【摘要】 目的 探讨外周血心钠素(atrial natriuretic peptide, ANP)、内脂素(visfatin)水平与非体外循环冠状动脉搭桥术(OPCABG)后新发房颤的相关性。方法 选取2018年1月至2021年12月郑州市第七人民医院收治的198例进行OPCABG患者，根据术后是否发生房颤分为房颤组63例和无房颤组135例。分别于入院时和术后24 h进行常规超声心动图检查，并采用双抗体夹心酶标免疫分析法检测其外周血ANP、内脂素水平。收集患者一般资料，然后采用单因素分析OPCABG术后新发房颤的相关因素，进一步将相关指标纳入多因素Logistic回归分析，筛选出独立危险因素。然后根据血清ANP及内脂素水平绘制ROC曲线，评估其对术后新发房颤的价值。结果 房颤组和无房颤组患者入院时左室射血分数(LVEF)、高敏C-反应蛋白(hs-CRP)、左房容积指数(LAVI)、外周血ANP及内脂素差异无统计学意义(P>0.05);房颤组和无房颤组患者年龄、术后24 h LVEF、hs-CRP、LAVI、外周血ANP及内脂素差异有统计学意义(P<0.05)。将有统计学意义和密切相关指标进行多因素Logistic回归分析，结果显示，年龄(OR=1.906,95%CI1.251～2.905)、术后24 h LAVI(OR=1.980,95%CI1.276～3.071)、术后24 h LVEF(OR=1.293,95%CI1.028～1.626)、术后hs-CRP(OR=1.446,95%CI1.177～1.777)、术后24 h外周血ANP(OR=1.602,95%CI1.070～2.398)、术后24 h外周血内脂素(OR=1.726,95%CI1.16～2.647)是OPCABG术后新发房颤的独立危险因素(OR>1,P<0.05)。受试者工作特征(ROC)曲线结果显示，外周血ANP水平截断值为48 ng/mL时，评估OPCABG术后新发房颤的ROC曲线下面积(AUC)为0.74(95%CI1.327～3.726),此时敏感度和特异度分别为75.34%、70.34%;外周血内脂素水平截断值为50 g/mL时，评估OPCABG术后新发房颤AUC为0.71(95%CI1.235～3.419),此时敏感度和特异度分别为72.48%、69.25%;两者联合检测评估OPCABG术后新发房颤的ROC曲线AUC为0.71(95%CI1.247～3.528),此时敏感度和特异度分别为79.43%、69.57%。结论 外周血ANP及内脂素水平异常升高是OPCABG术后新发房颤的重要危险因素，可为OPCABG术后24 h新发房颤预防提供重要参考依据，进而帮助患者改善预后。更多还原

【Abstract】 Objective To investigate and analyze the correlation of atrial natriuretic peptide(ANP) and visfatin levels in peripheral blood with new atrial fibrillation after off-pump coronary artery bypass grafting(OPCABG). Methods A total of 198 patients who underwent OPCABG in our hospital from January 2018 to December 2021 were selected and divided into the atrial fibrillation group(n=63) and the non-atrial fibrillation group(n=135) according to the occurrence of postoperative atrial fibrillation. Conventional echocardiography was performed on admission and 24 h after surgery, respectively, and the levels of ANP in peripheral blood and visfatin were detected by double-antibody sandwich enzyme-linked immunosorbent assay. The general data of patients were collected, the univariate analysis was used to analyze the factors related to new atrial fibrillation after OPCABG, and statistically significant single factors were further included in the multivariate Logistic regression analysis to screen out independent risk factors. ROC curve was drawn according to the serum ANP and visfatin levels in order to evaluate the value for postoperative new atrial fibrillation. Results There were no significant differences in left ventricular ejection fraction(LVEF), high sensitivity C reactive protein(hs-CRP), left atrial volume index(LAVI), peripheral blood ANP and visfatin between the atrial fibrillation group and the non-atrial fibrillation group on admission(P>0.05). There were significant differences in age, LVEF, hs-CRP, LAVI, peripheral blood ANP and visfatin 24 h after operation(P<0.05). Multivariate Logistic regression analysis showed that age(OR=1.906, 95%CI 1.251-2.905), postoperative 24 h LAVI(OR=1.980, 95%CI 1.276-3.071), postoperative 24 h LVEF(OR=1.293, 95%CI 1.028-1.626), postoperative 24 h hs-CRP(OR=1.446, 95%CI 1.177-1.777), peripheral blood ANP 24 h after operation(OR=1.602, 95%CI 1.070-2.398) and peripheral blood visfatin 24 h after operation(OR=1.726, 95%CI 1.16-2.647) were independent risk factors for new-onset atrial fibrillation after OPCABG(OR>1, P<0.05). The ROC curve results showed when the cut-off value of peripheral blood ANP level was 48 ng/mL, the area under the ROC curve for evaluating new-onset atrial fibrillation after OPCABG was 0.74(95%CI 1.327-3.726), and the sensitivity and the specificity was 75.34% and 70.34%, respectively; when the cut-off value of peripheral blood visfatin level was 50 g/mL, the area under the ROC curve for evaluating new-onset atrial fibrillation after OPCABG was 0.71(95%CI 1.235-3.419), and the sensitivity and the specificity was 72.48% and 69.25%, respectively; the area under the ROC curve of the combined detection for evaluating new-onset atrial fibrillation after OPCABG was 0.71(95%CI 1.247-3.528), and the sensitivity and the specificity were 79.43% and 69.57%, respectively. Conclusions Abnormally elevated levels of ANP and visfatin in peripheral blood are important risk factors for new-onset atrial fibrillation after OPCABG, which can provide an important reference for the prevention of new-onset atrial fibrillation within 24 hours after OPCABG, thereby helping to improve prognosis.更多还原