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目的:探讨中性粒细胞与淋巴细胞比例和孤立性心房颤动(房颤)射频消融术后复发的关系。方法:回顾分析119例行射频消融术治疗的孤立性房颤患者,阵发性房颤手术方式为环肺静脉电隔离,非阵发性房颤在环肺静脉电隔离基础上行线性消融,收集患者基本的临床资料、生化及物理检查指标。依据随访结果将患者分为复发组与未复发组,分析预测心律失常复发的相关危险因素。结果:随访14~27个月,平均(15.4±3.5)个月。共有38例(31.9%)复发。单因素分析显示,P<0.1的指标有非阵发性房颤、左房前后径(LAD)、左房容积指数(LAVI)、房颤持续时间、三酰甘油、中性粒细胞与淋巴细胞比值(NLR)。对以上指标进行二分类反应变量的Logistic回归分析,结果显示,LAVI(OR=1.102,95%CI:1.017~1.195,P=0.018)、NLR(OR=4.433,95%CI:1.863~10.546,P=0.001)以及房颤持续时间(OR=1.019,95%CI:1.000~1.038,P=0.046)具有统计学意义。ROC曲线分析显示,LAD的界值点为40.5mm,LAVI的界值点为26.3ml/m2,NLR的界值点为1.64,房颤持续时间的界值点为11.4个月。Kaplan-Meier生存曲线显示,LAD≥40.5mm组与LAD<40.5mm组(35.3%︰81.2%)、LAVI≥26.3ml/m2组与LAVI<26.3ml/m2组(60.8%︰77.9%)、房颤持续时间≥11.4个月组与<11.4个月组(46.2%︰94.8%)、NLR≥1.64组与NLR<1.64组(52.9%︰79.4%)消融成功率比较均差异有统计学意义(均P<0.05)。结论:LAD、LAVI、NLR、房颤持续时间是孤立性房颤射频消融术后房颤复发的独立危险因素,当LAD≥40.5mm、LAVI≥26.3ml/m2、NLR≥1.64,房颤持续时间≥11.4个月时,复发的概率明显增加。
Objective: To investigate the relationship between the neutrophil and lymphocyte ratio and the recurrence of isolated atrial fibrillation (AF) after radiofrequency catheter ablation. Methods: A total of 119 patients with isolated atrial fibrillation undergoing radiofrequency catheter ablation were retrospectively analyzed. Surgical methods of paroxysmal atrial fibrillation were circumferential pulmonary vein isolation. Non-paroxysmal atrial fibrillation was ablated on the basis of pulmonary vein isolation. The clinical data, biochemical and physical examination indicators. Patients were divided into recurrent group and non-recurrent group according to the follow-up results, and the risk factors related to the recurrence of arrhythmia were analyzed. Results: The follow-up ranged from 14 to 27 months, with an average of (15.4 ± 3.5) months. A total of 38 patients (31.9%) relapsed. Univariate analysis showed that non-paroxysmal atrial fibrillation, LAD, LAVI, duration of atrial fibrillation, triglyceride, neutrophil and lymphocyte Ratio (NLR). Logistic regression analysis showed that there was no significant difference between the two groups (LAVI = 1.102,95% CI: 1.017-1.1915, P = 0.018), NLR (OR = 4.433,95% CI 1.863-10.546, P = 0.001) and the duration of atrial fibrillation (OR = 1.019, 95% CI: 1.000-1.0838, P = 0.046) were statistically significant. ROC curve analysis showed that the cut-off point of LAD was 40.5mm, the cut-off point of LAVI was 26.3ml / m2, the cut-off point of NLR was 1.64, and the cut-off point of atrial fibrillation duration was 11.4 months. Kaplan-Meier survival curves showed that LAVI≥40.5mm group and LAVI <40.5mm group (35.3%: 81.2%), LAVI≥26.3ml / m2 group and LAVI <26.3ml / m2 group (60.8%: 77.9% The ablation success rates of NLR ≥ 1.64 months and <11.4 months (46.2%: 94.8%), NLR≥1.64 and NLR <1.64 (52.9%: 79.4%) were significantly different P <0.05). Conclusion: LAD, LAVI, NLR and duration of atrial fibrillation are independent risk factors of atrial fibrillation recurrence after solitary atrial fibrillation. When LAD≥40.5mm, LAVI≥26.3ml / m2, NLR≥1.64, duration of atrial fibrillation At ≥11.4 months, the probability of recurrence increased significantly.