摘要
目的探讨体重控制与超重及肥胖患者心房颤动(房颤)射频消融术后复发的关系。方法前瞻性连续入选2015年10月至2016年2月于首都医科大学附属北京安贞医院接受房颤射频消融治疗的超重及肥胖患者333例,年龄28~87岁,收集患者基线时的临床特征、实验室检查及治疗等信息,并分别在术后的第3、6和12个月进行随访,收集体重、房颤复发、卒中、大出血、心血管原因住院、死亡等信息。根据随访的BMI较基线的变化情况,将研究人群分为体重控制组(ΔBMI<-1 kg/m2)及体重未控制组(ΔBMI≥-1 kg/m2),出现房颤复发者采用复发前最后一次的BMI结果,无房颤复发者采用术后第12个月随访时的BMI结果。用logistic多因素回归分析校正其他已知的影响房颤复发的因素,探讨体重控制与房颤射频消融术后房颤复发之间的关系。结果体重控制组54例,体重未控制组279例。两组患者的年龄、性别、教育程度、左心房大小、合并高血压等的比例差异无统计学意义(P>0.05)。与体重未控制组比较,体重控制组中使用血管紧张素转换酶抑制剂/血管紧张素受体阻滞剂的患者比例较高[50.0%(27/54)比34.8%(97/279),P=0.034],但体重控制组中肥胖[33.3%(18/54)比29.7%(83/279)]、阵发性房颤[59.3%(32/54)比56.6%(158/279)]和房颤病程<5年[76.9%(40/52)比65.4%(178/272)]的患者比例与体重未控制组比较,差异均无统计学意义(P均>0.05)。此外,在房颤消融术后随访1年中,体重控制组房颤复发率明显低于体重未控制组[14.8%(8/54)比32.6%(91/279),P=0.009]。多因素logistic回归分析显示体重控制与房颤消融术后复发率低显著相关(OR=0.40,95%CI 0.18~0.90,P=0.026)。结论在超重及肥胖患者中,体重控制与房颤射频消融术后房颤复发率低具有相关性。
Objectives This study explored the relationship between weight control and atrial fibrillation (AF) recurrence after catheter ablation in overweight and obese patients. Methods We prospectively enrolled consecutive 333 overweight and obese patients aged 28 to 87 years old, who underwent catheter ablation for AF in Beijing Anzhen Hospital between October 2015 and February 2016. Data of patients′ characteristics, laboratory examination and treatment were collected at baseline. Each patient was followed up at 3, 6 and 12 months after ablation to collect information on weight, AF recurrence, stroke, major bleeding, hospitalization for cardiovascular reasons and death, etc. Patients were divided into weight controlled group (ΔBMI<-1 kg/m2) and weight uncontrolled group (ΔBMI≥-1 kg/m2), according to the changes in the most recent exposure BMI before AF recurrence in patients with recurrence or the BMI at 12 months′ follow-up in patients without recurrence and the BMI at baseline. Multivariate logistic regression was performed to adjust other known risk factors of AF recurrence and to explore the association between weight control and AF recurrence after catheter ablation. Results There were 54 patients in weight controlled group and 279 patients in weight uncontrolled group. There were no significant differences in age, gender, education level, left atrial size and history of hypertension between the two groups (all P>0.05). The proportion of patients using angiotensin-converting enzyme inhibitors/angiotensin receptor blockers was higher in the weight controlled group (50.0%(27/54) vs. 34.8%(97/279), P=0.034). However, there was no significant difference in the proportion of patients with obesity (33.3%(18/54) vs. 29.7%(83/279)), paroxysmal AF (59.3%(32/54) vs. 56.6%(158/279)) and AF duration less than 5 years (76.9%(40/52) vs. 65.4%(178/272)) between the weight controlled group and the uncontrolled group. During 1-year follow-up after ablation, the recurrence rate of AF was significantly lower in the weight co
作者
贾朝旭
蒋超
卢尚欣
刘嘉鹏
郭雪原
李松南
刘念
蒋晨曦
桑才华
汤日波
龙德勇
喻荣辉
白融
吴嘉慧
杜昕
董建增
马长生
Jia Zhaoxu;Jiang Chao;Lu Shangxin;Liu Jiapeng;Guo Xueyuan;Li Songnan;Liu Nian;Jiang Chenxi;Sang Caihua;Tang Ribo;Long Deyong;Yu Ronghui;Bai Rong;Wu Jiahui;Du Xin;Dong Jianzeng;Ma Changsheng(Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University,National Clinical Research Center for Cardiovascular Diseases, Beijing 100029, China)
出处
《中华心血管病杂志》
CAS
CSCD
北大核心
2019年第8期595-601,共7页
Chinese Journal of Cardiology
基金
北京市科委课题(D151100002215003)
国家重点研发计划课题(2016YFC0900901)
国家自然科学基金(81530016).
关键词
心房颤动
导管消融术
体重
复发
Atrial fibrillation
Catheter ablation
Body weight
Recurrence
