combination of the two can effectively improve the efficacy of AF recurrence risk assessment. |
| keywords:Atrial fibrillation One-stop procedure Cardiac function Recurrence Risk factors |
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