摘要
背景部分心房颤动(以下简称房颤)患者心脏射频消融术后会出现复发,而控制术后复发一直是临床亟须解决的问题。目的探讨房颤患者心脏射频消融术后复发的影响因素,为临床提早干预以降低心脏射频消融术后复发率提供可靠的参考依据。方法选取2016年5月—2018年6月在桂林市第二人民医院行心脏射频消融术的房颤患者122例为研究对象。收集患者一般资料〔包括年龄、性别、体质指数(BMI)、吸烟情况、饮酒情况、合并症(高血压、糖尿病、脑卒中、冠心病)发生情况、纽约心脏病协会(NYHA)分级、房颤类型〕、手术指标(包括手术时间、术后焦虑情况、术后抑郁情况)、影像学指标〔包括左心房容积、左心房前后径、左心房左右径、左心房上下径、左心房球形度、心外膜脂肪组织(EAT)体积〕、rs2200733基因多态性。对所有患者进行12个月的术后随访,根据患者随访期间是否出现房颤复发分为复发组和未复发组。房颤患者心脏射频消融术后复发的影响因素分析采用单因素及多因素Logistic回归分析。结果122例患者均完成了术后12个月的随访,无一例脱访,最终有50例(41.0%)患者出现复发。复发组rs2200733 CC、CT、TT基因型分别有2、18、30例,未复发组rs2200733 CC、CT、TT基因型分别有15、46、11例。风险等位基因T在复发组的频率为78.0%(78/100),在未复发组的频率为47.2%(68/144)。复发组和未复发组的rs2200733基因型分布均符合Hardy-Weinberg平衡(χ2=0.059,P=0.960;χ2=5.591,P=0.065),提示选择的样本有群体代表性。多因素Logistic回归分析结果显示,BMI≥27.0 kg/m2〔OR=2.222,95%CI(1.540,6.705)〕、术后焦虑〔OR=5.143,95%CI(2.338,11.311)〕、术后抑郁〔OR=5.603,95%CI(2.498,12.566)〕、左心房球形度>85.9%〔OR=2.246,95%CI(1.058,4.769)〕、EAT体积>114.0 cm3〔OR=2.100,95%CI(1.007,4.378)〕、rs2200733基因为显性模型〔OR=8.318,95%CI(3.535,19.574)〕是房颤患者心脏射频消融术后复发的危险因素(P<0.05)。结论肥胖、术后焦虑、术后抑郁、左心房球形度>85.9%、EAT体积>114.0 cm3、rs2200733基因为显性模型是房颤患者心脏射频消融术后复发的危险因素,临床医师可根据上述危险因素对术后患者进行积极干预,以降低术后复发风险。
Background Some patients with atrial fibrillation(AF)may experience recurrence after cardiac radiofrequency ablation,and the control of postoperative recurrence has always been an urgent clinical problem to be solved.Objective To explore the influencing factors of recurrence in patients with AF after cardiac radiofrequency ablation,in order to provide reliable reference for clinical early intervention to reduce the recurrence rate of patients after cardiac radiofrequency ablation.Methods A total of 122 patients with AF who underwent cardiac radiofrequency ablation in Second People's Hospital of Guilin from May 2016 to June 2018 were selected as the research objects.The general information〔including age,gender,body mass index(BMI),smoking,drinking,occurrence of comorbidities(hypertension,diabetes,stroke,coronary heart disease),New York Heart Association(NYHA)grading,type of AF〕,operation indicators(including operation time,postoperative anxiety,postoperative depression),imaging indicators〔including left atrial volume,left atrium anteroposterior diameter,left atrium transverse diameter,left atrium upper and lower diameter,left atrium sphericity,epicardial adipose tissue(EAT)volume〕,rs2200733 gene polymorphism of patients were collected.All patients were followed up for 12 months after operation,and they were divided into recurrence group and non-recurrence group according to whether they had AF recurrence during the follow-up period.Single factor and multivariate Logistic regression analysis were used to analyze the influencing factors of recurrence in patients with AF after cardiac radiofrequency ablation.Results All 122 patients were followed up for 12 months after operation,and none of them dropped out.Finally,50 patients(41.0%)relapsed after operation.There were 2,18 and 30 cases of rs2200733 CC,CT and TT genotypes in relapse group,and 15,46 and 11 cases of rs2200733 CC,CT and TT genotypes in non relapse group.The frequency of risk allele T was 78.0%(78/100)in relapse group and 47.2%(68/144)in non recurrence group.The distribution of rs2200733 genotype in recurrent group and non recurrent group was in accordance with Hardy Weinberg equilibrium(χ2=0.059,P=0.960;χ2=5.591,P=0.065),indicating that the selected samples were representative of the population.Multivariate Logistic regression analysis showed that BMI≥27.0 kg/m2〔OR=2.222,95%CI(1.540,6.705)〕,postoperative anxiety〔OR=5.143,95%CI(2.338,11.311)〕,postoperative depression〔OR=5.603,95%CI(2.498,12.566)〕,left atrium sphericity>85.9%〔OR=2.246,95%CI(1.058,4.769)〕,EAT volume>114.0 cm3〔OR=2.100,95%CI(1.007,4.378)〕,rs2200733 gene with dominant model〔OR=8.318,95%CI(3.535,19.574)〕were risk factors of recurrence in patients with AF after cardiac radiofrequency ablation(P<0.05).Conclusion Obesity,postoperative anxiety,postoperative depression,left atrial sphericity>85.9%,EAT volume>114.0 cm3,rs2200733 gene with dominant model are risk factors of recurrence in patients with AF after cardiac radiofrequency ablation,and clinicians can actively intervene patients according to the above risk factors to reduce the risk of postoperative recurrence.
作者
李闪悦
邓通元
吴君玲
LI Shanyue;DENG Tongyuan;WU Junling(Internal Medicine-Cardiovascular Department,Second People's Hospital of Guilin,Guilin 541000,China;Internal Medicine-Cardiovascular Department,Affiliated Hospital of Youjiang Medical University for Nationalities,Baise 533000,China;Emergency Department,Liuzhou Red Cross Hospital,Liuzhou 545000,China)
出处
《实用心脑肺血管病杂志》
2021年第1期21-27,共7页
Practical Journal of Cardiac Cerebral Pneumal and Vascular Disease
关键词
心房颤动
心脏射频消融术
复发
影响因素分析
Atrial fibrillation
Cardiac radiofrequency ablation
Recurrence
Root cause analysis
