【摘要】：背景:心房顫動(dòng)(atrial fibrillation,AF)是臨床上最常見的心律失常之一,其發(fā)生率隨年齡增長而增高,房顫可誘發(fā)心衰、引起腦栓塞等,嚴(yán)重影響患者生活質(zhì)量,危害身體健康。房顫導(dǎo)致中風(fēng)風(fēng)險(xiǎn)增加5倍,這表明房顫并非是單純的心血管疾病,因此,降低房顫的發(fā)病率、住院率、致殘率、病死率,是目前房顫治療最重要任務(wù)。長期臨床觀察,房顫的藥物治療效果并不十分理想,房顫不易轉(zhuǎn)復(fù),特別是慢性持續(xù)性房顫,并且藥物治療存在藥物副作用及不良反應(yīng)較多等缺點(diǎn)。經(jīng)過不斷的探索與研究,目前,導(dǎo)管消融在房顫治療中的地位不斷提高,已被推薦作為陣發(fā)性房顫的一線治療手段。然而,射頻消融術(shù)后的房顫復(fù)發(fā)事件仍居高不下,文獻(xiàn)報(bào)道其復(fù)發(fā)率約為25%~50%。房顫射頻消融術(shù)后復(fù)發(fā)相關(guān)的危險(xiǎn)因素包括年齡、肥胖、左房大小、房顫類型、房顫持續(xù)時(shí)間、BNP、炎癥、P波離散度、是否合并器質(zhì)性心臟病、抗心律失常藥物的應(yīng)用等,針對(duì)房顫射頻消融術(shù)后復(fù)發(fā)相關(guān)因素的研究顯得尤為重要。目的:探討血清高敏C反應(yīng)蛋白(hs-CRP)和肌鈣蛋白I(cTnI)與陣發(fā)性房顫射頻消融術(shù)后早期復(fù)發(fā)的關(guān)系。方法:選取2014年10月至2016年9月間在河南科技大學(xué)第一附屬醫(yī)院心血管內(nèi)科首次行三維標(biāo)測(cè)系統(tǒng)(EnSite-NAVX非接觸標(biāo)測(cè))指導(dǎo)下的環(huán)肺靜脈電隔離術(shù)的陣發(fā)性房顫患者60例,根據(jù)射頻消融術(shù)后三個(gè)月內(nèi)是否復(fù)發(fā)(觀察指標(biāo):患者的自主癥狀、12導(dǎo)聯(lián)體表心電圖及24小時(shí)動(dòng)態(tài)心電圖結(jié)果等)分為治療成功組(44例)和復(fù)發(fā)組(16例),分別在術(shù)前、術(shù)后第1、2、3天采集靜脈血進(jìn)行hs-CRP和cTnI水平測(cè)定,比較成功組和復(fù)發(fā)組術(shù)前、術(shù)后hs-CRP和cTn I變化情況。結(jié)果:60例陣發(fā)性房顫患者射頻消融手術(shù)前后hs-CRP和cTn I濃度峰值水平相比較差異有統(tǒng)計(jì)學(xué)意義(P0.05)。兩組患者術(shù)前hs-CRP和cTnI水平變化無明顯統(tǒng)計(jì)學(xué)差異(P0.05)。兩組患者術(shù)后hs-CRP濃度峰值、手術(shù)前后hsCRP濃度最大差值相比較差異有統(tǒng)計(jì)學(xué)意義(P0.05)。兩組患者術(shù)后cTn I濃度峰值、手術(shù)前后c Tn I濃度最大差值相比較差異無統(tǒng)計(jì)學(xué)意義(P0.05)。結(jié)論:hs-CRP濃度變化可能與陣發(fā)性房顫射頻消融術(shù)后早期復(fù)發(fā)有一定關(guān)系,而cTnI與陣發(fā)性房顫射頻消融術(shù)后早期復(fù)發(fā)無明顯相關(guān)性。
[Abstract]:Background: atrial fibrillation (atrial fibrillation,AF) is one of the most common arrhythmias in clinic. The incidence of atrial fibrillation increases with age. Atrial fibrillation can induce heart failure and cerebral embolism. Atrial fibrillation leads to a five-fold increase in the risk of stroke, indicating that atrial fibrillation is not a purely cardiovascular disease. Therefore, reducing the incidence, hospitalization, disability and mortality of atrial fibrillation is the most important task in the treatment of atrial fibrillation at present. Long-term clinical observation, the effect of drug treatment of atrial fibrillation is not very ideal, atrial fibrillation is not easy to recover, especially chronic persistent atrial fibrillation, and drug treatment has many shortcomings such as side effects and adverse reactions. Through continuous exploration and research, catheter ablation in the treatment of atrial fibrillation has been recommended as a first-line treatment of paroxysmal atrial fibrillation. However, the recurrence rate of atrial fibrillation after radiofrequency ablation is still high, and the recurrence rate is about 25%. Risk factors associated with recurrence of AF after radiofrequency ablation included age, obesity, left atrial size, type of AF, duration of AF, BNP, inflammation, P-wave dispersion, whether or not it was associated with organic heart disease, and the use of antiarrhythmic drugs. It is particularly important to study the factors related to recurrence of atrial fibrillation after radiofrequency ablation. Objective: to investigate the relationship between serum Gao Min C reactive protein (hs-CRP) and troponin I (cTnI) and early recurrence after radiofrequency ablation of paroxysmal atrial fibrillation. Methods: from October 2014 to September 2016, 60 patients with paroxysmal atrial fibrillation (PAF) were selected from the Department of Cardiovascular Medicine of the first affiliated Hospital of Henan University of Science and Technology under the guidance of EnSite-NAVX non-contact mapping system. According to whether the patients recurred within three months after radiofrequency ablation (indicators: autonomic symptoms, 12-lead electrocardiogram and 24-hour ambulatory electrocardiogram, etc.), they were divided into successful treatment group (44 cases) and recurrent group (16 cases). Venous blood was collected 3 days after operation to determine the levels of hs-CRP and cTnI. The changes of hs-CRP and cTn I were compared between the successful group and the recurrent group before and after operation. Results: the peak levels of hs-CRP and cTn I in 60 patients with paroxysmal atrial fibrillation were significantly different before and after radiofrequency ablation (P0.05). There was no significant difference in hs-CRP and cTnI levels between the two groups before operation (P0.05). The peak value of hs-CRP and the difference of hsCRP concentration before and after operation were significantly different between the two groups (P0.05). There was no significant difference between the two groups in the peak value of cTn I and the difference of c Tn I concentration before and after operation (P0.05). Conclusion: the change of hs-CRP concentration may be related to the early recurrence after radiofrequency ablation of paroxysmal atrial fibrillation, but there is no significant correlation between cTnI and early recurrence after radiofrequency ablation of paroxysmal atrial fibrillation.
【學(xué)位授予單位】：河南科技大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類號(hào)】：R541.75

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