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目的探讨非风湿性心房颤动(non-rheumatic atrial fibrillation,NRAF)患者射频消融手术前后左心房结构及功能的变化。方法 NRAF患者200例,其中100例行射频消融手术者为射频消融组,100例行药物保守治疗者为保守治疗组。2组治疗前及治疗后1a后均行经食管超声心动图检查和血脑钠肽(brain natriuretic peptide,BNP)、高敏C反应蛋白(high sensitivity C-reactive protein,hs-CRP)水平检测,比较2组左心房、左心耳结构和功能变化以及血清BNP、hs-CRP水平。结果 2组治疗前左心房内径(left atrial diameter,LAD)、左心房最大容积(left atrial maximum volume,LAVmax)、左心房容积指数(left atial volume index,LAVI)、左心耳最大容积(left atrial appendage maximum volume,LAAVmax)、左心房射血数(left atrial ejection fraction,LAEF)、左心耳射血分数(left atrial appendage ejection fraction,LAA-EF)、左心耳最大排空速度(left atrial appendage emptying maximun speed,LAA-PEV)、左室射血分数(left ventricular ejection fraction,LVEF)及血BNP、hs-CRP比较差异无统计学意义(P>0.05);治疗后1a,2组以上指标均较治疗前改善,且射频消融组LAD[(35.6±3.4)mm]、LAVmax[(66.5±4.4)mL]、LAVI[(72.6±5.4)mL/m~2]、LAAVmax[(4.1±0.5)mL]以及血BNP[(17.80±5.30)ng/L]、hs-CRP[(4.23±1.59)mg/L]低于保守治疗组[(39.2±2.1)mm、(72.7±3.1)mL、(89.4±2.7)mL/m~2、(4.5±0.6)mL、(30.10±6.30)ng/L、(5.50±2.20)mg/L],LAA-PEV[(38.1±6.5)cm/s]、LAA-EF[(22.2±3.5)%]、LAEF[(55.6±5.3)%]、LVEF[(65.0±1.4)%]高于保守治疗组[(33.6±7.3)cm/s、(20.2±3.1)%、(51.1±5.7)%、(60.1±1.1)%],2组比较差异均有统计学意义(P<0.05)。结论导管射频消融术可逆转NRAF患者左心房和左心耳结构及功能。
Objective To investigate the changes of left atrial structure and function before and after radiofrequency ablation in patients with non-rheumatic atrial fibrillation (NRAF). Methods 200 cases of NRAF patients, of which 100 cases of radiofrequency ablation were radiofrequency ablation group, 100 cases of conservative treatment of drug-conservative treatment group. The levels of brain natriuretic peptide (BNP) and high-sensitivity C-reactive protein (hs-CRP) in both groups before and after treatment were measured by transesophageal echocardiography. Group left atrium, left atrial appendage structure and function changes and serum BNP, hs-CRP levels. Results The left atrial diameter (LAD), left atrial maximum volume (LAVmax), left atial volume index (LAVI), left atrial appendage maximum volume, LAAVmax, left atrial ejection fraction (LAEF), left atrial appendage ejection fraction (LAA-EF), left atrial appendage emptying maximun speed , LAA-PEV), left ventricular ejection fraction (LVEF) and blood BNP, hs-CRP were not significantly different (P> 0.05) , LAV [(35.6 ± 3.4) mm], LAVmax [(66.5 ± 4.4) mL], LAVI [(72.6 ± 5.4) mL / m 2] and LAAVmax [(4.1 ± 0.5) mL] The levels of serum BNP [(17.80 ± 5.30) ng / L] and hs-CRP [(4.23 ± 1.59) mg / L were lower than those in the conservative treatment group [(39.2 ± 2.1) mm, (4.5 ± 0.6) mL, (30.10 ± 6.30) ng / L, (5.50 ± 2.20) mg / L] and LAA-PEV [(38.1 ± 6.5) cm / s] [(22.2 ± 3.5)%], LAEF [(55.6 ± 5.3)%], LVEF [(65 .0 ± 1.4%] was higher than that of the conservative treatment group [(33.6 ± 7.3) cm / s, (20.2 ± 3.1)%, (51.1 ± 5.7)%, (60.1 ± 1.1)%] Statistical significance (P <0.05). Conclusion Catheter RFA can reverse the structure and function of left atrium and left atrial appendage in patients with NRAF.