SII、CAR与房性心律失常患者导管射频消融术后复发的相关性

摘要/Abstract

摘要： 目的研究全身免疫炎症指数（SII）、C反应蛋白与白蛋白比值（CAR）与房性心律失常患者导管射频消融术（RFCA）后复发之间的相关性。方法纳入2019年1月至2024年4月期间在我院接受导管射频消融术并成功随访的房性心律失常患者167例,并根据复发情况分为复发组（37例）,非复发组（130例）。比较两组临床资料的差异,采用Logistic回归分析影响复发的危险因素,进行亚组分析以确定不同分类亚组中SII、CAR对复发的预测效应是否存在差异。随后绘制受试者工作特征曲线（ROC）评估SII、CAR及二者联合对RFCA术后复发的预测价值,使用临床决策曲线（DCA）评估模型的临床效能。结果复发组患者SII水平及CAR水平明显高于非复发组,差异有统计学意义（P<0.05）。术前SII和CAR水平以及左心房内径（LAD）、左心室射血分数（LVEF）是术后复发的独立危险因素。SII和CAR联合检测的曲线下面积（AUC）达0.8（95%CI：0.709-0.890）。结论 SII及CAR水平是房性心律失常消融后复发的独立预测因素,且二者联合能进一步提高预测效能。

关键词: 房性心律失常, 导管射频消融, 复发, 全身免疫炎症指数, C反应蛋白与白蛋白比值

黄洛君, 乐雯雯, 冯俊. SII、CAR与房性心律失常患者导管射频消融术后复发的相关性[J]. 心血管病防治知识, 2025, 15(6): 3-10.

参考文献

[1] 李丽,王铭铭,孙环. 不同人群心律失常情况调查及影响因素[J]. 中国卫生工程学,2021, 20(1):53-55.
[2] 张勇,许玉平,魏勋,等.慢性心力衰竭患者心肌纤维化与恶性心律失常的关系[J].中国分子心脏病学杂志,2021,21(6):4283-4286.
[3] Feigin V L, Stark B A, Johnson C O, et al.Global, regional, and national burden of stroke and its risk factors, 1990-2019: a systematic analysis for the Global Burden of Disease Study 2019[J]. The Lancet Neurology, 2021, 20(10): 795-820.
[4] 刘俊,欧阳非凡.2019年心律失常导管消融治疗研究进展[J].中华心血管病杂志(网络版),2020,03(01):1-9.
[5] Darby A E.Recurrent atrial fibrillation after catheter ablation: considerations for repeat ablation and strategies to optimize success[J]. Journal of atrial fibrillation, 2016, 9(1): 1427.
[6] Waldo A L, Feld G K.Inter-relationships of atrial fibrillation and atrial flutter: mechanisms and clinical implications[J]. Journal of the American College of Cardiology, 2008, 51(8): 779-786.
[7] Taghdiri A.Inflammation and arrhythmogenesis: a narrative review of the complex relationship[J]. International Journal of Arrhythmia, 2024, 25(1): 4.
[8] Wu G, Huang H, Cai L, et al.Long-term observation of catheter ablation vs. pharmacotherapy in the management of persistent and long-standing persistent atrial fibrillation(CAPA study)[J]. EP Europace, 2021, 23(5): 731-739.
[9] He L, Liu R, Yue H, et al.Interaction between neutrophil extracellular traps and cardiomyocytes contributes to atrial fibrillation progression[J]. Signal transduction and targeted therapy, 2023, 8(1): 279.
[10] Zhang S, Gang X, Yang S, et al.The alterations in and the role of the Th17/Treg balance in metabolic diseases[J]. Frontiers in Immunology, 2021, 12: 678355.
[11] 李世琦,霍剑波,刘志忠.血小板炎症在糖尿病肾病发生发展中作用的研究进展[J].标记免疫分析与临床,2020,27(12):2191-2196.
[12] Dix C, Zeller J, Stevens H, et al.C-reactive protein, immunothrombosis and venous thromboembolism[J]. Frontiers in Immunology, 2022, 13: 1002652.
[13] Dernellis J, Panaretou M.Relationship between C-reactive protein concentrations during glucocorticoid therapy and recurrent atrial fibrillation[J]. European heart journal, 2004, 25(13): 1100-1107.
[14] Zhang W J, Frei B.Albumin selectively inhibits TNFα-induced expression of vascular cell adhesion molecule-1 in human aortic endothelial cells[J]. Cardiovascular research, 2002, 55(4): 820-829.
[15] Kaplan E, Ekızler F A, Saribaş H, et al.Effectiveness of the systemic immune inflammation index to predict atrial fibrillation recurrence after cryoablation[J]. Biomarkers in Medicine, 2023, 17(2): 101-109.
[16] 郭洪山,闫振明,邹玲,闫艳,顾微,姜雨婷.C反应蛋白与白蛋白比值对老年急性非ST段抬高型心肌梗死病人住院期间新发心房颤动的预测价值[J].安徽医药,2023,27(10):2077-2081.
[17] Ellis K, Wazni O, Marrouche N, et al.Incidence of atrial fibrillation post‐cavotricuspid isthmus ablation in patients with typical atrial flutter: Left‐atrial size as an independent predictor of atrial fibrillation recurrence[J]. Journal of cardiovascular electrophysiology, 2007, 18(8): 799-802.
[18] Pérez F J, Schubert C M, Parvez B, et al.Long-term outcomes after catheter ablation of cavo-tricuspid isthmus dependent atrial flutter: a meta-analysis[J]. Circulation: Arrhythmia and Electrophysiology, 2009, 2(4): 393-401.