Hs-CRP与cTnI预测阵发性房颤射频消融术后早期复发的临床研究

发布时间：2018-11-03 18:52

【摘要】：背景:心房颤动(atrial fibrillation,AF)是临床上最常见的心律失常之一,其发生率随年龄增长而增高,房颤可诱发心衰、引起脑栓塞等,严重影响患者生活质量,危害身体健康。房颤导致中风风险增加5倍,这表明房颤并非是单纯的心血管疾病,因此,降低房颤的发病率、住院率、致残率、病死率,是目前房颤治疗最重要任务。长期临床观察,房颤的药物治疗效果并不十分理想,房颤不易转复,特别是慢性持续性房颤,并且药物治疗存在药物副作用及不良反应较多等缺点。经过不断的探索与研究,目前,导管消融在房颤治疗中的地位不断提高,已被推荐作为阵发性房颤的一线治疗手段。然而,射频消融术后的房颤复发事件仍居高不下,文献报道其复发率约为25%~50%。房颤射频消融术后复发相关的危险因素包括年龄、肥胖、左房大小、房颤类型、房颤持续时间、BNP、炎症、P波离散度、是否合并器质性心脏病、抗心律失常药物的应用等,针对房颤射频消融术后复发相关因素的研究显得尤为重要。目的:探讨血清高敏C反应蛋白(hs-CRP)和肌钙蛋白I(cTnI)与阵发性房颤射频消融术后早期复发的关系。方法:选取2014年10月至2016年9月间在河南科技大学第一附属医院心血管内科首次行三维标测系统(EnSite-NAVX非接触标测)指导下的环肺静脉电隔离术的阵发性房颤患者60例,根据射频消融术后三个月内是否复发(观察指标:患者的自主症状、12导联体表心电图及24小时动态心电图结果等)分为治疗成功组(44例)和复发组(16例),分别在术前、术后第1、2、3天采集静脉血进行hs-CRP和cTnI水平测定,比较成功组和复发组术前、术后hs-CRP和cTn I变化情况。结果:60例阵发性房颤患者射频消融手术前后hs-CRP和cTn I浓度峰值水平相比较差异有统计学意义(P0.05)。两组患者术前hs-CRP和cTnI水平变化无明显统计学差异(P0.05)。两组患者术后hs-CRP浓度峰值、手术前后hsCRP浓度最大差值相比较差异有统计学意义(P0.05)。两组患者术后cTn I浓度峰值、手术前后c Tn I浓度最大差值相比较差异无统计学意义(P0.05)。结论:hs-CRP浓度变化可能与阵发性房颤射频消融术后早期复发有一定关系,而cTnI与阵发性房颤射频消融术后早期复发无明显相关性。
[Abstract]:Background: atrial fibrillation (atrial fibrillation,AF) is one of the most common arrhythmias in clinic. The incidence of atrial fibrillation increases with age. Atrial fibrillation can induce heart failure and cerebral embolism. Atrial fibrillation leads to a five-fold increase in the risk of stroke, indicating that atrial fibrillation is not a purely cardiovascular disease. Therefore, reducing the incidence, hospitalization, disability and mortality of atrial fibrillation is the most important task in the treatment of atrial fibrillation at present. Long-term clinical observation, the effect of drug treatment of atrial fibrillation is not very ideal, atrial fibrillation is not easy to recover, especially chronic persistent atrial fibrillation, and drug treatment has many shortcomings such as side effects and adverse reactions. Through continuous exploration and research, catheter ablation in the treatment of atrial fibrillation has been recommended as a first-line treatment of paroxysmal atrial fibrillation. However, the recurrence rate of atrial fibrillation after radiofrequency ablation is still high, and the recurrence rate is about 25%. Risk factors associated with recurrence of AF after radiofrequency ablation included age, obesity, left atrial size, type of AF, duration of AF, BNP, inflammation, P-wave dispersion, whether or not it was associated with organic heart disease, and the use of antiarrhythmic drugs. It is particularly important to study the factors related to recurrence of atrial fibrillation after radiofrequency ablation. Objective: to investigate the relationship between serum Gao Min C reactive protein (hs-CRP) and troponin I (cTnI) and early recurrence after radiofrequency ablation of paroxysmal atrial fibrillation. Methods: from October 2014 to September 2016, 60 patients with paroxysmal atrial fibrillation (PAF) were selected from the Department of Cardiovascular Medicine of the first affiliated Hospital of Henan University of Science and Technology under the guidance of EnSite-NAVX non-contact mapping system. According to whether the patients recurred within three months after radiofrequency ablation (indicators: autonomic symptoms, 12-lead electrocardiogram and 24-hour ambulatory electrocardiogram, etc.), they were divided into successful treatment group (44 cases) and recurrent group (16 cases). Venous blood was collected 3 days after operation to determine the levels of hs-CRP and cTnI. The changes of hs-CRP and cTn I were compared between the successful group and the recurrent group before and after operation. Results: the peak levels of hs-CRP and cTn I in 60 patients with paroxysmal atrial fibrillation were significantly different before and after radiofrequency ablation (P0.05). There was no significant difference in hs-CRP and cTnI levels between the two groups before operation (P0.05). The peak value of hs-CRP and the difference of hsCRP concentration before and after operation were significantly different between the two groups (P0.05). There was no significant difference between the two groups in the peak value of cTn I and the difference of c Tn I concentration before and after operation (P0.05). Conclusion: the change of hs-CRP concentration may be related to the early recurrence after radiofrequency ablation of paroxysmal atrial fibrillation, but there is no significant correlation between cTnI and early recurrence after radiofrequency ablation of paroxysmal atrial fibrillation.
【学位授予单位】：河南科技大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R541.75

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