血清FGF-23对心房颤动患者射频消融术后复发的预测价值

doi:10.11958/20220317

摘要/Abstract

摘要：

目的探讨成纤维细胞生长因子-23（FGF-23）对心房颤动（AF）患者射频消融术后复发的预测价值。方法选取接受射频消融术治疗的AF患者132例，依射频消融术后12个月的复发情况分为复发组（41例）和未复发组（91例）。另根据患者血清FGF-23的表达水平将其分为FGF-23高表达组和FGF-23低表达组。采用彩色多普勒超声诊断仪检测左心房内径（LAD），采用酶联免疫吸附试验试剂盒检测血清FGF-23的水平。结果与未复发组比较，复发组持续性AF比例以及LAD、血清FGF-23水平升高（P<0.05）;持续性AF以及LAD、血清FGF-23水平过高均是AF患者射频消融术后复发的危险因素（P<0.05）;经受试者工作特征（ROC）曲线分析发现，血清FGF-23、LAD及两者联合检测预测AF患者射频消融术后复发的曲线下面积分别为0.770（95%CI：0.681~0.859）、0.743（95%CI：0.651~0.836）、0.828（95%CI：0.752~0.904）。FGF-23高表达组（FGF-23≥224.42 μg/L，56例）的射频消融术后复发率明显高于FGF-23低表达组（FGF-23<224.42 μg/L，76例），差异有统计学意义（44.64% vs. 21.05%，χ²=8.379，P<0.05）。结论血清FGF-23过高是AF患者射频消融术后复发的危险因素，且其对AF患者射频消融术后复发有较高的预测价值。

关键词: 心房颤动, 复发, 成纤维细胞生长因子-23, 预后, 射频消融术

Abstract:

Objective To explore the predictive value of fibroblast growth factor-23 (FGF-23) in recurrence of patients with atrial fibrillation (AF) after radiofrequency ablation. Methods A total of 132 AF patients who received radiofrequency ablation were selected. According to the recurrence 12 months after radiofrequency ablation, patients were divided into the recurrence group (41 cases) and the non-recurrence group (91 cases). In addition, according to the expression level of serum FGF-23, patients were divided into the FGF-23 high expression group (56 cases) and the FGF-23 low expression group (76 cases). The parameters such as left atrial diameter (LAD) were detected by color Doppler ultrasound diagnostic instrument, and the serum level of FGF-23 was detected by enzyme-linked immunosorbent assay kit. Results Compared with the non-recurrent group, the proportion of persistent AF, LAD and serum FGF-23 levels were higher in the recurrence group (P<0.05). Persistent AF, excessive LAD and high serum FGF-23 level were risk factors for recurrence in AF patients after radiofrequency ablation (P<0.05). Receiver operating characteristic curve (ROC) analysis showed that the areas under the curve of serum FGF-23, LAD and their combined detection to predict the recurrence of AF patients after radiofrequency ablation were 0.770 (95%CI: 0.681-0.859), 0.743 (95%CI: 0.651-0.836) and 0.828 (95%CI: 0.752-0.904) respectively. The recurrence rate after radiofrequency ablation was significantly higher in the FGF-23 high expression group (FGF-23≥224.42 μg/L, 56 cases) than that of the FGF-23 low expression group (FGF-23<224.42 μg/L, 76 cases, 44.64% vs. 21.05%, χ²=8.379, P<0.05). Conclusion High serum FGF-23 level is a risk factor for recurrence in AF patients after radiofrequency ablation, and it has high predictive value for recurrence after radiofrequency ablation in patients with AF.

Key words: atrial fibrillation, recurrence, fibroblast growth factor-23, prognoses, radiofrequency ablation

中图分类号:

R541.7+5

图/表 4

参考文献 20

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组别		n	年龄（岁）	性别（男/女）		BMI （kg/m²）	高血压 [例（%）]		糖尿病 [例（%）]		高脂血症 [例（%）]		吸烟史 [例（%）]		AF类型[例（%）]
组别		n	年龄（岁）	性别（男/女）		BMI （kg/m²）	高血压 [例（%）]		糖尿病 [例（%）]		高脂血症 [例（%）]		吸烟史 [例（%）]		持续性		阵发性
未复发组		91	57.45±11.38	56/35		22.57±2.31	41（45.05）		10（10.99）		30（32.97）		38（41.76）		38（41.76）		53（58.24）
复发组		41	58.31±10.24	22/19		22.75±2.46	21（51.22）		8（19.51）		12（29.27）		19（46.34）		25（60.98）		16（39.02）
t、χ²或Z			0.414	0.726		0.406	0.431		1.744		0.178		0.242		4.184^＊
组别	AST（U/L）				ALT（U/L）			SCr（μmol/L）		BUN（mmol/L）		LVEF		LAD（mm）		FGF-23（μg/L）
未复发组	29.52（18.23，38.92）				27.31（15.33，37.94）			76.97±13.64		5.33±1.74		0.55±0.08		44.87±3.68		202.97±31.28
复发组	28.45（17.61，37.85）				27.69（14.62，36.38）			72.54±15.97		5.69±1.41		0.54±0.06		48.92±4.31		243.69±36.15
t、χ²或Z	0.652				0.158			1.540		1.163		0.358		5.543^＊＊		6.589^＊＊

组别		n	年龄（岁）	性别（男/女）		BMI （kg/m²）	高血压 [例（%）]		糖尿病 [例（%）]		高脂血症 [例（%）]		吸烟史 [例（%）]		AF类型[例（%）]
组别		n	年龄（岁）	性别（男/女）		BMI （kg/m²）	高血压 [例（%）]		糖尿病 [例（%）]		高脂血症 [例（%）]		吸烟史 [例（%）]		持续性		阵发性
未复发组		91	57.45±11.38	56/35		22.57±2.31	41（45.05）		10（10.99）		30（32.97）		38（41.76）		38（41.76）		53（58.24）
复发组		41	58.31±10.24	22/19		22.75±2.46	21（51.22）		8（19.51）		12（29.27）		19（46.34）		25（60.98）		16（39.02）
t、χ²或Z			0.414	0.726		0.406	0.431		1.744		0.178		0.242		4.184^＊
组别	AST（U/L）				ALT（U/L）			SCr（μmol/L）		BUN（mmol/L）		LVEF		LAD（mm）		FGF-23（μg/L）
未复发组	29.52（18.23，38.92）				27.31（15.33，37.94）			76.97±13.64		5.33±1.74		0.55±0.08		44.87±3.68		202.97±31.28
复发组	28.45（17.61，37.85）				27.69（14.62，36.38）			72.54±15.97		5.69±1.41		0.54±0.06		48.92±4.31		243.69±36.15
t、χ²或Z	0.652				0.158			1.540		1.163		0.358		5.543^＊＊		6.589^＊＊

指标	β	SE	Wald χ²	P	OR	95%CI
AF类型	0.894	0.326	7.520	0.006	2.445	1.291~4.632
LAD	0.912	0.418	4.760	0.029	2.489	1.097~5.648
FGF-23	0.934	0.393	5.648	0.017	2.545	1.178~5.497
常数项	0.358	0.118	9.205	0.002	1.135	-

指标	β	SE	Wald χ²	P	OR	95%CI
AF类型	0.894	0.326	7.520	0.006	2.445	1.291~4.632
LAD	0.912	0.418	4.760	0.029	2.489	1.097~5.648
FGF-23	0.934	0.393	5.648	0.017	2.545	1.178~5.497
常数项	0.358	0.118	9.205	0.002	1.135	-

指标	AUC	AUC 95%CI	临界值	敏感度（%）	特异度（%）	约登指数
LAD	0.743	0.651~0.836	46.78 mm	82.93	57.14	0.401
FGF-23	0.770	0.681~0.859	224.42 μg/L	63.41	86.81	0.502
联合	0.828	0.752~0.904	-	80.49	72.53	0.530