目的 探讨中性粒细胞与淋巴细胞比值(NLR)对阵发性和持续性心房颤动(房颤)导管射频消融术后复发预测价值的比较.方法 选取2014年6月至2016年6月于大连医科大学附属第一医院心内科首次行导管射频消融术的554例房颤患者为研究对象,其中阵发性房颤394例,持续性房颤160例.根据血常规结果计算NLR值.阵发性房颤行环肺静脉电隔离(CPVI),持续性房颤在CPVI基础上加行线性消融.房颤复发定义为消融3个月空白期后,发生的任何快速性房性心律失常,且持续时间≥30 s.结果 平均随访(13.2±3.6)月,阵发性房颤87例(22.1%)复发,持续性房颤51例(31.9%)复发.在阵发性和持续性房颤中,复发组NLR均显著高于非复发组,差异有统计学意义(P＜0.05).经多因素Cox回归和ROC曲线分析显示,NLR对持续性房颤患者消融术后复发的预测价值优于阵发性房颤患者[HR=2.421(95%CI:1.688~3.472),P＜0.05 vs. HR=2.071(95%CI:1.682~2.551), P＜0.05;AUC=0.721(95%CI:0.633~0.809),P＜0.05 vs. AUC=0.688(95%CI:0.625~0.751),P＜0.05].在阵发性房颤中,NLR预测的最佳临界点为2.07.在持续性房颤中,NLR预测的最佳临界点为2.11.结论 NLR是阵发性和持续性房颤消融术后复发的独立预测因素,并且在持续性房颤中的预测价值优于阵发性房颤.当NLR≥2.07时阵发性房颤消融术后复发的概率明显增加;当NLR≥2.11时持续性房颤消融术后复发的概率明显增加.%Objective To investigate the comparison of neutrophil-to-lymphocyte ratio (NLR) for prediction value between paroxysmal atrial fibrillation (PAF) and persistent atrial fibrillation (PEAF) recurrence after radiofrequency catheter ablation (RFCA). Method Five hundred and fifty-four AF patients were included. NLR was calculated from the result of hemocyte analysis. Circumferential pulmonary vein isolation (CPVI) was conducted in PAF, and CPVI combined with linear ablation was conducted in PEAF. The AF recurrence was defined as any episode of atrial tachyarrhythmia, more than 30 seconds that occurred after the 3-month post-ablation blanking period. Result The mean follow-up(13.2±3.6)months. Eighty-seven patients (22.1%) recurred in PAF, and Fifty-one patients (31.9%) recurred in PEAF. In PAF and PEAF, NLR was significantly higher in the recurrence group than in the non-recurrence group (P<0.05). Multivariate Cox regression and ROC curve analysis showed that the predictive value of NLR for PEAF recurrence after RFCA was better than PAF [HR=2.421 (95%CI: 1.688~3.472), P<0.05 vs. HR=2.071 (95%CI: 1.682~2.551), P<0.05; AUC=0.721 (95%CI: 0.633~0.809), P<0.05 vs. AUC=0.688 (95%CI: 0.625~0.751), P<0.05] . The optimal ROC cut-off point of NLR was 2.07 in PAF. The optimal ROC cut-off point of NLR was 2.11 in PEAF. Conclusion NLR is an independent predictor for PAF and PEAF recurrence after RFCA. Moreover, the predictive value of NLR for PEAF recurrence after RFCA is better than PAF. When NLR≥2.07, the recurrence rate of PAF may be significantly increased. When NLR≥2.11, the recurrence rate of PEAF may be significantly increased.
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