生物学标志物对非体外循环冠状动脉旁路移植术后心房颤动的预测价值

摘要

目的 探讨N末端脑利钠肽前体(NT-proBNP)、高敏心肌肌钙蛋白T(hs-cTNT)和红细胞分布宽度(RDW)对非体外循环冠状动脉(冠脉)旁路移植(OPCABG)术后心房颤动的预测价值.方法 选择我院择期行单纯OPCAB手术240例,根据术后是否发生心房颤动分为心房颤动组(n=66)与窦性心律组(n=174).记录两组术前基线资料、实验室检测结果及围术期变化,分析OPCAB术后心房颤动的独立预测指标.结果 两组年龄、术前急性心肌梗死、术前应用他汀类药物和左房内径比较差异均有统计学意义(P<0.05).与窦性心律组比较,心房颤动组术前血清胱抑素C、NT-proBNP、hs-cTNT和RDW水平升高、术后机械通气时间长,差异均有统计学意义(P<0.05).多变量Logistic回归分析显示,年龄、术前应用他汀类药物、左房内径、NT-proBNP、hs-cTNT和RDW是OPCAB术后心房颤动的独立预测因素(P<0.05).NT-proBNP、hs-cTNT、RDW曲线下面积分别为0.758％、0.857％、0.648％.结论 年龄、左房内径、术前应用他汀类药物、NT-proBNP、hs-cTNT及RDW是OPCAB术后预测心房颤动的独立危险因素,且NT-proBNP、hs-cTNT和RDW的预测价值更高.%Objective To investigate predictive values of preoperative N-terminal pro-brain natriuretic peptide (NT-proBNP), high-sensitivity troponin T (hs-cTNT) and red blood cell distribution width (RDW) for postoperative atrial fibrillation (AF) in patients with off-pump coronary artery bypass grafting (OPCABG).Methods A total of 240 patients undergoing selective OPCAB only were divided into AF group (n=66) and sinus rhythm (SR) group (n=174) according to whether or not having postoperative AF.Preoperative basic data, results of laboratory test and changes of perioperative parameters were recorded, and independent predictors in prediction of postoperative AF after OPCAB were analyzed in two groups.Results There were significant differences in age, preoperative acute myocardial infarction, taking statins preoperatively and left atrium diameter between two groups (P<0.05).Compared with those in SR group, in AF group, preoperative cystatin C (Cys C), NT-proBNP,hs-cTNT and RDW levels were significantly increased, while postoperatively mechanical ventilation was longer (P<0.05).Multivariate logistic regression analysis showed that age, taking statins preoperatively, left atrium diameter, NT-proBNP, hs-cTNT and RDW were independent predictors in prediction of postoperative AF after OPCAB.Values of area under curve of NT-proBNP, hs-cTNT and RDW were 0.758％, 0.857％ and 0.648％.Conclusion Age left atrium, taking statins preoperatively, NT-proBNP, hs-cTNT and RDW were independent predictors in prediction of postoperative AF after OPCAB, and NT-proBNP, RDW and hs-cTNT have well predictive values for postoperative AF.