中性粒细胞/淋巴细胞比值对心房颤动患者射频消融术后复发的预测价值

Predictive Value of Neutrophil to Lymphocyte Ratio on Recurrence of Patients with Atrial Fibrillation after Radiofrequency Ablation

摘要: 目的：旨在探讨中性粒细胞/淋巴细胞比值(neutrophil to lymphocyte ratio, NLR)对心房颤动患者射频消融术后复发的预测价值。方法：回顾性选取2018年1月至2022年12月期间在江苏省扬州大学附属医院接受射频导管消融术的心房颤动患者为研究对象。所有患者均在术后随访1年，根据术后是否发生持续时间 ≥ 30 s的房颤、房扑、房速将患者分为复发组和未复发组。结果：本研究共纳入接受射频导管消融术的心房颤动患者164例，其中男性101例，女性63例，复发组29例，未复发组135例。两组间比较，复发组术前中性粒细胞计数、淋巴细胞计数、NLR、左房内径(left atrial diameter, LAD)高于未复发组，复发组术前高密度脂蛋白胆固醇(HDL-c)低于未复发组，差异有统计学意义(P < 0.05)；其余基线特征均无统计学差异(P > 0.05)。二元logistic回归分析显示，消融前HDL-c (OR = 0.046, 95%CI = 0.003~0.718, P = 0.028)、NLR (OR = 4.830, 95%CI = 2.118~11.010, P < 0.001)和LAD (OR = 1.225, 95%CI = 1.082~1.386, P = 0.001)是预测射频消融术后心房颤动复发的独立危险因素。ROC曲线分析显示，HDL-c、NLR、LAD的曲线下面积分别为0.713 (95% CI = 0.606~0.821, P < 0.001)、0.858 (95% CI = 0.782~0.934, P < 0.001)、0.864 (95% CI = 0.806~0.921, P < 0.001)。此外，NLR ≥ 2.765与射频消融术后心房颤动复发风险显著增加有关(P < 0.001)。结论：射频消融术前NLR升高与术后心房颤动复发风险增加相关，NLR对射频消融术后心房颤动复发具有较好的预测效能。

Abstract: Objective: The purpose of this study was to explore the value of neutrophil to lymphocyte ratio in predicting recurrence after radiofrequency ablation in patients with atrial fibrillation. Methods: Patients with atrial fibrillation who underwent radiofrequency catheter ablation in the Affiliated Hospital of Yangzhou University in Jiangsu Province from January 2018 to December 2022 were retrospectively selected. All patients were followed up for 1 year. According to the occurrence of atrial fibrillation, atrial flutter and atrial tachycardia with duration ≥ 30 s after the operation, the patients were divided into a recurrent group and a non-recurrent group. Result: A total of 164 patients with atrial fibrillation who underwent radiofrequency catheter ablation were included in this study, including 101 males and 63 females, 29 patients with recurrence and 135 patients without recurrence. The preoperative neutrophil count, lymphoid cell count, neutrophil to lymphocyte ratio and left atrial diameter in the recurrent group were higher than those in the non-recurrent group, while the preoperative high density lipoprotein cholesterol in the recurrent group was significantly lower than that in the non-recurrent group (P < 0.05). There was no significant difference in other baseline characteristics (P > 0.05). Binary logistic regression analysis showed that HDL-c (OR = 0.046, 95%CI = 0.003~0.718, P = 0.028), NLR (OR = 4.830, 95%CI = 2.118~11.010, P < 0.001) and LAD (OR = 1.225, 95%CI = 1.082~1.386, P = 0.001) were independent risk factors for predicting recurrence of atrial fibrillation after radiofrequency ablation. ROC curve analysis showed that the areas under the curve of HDL-c, NLR and LAD were 0.713 (95%CI = 0.606~0.821, P < 0.001), 0.858 (95%CI = 0.782~0.934, P < 0.001) and 0.864 (95%CI = 0.806~0.921, P < 0.001). In addition, NLR ≥ 2.765 was significantly associated with an increased risk of recurrence of atrial fibrillation after radiofrequency ablation (P < 0.001). Conclusion: The increase of NLR before radiofrequency ablation is related to the increased risk of postoperative atrial fibrillation recurrence. Additionally, NLR is a better predictor of recurrence of atrial fibrillation after radiofrequency ablation.