血清游离甲状腺素与心房颤动导管射频消融术后复发的关系

摘要

目的 探讨血清游离甲状腺素(FT4)水平与心房颤动(AF)导管射频消融(RFCA)术后复发的相关性及其机制.方法 选择2013年9月至2015年12月在苏州大学附属第一医院行RFCA的AF患者156例,男性97例,平均年龄(62.2±9.1)岁,其中阵发性AF(PAF)患者135例(86.5%),持续性AF患者21例(13.5%).术后随访,并对可能影响AF患者术后复发的因素进行Logistic回归分析,评估FT4对AF患者RFCA术后复发的影响.结果 156例AF患者中,复发50例(32.1%),其中PAF组复发39例(28.9%),持续性AF组复发11例(52.4%),差异有统计学意义(χ2=4.605,P=0.032).以FT4四分位数进行分组,从低水平组到高水平组的复发率分别为12.8%、22.5%、36.8%和56.4%(P<0.001).多因素Logistic回归分析显示,FT4是AF术后复发的独立危险因素(OR=1.328,95%CI:1.106~1.594,P=0.002),并且较高的FT4水平会增加AF的复发率(OR=5.030,95%CI:1.450~17.446,P=0.011).受试者工作特征曲线显示,FT4对RFCA术后AF复发的预测价值:曲线下面积AUC=0.707,95%CI:0.622~0.792,P<0.001,敏感度72.0%,特异度61.3%.结论较高的FT4水平会增加AF患者RFCA术后的复发率.%Objective To explore the correlation between serum free thyroxine( FT4 ) and recurrence of atrial fibrillation ( AF ) after radiofrequency catheter ablation ( RFCA ) and its possible mechanism. Methods A total of 156 patients [97 males,(62. 2 ± 9. 1)yrs] with AF undergone RFCA were enrolled in the study from September 2013 to December 2015 in the First Affiliated Hospital of Soochow University;in which 135 patients(86. 5%)had paroxymal AF,and 21(13. 5%)persistent AF. Logistic regression analysis was used to evaluate the effect of FT4 on the recurrence of AF in postoperative follow?up. Results After a mean follow?up of 12 months,50 patients(32. 1%)experienced recurrence,of which 39 cases(28. 9%)were in paroxysmal AF group and 11 cases ( 52. 4%) in persistent AF group (χ2 =4. 605, P =0. 032 ) . The recurrence rates were 12. 8%,22. 5%,36. 8% and 56. 4% in different FT4 quartile groups,from low to the high respectively(P<0. 001). After adjustment of age,sex,LAD,persistent AF and electrical cardioversion, there was an increased risk of recurrence in the subjects with the highest FT4 quartile(OR=5. 030,95%CI:1. 450?17. 446,P=0. 011) . FT4 was also an independent risk factor of recurrence ( OR =1. 328,95%CI:1.106?1.594,P = 0.002). According to Receiver Operating Characteristic(ROC)curve,FT4 had a sensitivity of 72. 0% and a specificity of 61. 3% ( AUC = 0. 707 ) in predicting recurrence of AF after ablation. Conclusions High FT4 level may increase AF recurrence after RFCA.