心房颤动冷冻球囊消融术后心肌损伤与炎症标志物动态演变特征

摘要

目的 评估冷冻球囊消融(CBA)治疗心房颤动(AF)术后心肌损伤标志物和炎症标志物水平的动态变化,并与急性心肌缺血引起的标志物水平变化进行对比,研究AF患者经CBA后的心肌损伤与炎症的演变特征.方法 连续纳入50例行CBA治疗的AF患者(AF组),50例行择期经皮冠状动脉介入术(PCI)的稳定性心绞痛患者(SA组),50例行急诊PCI的急性冠状动脉综合征患者(ACS组).分别于术前,术后24、48、72 h测定血清肌酸激酶同工酶(CKMB)、肌钙蛋白I(cTnI)、高敏C反应蛋白(hsCRP)水平.结果 SA组CKMB及cTnI水平在术前及术后未呈现明显改变.AF组与ACS组CKMB及cTnI水平于术后24 h达到峰值,hsCRP水平在术后48 h达到峰值;ACS组CKMB、cTnI、hsCRP峰值均显著高于AF组和SA组.在AF组与ACS组中,cTnI与hsCRP呈相关性(r=0.275,P=0.045,AF组术后48 h;r=0.351,P=0.01,ACS组术后48 h),然而术后48 h hsCRP/cTnI比值在AF组中显著高于ACS组(4.3 vs 0.8,P＜0.001).结论 与ACS行急诊PCI患者相比,CBA术后患者心肌损伤和炎症标志物在术后达峰方面结果相似,但两者的比值存在显著差异,这说明CBA术后患者心肌损伤和炎症标志物的变化仍有其自身的特征性变化.%Objective To evaluate the dynamic evolution characteristics of acute myocardial injury and inflammation biomarkers after cryoballon ablation (CBA) for atrial fibrillation (AF) and to compare the changes of those biomarkers during acute cardiac ischemia in order to demonstrate the evolution of cardiac injury and inflammation after CBA.Methods Fifty consecutive AF patients (AF group) undergoing cryoballoon ablation,fifty stable angina patients (SA group) undergoing elective percutaneous coronary intervention (PCI) and fifty acute coronary syndrome patients (ACS group) undergoing emergent PCI were recruited.Creatine kinase-MB (CKMB),cardiac troponin-I (cTnI) and high-sensitivity C-reactive protein (hsCRP) were respectively measured at baseline,at 24,48 and 72 h after the procedure.Results No significant changes of CKMB and cTnI were detected in SA group.CKMB and cTnI reached the peak at 24 h after procedure and hsCRP peaked at 48 h after procedure in both AF group and in ACS group with greater elevation ACS group.Correlation between cTnI and hsCRP was found in both groups (r=0.275,P=0.045,AF group at 48 h;r=0.351,P=0.01,ACS group at 48 h).The ratio of hsCRP and cTnI was much higher in AF group than that in ACS group (4.3 vs 0.8,P＜0.001).Conclusions Compared with ACS patients undergoing emergent PCI,AF patients undergoing CBA exhibit similar peaking time of myocardial injury and inflammation biomarkers release.The ratio of these two biomarkers exist a significant difference between these two groups,indicating unique evolution characteristics of cardiac biomarker release after CBA for AF.[Chinese Journal of Cardiac Pacing and Electrophysicol,2017,31(5):427-432.