血清学标志物联合心脏超声参数对高血压合并房颤射频消融术后复发的预测价值

Predictive Value of Serologic Markers Combined with Cardiac Ultrasound Parameters for Recurrence after Radiofrequency Ablation of Hypertension Combined with Atrial Fibrillation

摘要: 目的：本研究旨在评估血清学检验和心脏超声检查联合分析对房颤合并高血压患者射频消融术后复发的预测价值，为临床精准治疗提供科学依据。方法：回顾性分析了2020~2023年广西医科大学第一附属医院收治的131名首次接受射频消融术的房颤合并高血压患者，根据患者术后复发与否分为复发组和非复发组。收集患者的术前实验室检查结果和心脏超声参数，采用单因素和多因素Logistic回归分析评估术后复发的独立危险因素。构建受试者操作特征(ROC)曲线，以评估不同因素的预测效能和最佳截断值，并通过DeLong检验比较单一预测因子与联合预测因子的预测能力。结果：12个月随访期间，27例患者(占20.6%)出现了晚期房颤复发。单因素和多因素回归分析显示，N端脑钠肽前体(NT-proBNP)、左房内径(LAD)以及左室射血分数(LVEF)是射频消融术后复发的独立危险因素，NT-proBNP (OR: 1.003, 1.001~1.004)，LAD (OR: 1.095, 1.009~1.189)，LVEF (OR: 0.947, 0.898~0.998)。ROC曲线分析结果显示：NT-proBNP、LVEF以及LAD的AUC分别为0.765 (95% CI: 0.662~0.869)、0.674 (95% CI: 0.562~0.787)、0.706 (95% CI: 0.596~0.817)，而三者联合的AUC为0.834 (95% CI: 0.749~0.922)。三者的临界值分别为567.5 (灵敏度77.8%，特异度72.1%)、59.5 (灵敏度66.7%，特异度67.3%)、45.5 (灵敏度48.1%，特异度83.7%)。联合预测模型预测能力显著高于单独用LAD (P < 0.05)或者单独使用LVEF (P < 0.05)，然而与NT-proBNP (P = 0.102)相比，无显著差异。结论：NT-proBNP、LAD和LVEF为房颤合并高血压患者射频消融术后复发的独立危险因素。通过三者的联合分析，能够显著提高房颤复发预测的准确性。

Abstract: Objective: The aim of this study was to evaluate the predictive value of the combined analysis of serological tests and cardiac ultrasonography on the recurrence after radiofrequency ablation in patients with atrial fibrillation combined with hypertension, and to provide a scientific basis for clinical personalised diagnosis and treatment. Methods: A total of 131 patients with atrial fibrillation combined with hypertension who underwent radiofrequency ablation for the first time in the First Affiliated Hospital of Guangxi Medical University from 2020~2023 were retrospectively analysed, and the patients were divided into recurrence and non-recurrence groups according to whether they had postoperative recurrence or not. Patients’ preoperative laboratory findings and cardiac ultrasound parameters were collected, and independent risk factors for postoperative recurrence were assessed using univariate and multivariate logistic regression analyses. Subject operating characteristic (ROC) curves were constructed to assess the predictive efficacy and optimal cut-off values of different factors, and the predictive ability of single predictors was compared with that of combined predictors by DeLong test. Results: After 12 months of follow-up, we found that 27 patients (20.6%) experienced late atrial fibrillation recurrence. Univariate and multifactorial regression analyses showed that N-terminal brain natriuretic peptide precursor (NT-proBNP), left atrial internal diameter (LAD), and left ventricular ejection fraction (LVEF) were independent risk factors for recurrence after radiofrequency ablation. NT-proBNP (OR: 1.003, 1.001~1.004); LAD (OR: 1.095, 1.009~1.189); LVEF (OR: 0.947, 0.898~0.998). ROC curve analysis demonstrated that the Area Under the Curve (AUC) values of NT-proBNP, LVEF, and LAD were 0.765 (95% CI: 0.662~0.869), 0.674 (95% CI: 0.562~0.787), 0.706 (95% CI: 0.596~0.817), while the AUC of the combination of the three was 0.834 (95% CI: 0.749~0.922). The critical values of the three were 567.5 (sensitivity 77.8%, specificity 72.1%), 59.5 (sensitivity 66.7%, specificity 67.3%), and 45.5 (sensitivity 48.1%, specificity 83.7%), respectively. The predictive ability of the combined prediction model of NT-proBNP, LVEF, and LAD was significantly higher than that of LAD alone (P < 0.05) or LVEF alone (P < 0.05), however, no significant difference was found when compared to NT-proBNP (P = 0.102). Conclusion: As evidenced by the present study, NT-proBNP, LAD and LVEF have been identified as significant risk factors for the occurrence of radiofrequency ablation recurrence in patients diagnosed with atrial fibrillation in conjunction with hypertension. The analysis of these three indicators in combination has been shown to enhance the accuracy of predicting AF recurrence.