房颤射频消融术后复发风险预测评分系统的建立及评价

目的:探讨心房颤动(房颤)患者射频消融术后复发的风险因素,并依此构建个性化的风险评分系统。方法:选取2017年1~8月行射频消融术的房颤患者154例作为研究对象,依据术后3个月的随访结果将患者分为复发组及未复发组,采用单因素分析和Logistic回归分析对各风险因素进行分析,构建其评分系统,采用Hosmer-Lemeshow拟合优度检验和ROC曲线下面积评价评分系统的准确度及区分度。结果:术后随访3个月的结果显示共37例(24.03%)房颤患者出现复发,房颤类型、病程、体质量指数(BMI)、左房前后径(LAD)、左房容积(LAV)及超敏C反应蛋白(hs-CRP)水平均是房颤复发的独立风险因素(P<0.05)。构建的风险评分系统得分为0~26分,Hosmer-Lemeshow拟合优度检验:x^2=7.520,P=0.482;ROC曲线下面积为0.864(95%CI:0.837~0.891),预测评分值为15分时,约登指数最大(0.605),此时的敏感度和特异度分别为77.3%和83.2%。结论:房颤患者射频消融术后的复发率较高,依据风险因素构建的风险评分系统具有较高的预测效率和区分能力,可作为房颤患者射频消融术后复发风险评估的参考工具。

Establishment and Evaluation of Recurrence Risk Prediction and Scoring System for Patients with Atrial Fibrillation after Radiofrequency Ablation

Objective: To investigate the risk factors of recurrence after radiofrequency ablation in patients with atrial fibrillation(AF), and construct a personalized risk scoring system. Methods: 154 cases of patients with atrial fibrillation who underwent radiofrequency ablation from January to August 2017 were divided into the recurrence group and the non-recurrence group according to the follow-up results at 3 months after operation. Univariate analysis and Logistic regression analysis were used to analyze the risk factors, and the scoring system was constructed. The accuracy and discrimination of the scoring system were evaluated by Hosmer--Leme show goodness of fit test and area under ROC curve. Results: The results of follow-up for 3 months showed that 37 patients(24.03%) with atrial fibrillation had recurrence. Atrial fibrillation type, course of disease, body mass index(BMI), left atrial anteroposterior diameter(LAD), left atrial volume(LAV) and hypersensitive C-reactive protein(hs-CRP) level were independent risk factors for recurrence of atrial fibrillation. The score of the constructed risk scoring system was 0≤26, and Hosmer--Leme show goodness of fit test: x^2=7.520, P=0.482;When the area under the ROC curve was 0.864(95%CI:0.837~0.891) and the predicted score was 15, the Youden index was the largest(0.605),and the sensitivity and specificity were 77.3% and 83.2%, respectively. Conclusion: The recurrence rate of patients with atrial fibrillation after radiofrequency ablation is high. the risk scoring system based on risk factors has high predictive efficiency and discrimination ability,and can be used as reference to evaluate the risk of recurrence after radiofrequency ablation in patients with atrial fibrillation.