方浩,王昌会,解杨婧,章胜,方玉莹,陈大年

• 1:安徽医科大学第一附属医院心血管内科

摘要(Abstract)：

目的 探讨心房颤动（房颤）患者导管消融术后复发的危险因素，并构建临床预测模型。方法 纳入2018年1月至2019年12月于安徽医科大学第一附属医院首次行导管消融术的房颤患者，随机分为开发集和验证集，比较两组患者的临床基线资料、血液学、心脏超声影像学指标等相关因素；应用单因素及多因素Logistic回归分析确定房颤术后复发的独立危险因素，借助R软件建立预测房颤术后复发的列线图模型，并对其进行验证。结果 多因素Logistic回归分析显示非阵发性房颤（OR 2.279,95%CI 1.409～3.687,P=0.001）、身体质量指数（BMI）(OR1.089,95%CI1.016～1.167,P=0.016)、左心房内径（LAD）(OR1.931,95%CI1.259～2.963,P=0.003)、中性粒细胞与淋巴细胞比值（NLR）≥1.758(OR2.443,95%CI1.543～3.869,P <0.001)均是房颤患者术后复发的独立危险因素。以此建立的列线图在开发集中预测房颤术后复发的一致性指数为0.712(95%CI 0.640～0.756)，同时也得到验证集验证的支持（C指数：0.748,95%CI0.678～0.809），校准曲线显示列线图预测结果与实际结果的吻合度较好。列线图模型在开发集[曲线下面积（AUC）0.712,95%CI 0.640～0.756；灵敏度0.865，特异度0.443]和验证集（AUC 0.748,95%CI 0.678～0.809；灵敏度0.652，特异度0.800）均表现出良好的预测能力，两组间AUC值差异无统计学意义（Z=0.766,P=0.443）。Logistic回归分析发现APPLE评分、CAAP-AF评分均为房颤术后复发的预测因子（OR 1.576,95%CI 1.295～1.919,P<0.001;OR1.315,95%CI1.189～1.454,P<0.001）。基于开发集中三者受试者工作特征曲线分析，列线图模型（AUC 0.712）与APPLE评分（AUC 0.636）相比，差异有统计学意义（P<0.001）；与CAAP-AF评分（AUC0.662）相比，差异亦有统计学意义（P=0.041），具有更好的预测价值。结论房颤类型、LAD、BMI及NLR构建的列线图模型可对房颤导管消融术后的复发进行有效预测，具有较好的应用价值。

关键词(KeyWords)： 心房颤动;导管消融术;复发;独立危险因素;列线图

Abstract:

Keywords:

基金项目(Foundation):

作者(Author): 方浩,王昌会,解杨婧,章胜,方玉莹,陈大年

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