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中华心脏与心律电子杂志

中华心脏与心律电子杂志 ›› 2017, Vol. 05 ›› Issue (01) : 7 -11. doi: 10.3877/cma.j.issn.2095-6568.2017.05.002

所属专题： 文献；

论著

心率减速力、体表心电图V1导联f波平均振幅及超敏C反应蛋白与心房颤动射频消融术后复发的相关性研究
宋玮1, 周发展1, 闫文菊1, 郭忠秀1, 丰伟2, 张焕轶1,†()   
  1. 1. 271000　泰安，山东省泰安市中心医院心内科
    2. 271000　泰安，山东省泰安市中心医院消化内科
  • 出版日期:2017-03-25
  • 通信作者: 张焕轶

Correlation study of deceleration capacity of heart rate, fibrillatory wave amplitude on lead V1 of surface electrocardiography, hsCRP and recurrence of atrial fibrillation after radiofrequency catheter ablation

Wei Song1, Fazhan Zhou1, Wenju Yan1, Zhongxiu Guo1, Wei Feng2, Huanyi Zhang1,†()   

  1. 1. Depatrment of Cardiology, Taian City Center Hospital, Taian 271000, China
    2. Depatrment of gastroenterology, Taian City Center Hospital, Taian 271000, China
  • Published:2017-03-25
  • Corresponding author: Huanyi Zhang
  • About author:
    Corresponding author: Zhang Huanyi, Email:
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宋玮, 周发展, 闫文菊, 郭忠秀, 丰伟, 张焕轶. 心率减速力、体表心电图V1导联f波平均振幅及超敏C反应蛋白与心房颤动射频消融术后复发的相关性研究[J]. 中华心脏与心律电子杂志, 2017, 05(01): 7-11.

Wei Song, Fazhan Zhou, Wenju Yan, Zhongxiu Guo, Wei Feng, Huanyi Zhang. Correlation study of deceleration capacity of heart rate, fibrillatory wave amplitude on lead V1 of surface electrocardiography, hsCRP and recurrence of atrial fibrillation after radiofrequency catheter ablation[J]. Chinese Journal of Heart and Heart Rhythm(Electronic Edition), 2017, 05(01): 7-11.

目的

探讨心率减速力(DC)、体表心电图V1导联f波平均振幅、超敏C反应蛋白(hsCRP)与心房颤动(AF)患者射频消融术后复发的相关性。

方法

选取2015年6月至2016年8月因AF在泰安市中心医院住院并首次行射频消融术患者70例，根据术后随访结果分为未复发组45例，复发组25例。统计两组患者一般资料、DC值、体表心电图V1导联f波平均振幅及hsCRP并进行比较，建立Logistic回归模型，筛选AF患者射频消融术后复发的危险因素，分别对DC值、体表心电图V1导联f波平均振幅、hsCRP及两两联合、三者联合进行受试ROC曲线绘制，评价三者对AF术后复发的预测价值。

结果

复发组患者DC值(5.78±0.99)ms、hsCRP(1.85±0.77)mg/L高于未复发组(4.93±0.95)ms、(1.39±0.61)mg/L，体表心电图V1导联f波平均振幅(0.095±0.013)mV小于未复发组(0.110±0.017)mV，差异均有统计学意义(均P<0.05)；经多因素Logistic回归分析显示，DC(OR＝3.99，95%CI：1.36～11.68，P＝0.012)、体表心电图V1导联f波平均振幅(OR＝0.000，95%CI：0.000～0.000，P＝0.013)、hsCRP(OR＝5.15，95%CI：1.11～23.78，P＝0.036)是AF患者射频消融术后复发的独立危险因素；DC值、体表心电图V1导联f波平均振幅、hsCRP预测AF术后复发ROC曲线下面积分别为0.731、0.741、0.667，三者联合预测AF射频消融术后复发曲线下面积为0.837，高于各自值及两两联合(P<0.05)。

结论

DC、体表心电图V1导联f波平均振幅及hsCRP与AF射频消融术后复发具有显著相关性，联合检测三者对预测AF射频消融术后复发具有重要临床价值。

关键词: 心率减速力, f波振幅, 超敏C反应蛋白, 心房颤动, 射频消融
Objective

To investigate the correlation between deceleration capacity of heart rate(DC), fibrillatory wave amplitude on lead V1 of surface electrocardiography, hsCRP and recurrence after radiofrequency ablation in patients with atrial fibrillation(AF).

Methods

Select the 70 AF patients who was operated with radio frequency catheter ablation for the first time from June 2015 to August 2016.According to the follow-up results, 45 cases were divided into the non-recurrence group and 25 cases in the recurrence group.General information, DC values, fibrillatory wave amplitude on lead V1 of surface electrocardiography, hsCRP of the two groups were collected and compared, establish Logistic regression model, screening of risk factors for AF patients after radiofrequency catheter ablation.DC values, fibrillatory wave amplitude on lead V1 of surface electrocardiography , hsCRP and the combination of the two, the combination of the three subjects were drawn the Receiver operating curve(ROC), to evaluate the predictive value of the combination of the three on the recurrence of the AF patients who was operated with radio frequency catheter ablation.

Results

The DC value(5.78±0.99)ms and hsCRP(1.85±0.77)mg/L in the recurrence group was higher than that in the non recurrence group(4.93±0.95)ms、(1.39±0.61)mg/L. The fibrillatory wave amplitude on lead V1 of surface electrocardiography in the recurrence group(0.095±0.013) mV was less than non recurrence group(0.110±0.017)mV(P<0.05). Multivariate Logistic regression analysis showed that the DC value(OR=3.99, 95%CI: 1.36-11.68, P=0.012), fibrillatory wave amplitude on lead V1 of surface electrocardiography(OR=0.000, 95%CI: 0.000-0.000, P=0.013), hsCRP(OR=5.15, 95%CI: 1.11-23.78, P=0.036)are independent risk factor for recurrence after radiofrequency ablation in patients with AF.The ROC curves of DC, fibrillatory wave amplitude on lead V1 of surface electrocardiography and hsCRP showed AUC were 0.731, 0.741 and 0.667. The ROC curves of combination of the three subjects showed AUC was 0.837, higher than their respective and the combination of the two values (P<0.05).

Conclusion

DC values, fibrillatory wave amplitude on lead V1 of surface electrocardiography and hsCRP had significant correlation with the recurrence of atrial fibrillation after adiofrequency catheter ablation. three combinations had predictive value in atrial AF patients who recurrent after radiofrequency catheter ablation.

Key words: Deceleration capacity of rate, Fibrillatory wave amplitude, High-sensitivity C-reactive protein, Atrial fibrillation, Catheter radiofrequency ablation
表1 未复发组与复发组基本资料比较
组别 例数 年龄(岁) 男性[例(%)] BMI(kg/m2) 合并高血压[例(%)] 合并冠心病[例(%)] LAAP(mm) LVEF(%)
未复发组 45 57.58±10.03 27(60.00) 24.55±1.56 15(33.33) 22(48.89) 38.8±73.75 59.27±6.17
复发组 25 57.68±9.36 15(60.00) 25.995±1.75 16(64.00) 10(40.00) 40.92±4.15 59.88±8.27
t/χ2值 ? 0.04 0.00 3.54 6.13 0.51 2.11 0.32
P值 ? 0.97 1.00 0.001 0.023 0.617 0.038 0.748
组别 例数 胆固醇(mmol/L) 低密度胆固醇(mmol/L) 同型半胱氨酸(μmol/L) 病程(月) 持续性AF(%) 术前DC(ms) f波平均振幅(mv) hsCRP(mg/L)
未复发组 45 4.88±0.85 2.50±0.53 10.74±2.71 10.29±5.14 17(37.78) 4.93±0.95 0.110±0.017 1.39±0.61
复发组 25 4.86±0.64 2.51±0.65 11.51±4.05 12.56±4.13 17(68.00) 5.78±0.99 0.095±0.013 1.85±0.77
t/χ2值 ? 0.07 0.10 0.86 2.89 5.87 3.53 3.77 2.75
P值 ? 0.945 0.924 0.397 0.033 0.024 0.001 0.000 0.008
表2 AF术后复发因素的多因素Logistic回归分析结果
因素 B S.E. Wald值 P值 OR值(95%CI)
BMI 0.32 0.25 1.64 0.201 1.38(0.26～9.87)
合并高血压 1.13 0.87 1.68 0.195 3.08(0.56～16.91)
LAAP 0.17 0.15 1.26 0.262 1.184(0.88～1.59)
持续性AF 1.86 0.88 4.49 0.034 6.43(1.15～36.97)
病程 0.17 0.09 3.58 0.058 1.19(1.00～1.43)
f波平均振振幅振幅幅 －92.34 37.09 6.20 0.013 0.000(0.000～0.000)
DC 1.38 0.55 6.35 0.012 3.99(1.36～11.68)
hsCRP 1.64 0.78 4.40 0.036 5.15(1.11～23.78)
表3 DC、体表心电图V1导联f波平均振幅及hsCRP对AF射频消融术后复发的预测价值
项目 AUC 界值 敏感度(%) 特异度(%) P值
术前DC 0.731 5.8 56.00 82.22 <0.001
f波平均振幅 0.741 0.11 92.00 46.67 <0.001
hsCRP 0.667 1.8 56.00 80.00 0.021
DC联合f波平均振幅 0.822 ? 72.00 82.22 <0.001
DC联合hsCRP 0.779 ? 60.00 97.78 <0.001
hsCRP联合f波平均振幅 0.778 ? 98.00 46.67 <0.001
三者联合 0.837 ? 64.00 88.89 <0.001
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