血浆NT-proBNP水平对持续性房颤患者射频消融术后预后的预测价值
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摘要
目的研究血浆后氨基末端脑钠肽前体(NT-proBNP)水平对持续性房颤(简称房颤)患者射频消融术后预后的预测价值。方法将四川大学华西医院2014年1月至2017年1月间收治的130例房颤患者纳为研究对象,同时纳入50例健康体检者为健康对照组,根据患者房颤类型将其分为持续性房颤组(n=77)与阵发性房颤组(n=53),比较3组血浆NT-proBNP水平;所有持续性房颤患者(n=77)行射频消融治疗,根据其术后是否转复窦性心律将其分为转复窦律组(n=27)与未转复窦律组(n=50),随访1年,根据患者手术效果将其分为手术成功组(n=30)与手术失败组(n=47),分析术后转复窦律与手术效果的相关性;比较术后转复窦律组与未转复窦律组的血浆NT-proBNP水平;比较手术失败组与成功组的血浆NT-proBNP水平;分析血浆NT-proBNP水平与患者预后的关系。结果健康对照组、阵发性房颤组、持续性房颤组患者的血浆NT-proBNP水平呈依次上升趋势,组间差异显著(P<0.05);术后是否转复窦律与手术效果存在相关性(r=0.716,P<0.05);术后转复窦律组的血浆NT-proBNP水平显著低于未转复窦律组(P<0.05);手术成功组术前及术后24 h血浆NT-proBNP浓度均显著低于失败组(P<0.05);相关性分析提示,血浆NT-proBNP水平与持续性房颤患者射频消融术后复发呈正相关(r=0.367,P<0.05)。结论血浆NT-proBNP浓度在持续性房颤射频消融患者预后中具有良好的应用价值。
Objective To investigate the predictive value of plasma N-terminal pro-brain natriuretic peptide(NT-proBNP)level in patients with persistent atrial fibrillation(AF)after radiofrequency ablation. Methods 130 cases of patients with atrial fibrillation admitted to West China Hospital of Sichuan University from January 2014 to January 2017 were included in the study. At the same time,50 healthy examiners were included in healthy control group. According to the types of atrial fibrillation,they were divided into persistent atrial fibrillation group(n=77)and paroxysmal atrial fibrillation group(n=53). The plasma levels of NT-proBNP in the 3 groups were compared. All patients with persistent atrial fibrillation(n=77)were given radiofrequency ablation,and were divided into sinus rhythm cardioversion group(n=27)and sinus rhythm non-cardioversion group(n=50)according to whether there was sinus rhythm cardioversion after operation. After 1 year of follow-up,the patients were divided into surgery success group(n=30)and surgery failure group(n=47)according to the surgical results,and the correlation between the postoperative sinus rhythm cardioversion and surgical outcomes was analyzed. The plasma NT-proBNP levels were compared between sinus rhythm cardioversion group and sinus rhythm non-cardioversion group or failure group and surgery success group. The relationship between plasma NT-proBNP level and prognosis was analyzed.Results The levels of plasma NT-proBNP in control group,paroxysmal atrial fibrillation group and persistent atrial fibrillation group were increased in turn(P<0.05). There was a correlation between the presence or absence of sinus rhythm cardioversion and surgical outcomes(r = 0.716,P<0.05). The level of plasma NT-proBNP in sinus rhythm cardioversion group was significantly lower than that in sinus rhythm noncardioversion group(P<0.05). The plasma NT-proBNP concentrations before operation and at 24 h after operation in surgery successful group were significantly lower than those in surgery failure group(P<0.05).Correlation analysis showed that plasma NT-proBNP level was positively correlated with preoperative recurrence after radiofrequency ablation in patients with persistent atrial fibrillation(r = 0.367,P<0.05).Conclusion Plasma NT-proBNP concentration has a good application value in the prognosis of patients with persistent atrial fibrillation after radiofrequency ablation.
Objective To investigate the predictive value of plasma N-terminal pro-brain natriuretic peptide(NT-proBNP)level in patients with persistent atrial fibrillation(AF)after radiofrequency ablation. Methods 130 cases of patients with atrial fibrillation admitted to West China Hospital of Sichuan University from January 2014 to January 2017 were included in the study. At the same time,50 healthy examiners were included in healthy control group. According to the types of atrial fibrillation,they were divided into persistent atrial fibrillation group(n=77)and paroxysmal atrial fibrillation group(n=53). The plasma levels of NT-proBNP in the 3 groups were compared. All patients with persistent atrial fibrillation(n=77)were given radiofrequency ablation,and were divided into sinus rhythm cardioversion group(n=27)and sinus rhythm non-cardioversion group(n=50)according to whether there was sinus rhythm cardioversion after operation. After 1 year of follow-up,the patients were divided into surgery success group(n=30)and surgery failure group(n=47)according to the surgical results,and the correlation between the postoperative sinus rhythm cardioversion and surgical outcomes was analyzed. The plasma NT-proBNP levels were compared between sinus rhythm cardioversion group and sinus rhythm non-cardioversion group or failure group and surgery success group. The relationship between plasma NT-proBNP level and prognosis was analyzed.Results The levels of plasma NT-proBNP in control group,paroxysmal atrial fibrillation group and persistent atrial fibrillation group were increased in turn(P<0.05). There was a correlation between the presence or absence of sinus rhythm cardioversion and surgical outcomes(r = 0.716,P<0.05). The level of plasma NT-proBNP in sinus rhythm cardioversion group was significantly lower than that in sinus rhythm noncardioversion group(P<0.05). The plasma NT-proBNP concentrations before operation and at 24 h after operation in surgery successful group were significantly lower than those in surgery failure group(P<0.05).Correlation analysis showed that plasma NT-proBNP level was positively correlated with preoperative recurrence after radiofrequency ablation in patients with persistent atrial fibrillation(r = 0.367,P<0.05).Conclusion Plasma NT-proBNP concentration has a good application value in the prognosis of patients with persistent atrial fibrillation after radiofrequency ablation.
引文
[1]丁峰,宋宏宁,陈金玲,等.左心房超声定量分析对心房颤动患者消融术后复发的预测价值[J].中华超声影像学杂志,2017,26(8):650-656.
[2]叶国杰,张力,张金盈.舒张功能不全的房颤患者超声心动图指标与NT-proBNP的相关性[J].临床心血管病杂志,2016,32(12):1198-1200.
[3]黄从新.对2006年AHA/ACC/ESC心房颤动治疗指南的评价[J].中国实用内科杂志,2007(22):1731-1734.
[4]刘诗琴,黄建芳,谈思怡,等.人N端脑钠肽前体(NT-ProBNP)单抗制备及双抗体夹心ELISA检测方法的建立[J].免疫学杂志,2016,32(5):441-445.
[5]卢振华,刘念,白融,等. 2型糖尿病合并持续性心房颤动导管消融术后复发因素研究[J].临床心血管病杂志,2017,33(4):356-360.
[6]何扬利,曾敏,吴智勇,等.老年非瓣膜性房颤伴急性脑梗死患者的血浆尿酸、脑钠肽水平变化及与CHADS2评分的关系[J].中国老年学杂志,2016,36(10):2365-2367.
[7]徐正云,任国珍.老年心力衰竭合并心房颤动病人血清NT-proBNP的临床意义[J].中西医结合心脑血管病杂志,2017,15(17):2157-2160.
[8]谭今,于涛,黄克力,等. NT-proBNP、血乳酸、肌钙蛋白Ⅰ及血浆胱抑素C等对体外循环心脏手术患者预后的影响[J].实用医学杂志,2018,34(5):755-759.
[9]张维贞,向丽,黄山.分子诊断技术在心房颤动临床诊疗中的应用[J].分子诊断与治疗杂志,2018,10(4):283-288.
[10]段文涛,史东,王新夺,等.胺碘酮联合螺内酯在持续性心房颤动转复后维持窦性心律中的作用[J].中国老年学杂志,2017,37(8):1924-1925.
[11]肖淼淼,郑康超,肖辉雪,等. CSE/H2 S在心血管系统的作用及机制[J].医学分子生物学杂志,2016,13(6):365-370.
[12]刘诗琴,黄建芳,谈思怡,等.人N端脑钠肽前体(NT-ProBNP)单抗制备及双抗体夹心ELISA检测方法的建立[J].免疫学杂志,2016,32(5):441-445.
[13]张鸿雁,李楠,林敏.孤立性房颤患者血浆NTproBNP、CRP及D-二聚体水平变化及意义[J].山东医药,2016,56(24):68-70.
[14]施伟丽,徐浩,丛伟红,等.从Hsp90对eNOS活性的影响探讨Hsp90在心血管疾病中的保护作用[J].医学分子生物学杂志,2016,13(6):350-354.
[15]刘力,王志权,朱启明,等.心房颤动射频消融术后复发相关危险因素的临床研究[J].心脑血管病防治,2016,16(3):187-189.
[16]王勇,李杰.心房颤动患者行肺静脉大环隔离消融术后复发的影响因素分析[J].山东医药,2017,57(30):64-66.
[17]丁云,孙建国,吴建荣,等.胺碘酮与伊布利特对老年转复消融术后持续性心房颤动的临床疗效评价[J].中国临床药理学杂志,2016,32(6):570-572.
[18]吴毓优,吕鹏飞,高炳玉,等.二尖瓣置换术同期行双极射频消融术治疗房颤及术前危险因素与术后转律的关系[J].海南医学,2016,27(17):2848-2850.
[19]孙晓臣. N端脑钠肽前体与阵发性心房颤动复发的关系探讨[J].中西医结合心脑血管病杂志,2018,16(8):1088-1090.
[20]张鸿雁,李楠,林敏.孤立性房颤患者血浆NTproBNP、CRP及D-二聚体水平变化及意义[J].山东医药,2016,56(24):68-70.
[21]刘诗琴,黄建芳,谈思怡,等.人N端脑钠肽前体(NT-ProBNP)单抗制备及双抗体夹心ELISA检测方法的建立[J].免疫学杂志,2016,32(5):441-445.
[2]叶国杰,张力,张金盈.舒张功能不全的房颤患者超声心动图指标与NT-proBNP的相关性[J].临床心血管病杂志,2016,32(12):1198-1200.
[3]黄从新.对2006年AHA/ACC/ESC心房颤动治疗指南的评价[J].中国实用内科杂志,2007(22):1731-1734.
[4]刘诗琴,黄建芳,谈思怡,等.人N端脑钠肽前体(NT-ProBNP)单抗制备及双抗体夹心ELISA检测方法的建立[J].免疫学杂志,2016,32(5):441-445.
[5]卢振华,刘念,白融,等. 2型糖尿病合并持续性心房颤动导管消融术后复发因素研究[J].临床心血管病杂志,2017,33(4):356-360.
[6]何扬利,曾敏,吴智勇,等.老年非瓣膜性房颤伴急性脑梗死患者的血浆尿酸、脑钠肽水平变化及与CHADS2评分的关系[J].中国老年学杂志,2016,36(10):2365-2367.
[7]徐正云,任国珍.老年心力衰竭合并心房颤动病人血清NT-proBNP的临床意义[J].中西医结合心脑血管病杂志,2017,15(17):2157-2160.
[8]谭今,于涛,黄克力,等. NT-proBNP、血乳酸、肌钙蛋白Ⅰ及血浆胱抑素C等对体外循环心脏手术患者预后的影响[J].实用医学杂志,2018,34(5):755-759.
[9]张维贞,向丽,黄山.分子诊断技术在心房颤动临床诊疗中的应用[J].分子诊断与治疗杂志,2018,10(4):283-288.
[10]段文涛,史东,王新夺,等.胺碘酮联合螺内酯在持续性心房颤动转复后维持窦性心律中的作用[J].中国老年学杂志,2017,37(8):1924-1925.
[11]肖淼淼,郑康超,肖辉雪,等. CSE/H2 S在心血管系统的作用及机制[J].医学分子生物学杂志,2016,13(6):365-370.
[12]刘诗琴,黄建芳,谈思怡,等.人N端脑钠肽前体(NT-ProBNP)单抗制备及双抗体夹心ELISA检测方法的建立[J].免疫学杂志,2016,32(5):441-445.
[13]张鸿雁,李楠,林敏.孤立性房颤患者血浆NTproBNP、CRP及D-二聚体水平变化及意义[J].山东医药,2016,56(24):68-70.
[14]施伟丽,徐浩,丛伟红,等.从Hsp90对eNOS活性的影响探讨Hsp90在心血管疾病中的保护作用[J].医学分子生物学杂志,2016,13(6):350-354.
[15]刘力,王志权,朱启明,等.心房颤动射频消融术后复发相关危险因素的临床研究[J].心脑血管病防治,2016,16(3):187-189.
[16]王勇,李杰.心房颤动患者行肺静脉大环隔离消融术后复发的影响因素分析[J].山东医药,2017,57(30):64-66.
[17]丁云,孙建国,吴建荣,等.胺碘酮与伊布利特对老年转复消融术后持续性心房颤动的临床疗效评价[J].中国临床药理学杂志,2016,32(6):570-572.
[18]吴毓优,吕鹏飞,高炳玉,等.二尖瓣置换术同期行双极射频消融术治疗房颤及术前危险因素与术后转律的关系[J].海南医学,2016,27(17):2848-2850.
[19]孙晓臣. N端脑钠肽前体与阵发性心房颤动复发的关系探讨[J].中西医结合心脑血管病杂志,2018,16(8):1088-1090.
[20]张鸿雁,李楠,林敏.孤立性房颤患者血浆NTproBNP、CRP及D-二聚体水平变化及意义[J].山东医药,2016,56(24):68-70.
[21]刘诗琴,黄建芳,谈思怡,等.人N端脑钠肽前体(NT-ProBNP)单抗制备及双抗体夹心ELISA检测方法的建立[J].免疫学杂志,2016,32(5):441-445.