脑钠肽对老年人心房颤动复律和复发的评价作用

目的 通过测定老年人窦性心律（窦律）患者和心房颤动（房颤）患者复律前后的血清脑钠肽（BNP）浓度，探讨其对老年房颤患者的评价作用及在房颤复律前后中的应用价值。方法 选择心功能正常的老年患者102例，其中阵发性房颤28例，持续性房颤40例，窦律34例，采用放射免疫方法测定窦律患者血清BNP浓度，同时对房颤患者进行复律，测定复律前、复律后24h及30d的血清BNP浓度。结果 老年房颤患者的血清BNP浓度显著高于窦律患者，并在复律后显著降低，差异有统计学意义。窦律维持组的血清BNP浓度低于房颤复发组（238．24±97．45）pg／ml vs（323．24±62．78）pg／ml，P〈0．05]。单因素分析显示年龄、左心房内径、房颤持续时间及BNP浓度与房颤的复发有关，多因素回归分析显示BNP浓度和年龄是复律后房颤复发的独立影响因子。结论 BNP的检测可能对老年人房颤的诊断和评估、预测复律的疗效及房颤的复发具有重要的临床价值。

Effect of plasma brain natriuretic peptide in elderly patients with atrial fibrillation undergoing electrical cardioversion

Objective To assess the usefulness of BNP as a predictor of successful cardioversion in elderly patients with atrial fibrillation (AF) and subsequent maintenance of sinus rhythm. Methods One hundred and two patients with atrial fibrillation undergoing cardioversion were enrolled. The control group had normal sinus rhythm and was comparable to the examined group. Plasma BNP levels were determined before cardioversion, and 24 hours and 30 days after cardioversion. Results Median levels of BNP were significantly elevated in subjects with AF. The mean BNP level was significantly higher before cardioversion than 24 hours and 30 days after cardioversion. Patients who reverted back to AF after 30 days had a higher level of BNP, than that of those who remained in sinus rhythm. Univariate analysis revealed that age, duration of AF, left atrial dimen-tion and plasma BNP level were associated with AF relapsing. Multivariate analysis revealed that higher plasma BNP level and age were independent predictors of AF recurrence. Conclusions In elderly patients with AF, BNP level may have predictive value of AF recurrence after successful cardioversion.