Predictive value of risk factors in atrial fibrillation after implantation of cardiac implantable electronic devices
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摘要: 目的 探究心脏电子植入装置(CIEDs)植入后发生心房颤动(AF)患者的危险因素及预测价值，为早期发现高风险人群、及时采取干预措施提供科学依据。方法 回顾性分析我院住院植入CIEDs患者的临床资料，根据术后起搏器程控检查将未发生心房高频事件(AHREs)患者作为对照组(86例)，发生AHREs进一步使用穿戴式12导联心电设备检测到AF患者作为病例组(34例)，采用单因素和多因素logistic回归分析CIEDs置入后AF发生的独立危险因素，ROC曲线分析其对AF发生的预测价值。结果 单因素分析结果显示，吸烟、高血压、脑梗死、中性粒细胞、尿酸、左房内径、钙拮抗剂的占比高于对照组，差异有统计学意义(P < 0.05)。多因素logistic回归分析显示，吸烟、高血压、脑梗死、左房内径为CIEDs植入后发生AF的独立危险因素(P < 0.05)，ACEI/ARB为保护因素(P < 0.05)。联合预测AF的ROC曲线下面积为0.920，预测灵敏度和特异度分别为94.12%、76.74%。结论 吸烟、高血压、脑梗死、左房内径可作为临床预测CIEDs植入后是否并发AF的重要参考依据。Abstract: Objective To explore the predictive value of risk factors in atrial fibrillation(AF) of patients after implantation of cardiac implantable electronic devices(CIEDs), and provide a scientific basis for early detection of high-risk groups and timely intervention measures.Methods Clinical data of inpatients with CIEDs implanted in our hospital were retrospectively analyzed. According to the postoperative pacemaker program control examination, patients with AHRE were selected as the control group(n=86), and patients with AHRE were selected as the case group(n=34) when AF was detected by wearing 12-lead ECG equipment. Univariate and multivariate logistic regression were used to analyze the independent risk factors for AF occurrence after CIEDs implantation, and to analyze their predictive value for AF occurrence.Results Univariate analysis showed that the proportion of smoking, hypertension, cerebral infarction, neutrophils, UA, left atrial diameter and calcium antagonists was higher than those of control group, with statistical significance(P < 0.05). Multivariate logistic regression analysis showed that smoking, hypertension, cerebral infarction and left atrial diameter were independent risk factors for AF after CIEDs implantation(P < 0.05), and ACEI/ARB was protective factor(P < 0.05). The area under ROC curve was 0.920, and the prediction sensitivity and specificity were 94.12% and 76.74%, respectively.Conclusion Smoking, hypertension, cerebral infarction and left atrial diameter are used as important influence factors for predicting AF in patients after CIEDs implantation.
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图 1 CIEDs植入后预测新发AF的ROC曲线
Figure 1. ROC curve for predicting new AF after CIEDs implantation
表 1 新发AF组与对照组患者的基线资料比较
Table 1. Comparison of baseline data between patients with new atrial fibrillation and control group
例(%), X±S, M(P25, P75) 指标 新发AF组(34例) 对照组(86例) t/z/χ2 P值 性别 0.004 0.951 女 16(47.1) 41(47.7) 男 18(52.9) 45(52.3) 年龄/岁 76.00(67.25，82.00) 76.00(65.00，82.00) 0.565 0.452 吸烟 11(32.4) 9(10.5) 8.405 0.004 身高/cm 167.26±9.07 164.14±7.98 -1.858 0.066 体重/kg 69.53±13.51 67.15±13.83 -0.855 0.395 BMI /(kg/cm2) 23.54(21.92，28.31) 24.19(22.10，27.74) 0.012 0.912 收缩压/mmHg 129.53±21.58 128.34±20.07 -0.287 0.775 舒张压/mmHg 74.50(62.75，82.00) 74.00(65.00，78.00) 0.191 0.662 脉压/mmHg 55.68±18.06 56.76±16.77 0.311 0.756 心率/(次/min) 76.50(63.00，85.75) 71.00(65.00，79.00) 1.347 0.246 高血压 21(61.8) 32(37.2) 5.958 0.015 糖尿病 8(23.5) 19(22.1) 0.029 0.865 冠心病 19(55.9) 37(43.0) 1.619 0.203 脑梗死 15(44.1) 9(10.5) 17.247 < 0.001 抗血小板药 8(23.5) 24(27.9) 0.239 0.625 ACEI/ARB 7(20.6) 42(48.8) 8.048 0.005 钙拮抗剂 17(50.0) 18(20.9) 9.967 0.002 利尿剂 11(32.4) 15(17.4) 3.192 0.074 他汀 22(64.7) 52(60.5) 0.185 0.667 疾病原因 7.488 0.097 AVB 12(35.3) 33(38.4) HF 0(0.0) 12(14.0) SSS 14(41.2) 29(33.7) SSS+AVB 2(5.9) 3(3.5) VT 6(17.6) 9(10.5) 注：AVB：房室传导阻滞；HF：心力衰竭；SSS：病态窦房结综合征；VT：室性心动过速。 
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表 2 新发AF组与对照组心脏彩超及实验室指标的比较
Table 2. Comparison of cardiac color ultrasound and laboratory indexes
M(P25, P75) 指标 新发AF组(34例) 对照组(86例) t/z P值 中性粒细胞/(×109/L) 5.11(3.72，6.52) 3.86(3.21，4.86) 8.395 0.004 淋巴细胞/(×109/L) 1.54(1.08，2.06) 1.69(1.29，1.94) 0.733 0.392 TC/(mmol/L) 3.69(3.26，4.26) 3.78(3.13，4.52) 1.009 0.315 LDL-C/(mmol/L) 2.18(1.90，2.77) 2.25(1.70，2.77) 0.097 0.755 HDL-C/(mmol/L) 0.98(0.90，1.23) 1.08(0.94，1.33) 2.613 0.106 尿酸/(μmol/L) 391.65(98.44) 305.90(88.78) 17.706 < 0.001 TG/(mmol/L) 1.02(0.80，1.50) 1.04(0.82，1.56) 0.290 0.590 LAD/mm 40.50(35.25，47.75) 36.00(34.00，41.75) 10.115 0.001 肺动脉压/mm 38.50(35.00，45.00) 39.00(34.00，44.50) 0.350 0.554 LVEF/% 52.00(43.50，57.00) 56.00(50.00，60.00) 3.323 0.068 LVPWT/mm 10.00(10.00，11.00) 10.00(10.00，11.00) 1.543 0.214
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表 3 CIEDs植入后新发房颤发生的多因素分析
Table 3. Multivariate analysis of new atrial fibrillation after CIEDs implantation
变量 β SE Wald χ2 P值 OR(95%CI) 吸烟 3.019 0.912 10.947 0.001 20.47(3.42~122.42) 高血压 1.702 0.858 3.937 0.047 5.49(1.02~29.47) 脑梗死 2.884 0.817 12.464 < 0.001 17.89(3.61~88.73) 淋巴细胞 0.331 0.190 3.032 0.082 1.39(0.96~2.02) 尿酸 0.007 0.004 3.276 0.070 1.01(1.00~1.02) LAD 0.210 0.064 10.832 0.001 1.23(1.09~1.40) ACEI/ARB -1.899 0.804 5.585 0.018 0.15(0.03~0.72) 钙拮抗剂 1.084 0.827 1.720 0.190 2.96(0.59~14.95)
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