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中华脑血管病杂志(电子版)

中华脑血管病杂志(电子版) ›› 2022, Vol. 16 ›› Issue (03) : 188 -192. doi: 10.11817/j.issn.1673-9248.2022.03.008

论著

心房颤动患者导管射频消融术后复发的危险因素及血小板与淋巴细胞比值对术后复发的诊断价值
张智文1, 雷志博1, 李牧蔚1,†(), 黄改荣1, 王山岭1, 刘静静1, 王婷1, 赵丹清1, 杨海涛1   
  1. 1. 450003　郑州，郑州大学人民医院（河南省人民医院）心血管内科
  • 收稿日期:2021-09-15 出版日期:2022-06-01
  • 通信作者: 李牧蔚
  • 基金资助:
    河南省自然科学基金(202300410465); 河南省医学科技攻关计划项目(LHGJ20190784)

Clinical significance of platelet to lymphocyte ratio in evaluating the recurrence of radiofrequency ablation in patients with atrial fibrillation

Zhiwen Zhang1, Zhibo Lei1, Muwei Li1,†(), Gairong Huang1, Shanling Wang1, Jingjing Liu1, Ting Wang1, Danqing Zhao1, Haitao Yang1   

  1. 1. Department of Cardiology, Zhengzhou University People's Hospital, Henan Provincial People's Hospital, Zhengzhou 450003, China
  • Received:2021-09-15 Published:2022-06-01
  • Corresponding author: Muwei Li
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引用本文：

张智文, 雷志博, 李牧蔚, 黄改荣, 王山岭, 刘静静, 王婷, 赵丹清, 杨海涛. 心房颤动患者导管射频消融术后复发的危险因素及血小板与淋巴细胞比值对术后复发的诊断价值[J]. 中华脑血管病杂志(电子版), 2022, 16(03): 188-192.

Zhiwen Zhang, Zhibo Lei, Muwei Li, Gairong Huang, Shanling Wang, Jingjing Liu, Ting Wang, Danqing Zhao, Haitao Yang. Clinical significance of platelet to lymphocyte ratio in evaluating the recurrence of radiofrequency ablation in patients with atrial fibrillation[J]. Chinese Journal of Cerebrovascular Diseases(Electronic Edition), 2022, 16(03): 188-192.

目的

探讨心房颤动（简称房颤）患者射频导管消融术（RFCA）后复发的危险因素及血小板与淋巴细胞比值（PLR）对术后复发的诊断价值。

方法

纳入2013年1月至2018年1月于河南省人民医院接受RFCA的312例房颤患者。按照患者术后3个月是否复发房颤，分为复发组（85例）和未复发组（227例），分析2组患者的一般临床资料、实验室检查指标和超声心动图指标，采用Logistic回归分析RFCA后房颤复发的危险因素，采用受试者工作特征（ROC）曲线评价PLR预测RFCA后房颤复发的价值；按照患者PLR中位数，将患者分为高PLR组（156例）和低PLR组（156例），并使用Kaplan-Meier生存曲线分析2组患者的预后。

结果

单因素分析结果显示，年龄、房颤病程、房颤类型、超敏C反应蛋白（hs-CRP）、中性粒细胞、血小板、淋巴细胞、PLR及左心房内径对房颤患者RFCA术后房颤有一定影响（P＜0.05）。多因素Logistic回归分析显示，年龄（OR=1.047）、持续性房颤（OR=2.519）、hs-CRP（OR=2.249）、血小板（OR=1.023）、PLR（OR=1.030）及左心房内径（OR=1.224）是RFCA术后房颤复发的独立危险因素（P＜0.05），淋巴细胞（OR=0.255）是RFCA后房颤复发的保护因素（P＜0.05）。ROC曲线结果显示，PLR预测RFCA术后房颤复发的曲线下面积为0.725（95%CI：0.672~0.774，P＜0.001）。Kaplan-Meier生存曲线结果显示高PLR组RFCA术后的房颤复发率明显高于低PLR组（P＜0.001）。

结论

房颤患者PLR水平与RFCA术后房颤复发密切相关，高PLR水平可作为预测房颤复发的信号，临床应加强PLR监测以及时评估患者的预后。

关键词: 血小板/淋巴细胞比值, 炎性反应, 心房颤动, 射频消融术, 复发
Objective

To investigate the clinical significance of platelet to lymphocyte ratio (PLR) in evaluating the recurrence of patients with atrial fibrillation (AF) after radiofrequency catheter ablation (RFCA).

Methods

Totally 312 patients with AF who received RFCA in Henan Provincial People’s Hospital from January 2013 to January 2018 were included. Patients were divided into recurrence group (n=85) and non-recurrence group (n=227) according to whether AF reoccurred 3 months after ablation. The general clinical data, laboratory indexes and echocardiography indexes of the two groups were analyzed. Logistic regression was used to analyze the related factors of AF recurrence after RFCA, and receiver operating characteristic (ROC) curve was used to evaluate the value of PLR in predicting the recurrence of AF after RFCA. The patients were divided into high PLR group (n=156) and low PLR group (n=156) according to the median PLR, and Kaplan-Meier survival curve was used to analyze the prognosis.

Results

Univariate analysis showed that age, course of atrial fibrillation, type of atrial fibrillation, high-sensitivity C-reactive protein (hs-CRP), neutrophils, platelets (PLT), lymphocytes, PLR, and left atrial diameter (LAD) had a positive effect on the AF recurrence after RFCA (P＜0.05). Multiple Logistic regression showed that age (OR=1.047), persistent atrial fibrillation (OR=2.519), hs-CRP (OR=2.249), PLT (OR=1.023), PLR (OR=1.030) and LAD (OR=1.224) were the independent risk factors for recurrence of AF recurrence after RFCA (P＜0.05), lymphocyte (OR=0.255) was protective factor for recurrence of AF recurrence after RFCA (P＜0.05). ROC curve showed that area under curve (AUC) predicted by PLR for AF recurrence after RFCA was 0.725（95%CI：0.672-0.774，P＜0.001）. The results of Kaplan-Meier survival curve showed that the recurrence of AF in high PLR group was significantly higher than that in low PLR group (P＜0.001).

Conclusion

The level of PLR is closely related to the recurrence of AF after RFCA. The high level of PLR can be used as a signal to predict the recurrence of AF. Clinical monitoring of PLR should be strengthened to evaluate the prognosis of patients in a timely manner.

Key words: Platelet/lymphocyte ratio, Inflammatory reaction, Atrial fibrillation, Radiofrequency catheter ablation, Recrudesce
表1 复发组与未复发组之间基线及临床指标比较
指标

复发组

（n=85）

未复发组

（n=227）

 统计值 P值
性别男/女，[例] 52/33 148/79 χ2=0.435 0.510
年龄（岁，
x¯
±s）		 57.4±10.7 52.6±10.5 t=2.582 0.001
抽烟[例（%）] 12（14.1） 45（19.8） χ2=1.349 0.246
饮酒[例（%）] 13（15.3） 40（17.6） χ2=0.237 0.625
高血压[例（%）] 37（43.5） 84（37.0） χ2=1.109 0.292
冠心病[例（%）] 11（12.9） 22（9.7） χ2=0.690 0.406
糖尿病[例（%）] 18（21.2） 34（15.0） χ2=1.711 0.191
血脂异常[例（%）] 30（35.3） 61（26.9） χ2=2.123 0.145
体质量指数（kg/m2,
x¯
±s）		 24.2±3.1 25.1±3.8 t=1.190 0.236
房颤病程[年，例（%）] χ2=10.569 0.001
≥1 32（37.6） 45（19.8）
＜1 53（62.4） 182（80.2）
房颤类型[例（%）] χ2=15.890 ＜0.001
阵发性房颤 35（41.2） 150（66.1）
持续性房颤 50（58.8） 77（33.9）
hs-CRP（mg/L，
x¯
±s）		 3.8±0.8 3.2±0.9 t=5.412 ＜0.001
中性粒细胞（×109/L,
x¯
±s）		 5.1±0.9 4.9±0.8 t=2.063 0.040
PLT（×109/L,
x¯
±s）		 257.1±30.6 234.3±32.2 t=5.647 ＜0.001
淋巴细胞（×109/L,
x¯
±s）		 1.9±0.5 2.1±0.4 t=-3.734 ＜0.001
PLR（
x¯
±s）		 135.8±25.2 114.6±26.1 t=6.463 ＜0.001
LAD（mm,
x¯
±s）		 42.3±4.1 39.8±3.4 t=5.169 ＜0.001
LVEDD（mm,
x¯
±s）		 44.8±5.3 46.1±6.1 t=-1.849 0.066
LVEF（%,
x¯
±s）		 57.5±8.7 59.2±8.6 t=-1.550 0.122
治疗药物[例（%）]
ACEI/ARB 23（27.1） 74（32.6） χ2=0.886 0.347
CCB 17（20.0） 50（22.0） χ2=0.151 0.698
β受体阻滞剂[例（%）] 46（54.1） 147（64.8） χ2=2.967 0.085
胺碘酮[例（%）] 22（25.9） 77（33.9） χ2=1.845 0.174
表2 经导管射频消融术后房颤复发的多因素Logistic回归分析
变量 β值 SE值 Wald χ2值 OR值 95%CI P值
年龄 0.046 0.017 6.925 1.047 1.012~1.083 0.008
房颤病程 0.535 0.366 2.143 1.708 0.834~3.496 0.143
持续性房颤 0.924 0.341 7.331 2.519 1.291~4.918 0.007
hs-CRP 0.810 0.218 13.829 2.249 1.467~3.446 ＜0.001
中性粒细胞 0.293 0.192 2.337 1.340 0.921~1.951 0.126
PLT 0.023 0.006 15.684 1.023 1.012~1.035 ＜0.001
淋巴细胞 -1.366 0.416 10.798 0.255 0.113~0.576 0.001
PLR 0.030 0.007 19.764 1.030 1.017~1.044 ＜0.001
LAD 0.202 0.048 17.996 1.224 1.115~1.343 ＜0.001
图1 血小板与淋巴细胞比值预测经导管射频消融术后复发的受试者操作特征曲线
图2 高PLR组与低PLR组的Kaplan-Meier生存曲线比较注：PLR为血小板与淋巴细胞比值，在该生存曲线中生存概率代表房颤未复发的概率
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