【摘要】 目的探讨心房电-机械检测(Pd、Pmax、LAD)和心脏神经内分泌激素BNP水平与阵发性房颤(PAF)相关性及对PAF的预测价值。方法选择130例阵发房颤患者,及92例无房颤者为对照组,分别测定两组P波离散度(Pd),P波最大时限(Pmax),测量左房最大内径(LAD)及监测血液脑钠肽(BNP)水平,随访1～3年,观察两组患者房颤发作情况。结果有PAF患者Pd(p<0.001),Pmax(p<0.001),LA(p<0.05),BNP(p>0.05)大于无PAF患者;单变量分析显示LAD、Pmax、Pd为阵发性心房颤动的预测因子,多变量分析显示Pd为PAF的独立预测因子;以Pd≥45.0ms为切点值预测阵发性房颤的敏感性为90.6%,特异性为70.0%,阳性预测准确率为71.4%。结论Pd、Pmax、LAD及BNP联合分析,对PAF有重要的预测价值,尤其Pd可作为PAF的一个无创特异的独立预测指标。更多还原

【Abstract】 Objective To investigate their relationships and their forecast values between Cardiac Electro-mechanical(Pd、Pmax、LAD)detection and neurosecretory hormone brain natriuretic peptide(BNP) for paroxysmal atrial fibrillation(PAF).Methods 130 patients in one group with PAF, and 92 patients in the control group of non-atrial-fibrillation were surveyed their body electrocardiogram only under the condition of sinus rhythm.Those persons have no significance in concomitance risk factors and diseases.The maximum P-wave duration(Pmax),the minimum P-wave duration(Pmin) and P-wave dispersion(Pd) were measured by electrophysiological recorder.Left atrial diameter(LAD) was computerd by Doppler echocardiogram, and their BNP levels also was measured.To observe their PAF recurrence in 1～3 years.Results The LAD、Pd 、Pmax、BNP of PAF patients were obviously higher than those in control group with significance.Single factor analyzed showing LAD、Pd and Pmax were all forecast factors of PAF, Multi-factor analysis showed Pd was the only forecast factor of PAF.The higher Pd with a cut-off point of 45.0ms as a predictor of PAF occurrence, which the sensitive is 90.6% , the specificity is 70.0% , the positive predictive value is 71.4%.Conclusions The LAD、Pmax、Pd and BNP combined to evaluate, which could increase the predictive values for the PAF recurrence.Especially Pd might be an effective data for PAF prediction, which is a specificity independent forecast index in non-invasive examination.更多还原