[1]章 胜,王昌会,方 浩,等.非瓣膜病房颤患者左心耳血栓形成的预测因素[J].医学信息,2021,34(18):84-89.[doi:10.3969/j.issn.1006-1959.2021.18.022]
　ZHANG Sheng,WANG Chang-hui,FANG Hao,et al.Predictive Factors of Left Atrial Appendage Thrombosis in Patients with Non-valvular Atrial Fibrillation[J].Medical Information,2021,34(18):84-89.[doi:10.3969/j.issn.1006-1959.2021.18.022]
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非瓣膜病房颤患者左心耳血栓形成的预测因素()
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医学信息[ISSN:1006-1959/CN:61-1278/R]

卷:
34卷
期数:
2021年18期
页码:
84-89
栏目:
论著
出版日期:
2021-09-18

文章信息/Info

Title:
Predictive Factors of Left Atrial Appendage Thrombosis in Patients with Non-valvular Atrial Fibrillation
文章编号:
1006-1959（2021）18-0084-06
作者:
章 胜; 王昌会; 方 浩; 陈大年
合肥市蜀山区安徽医科大学第一附属医院心内科二病区，安徽 合肥 230000
Author(s):
ZHANG Sheng; WANG Chang-hui; FANG Hao; CHEN Da-nian
The Second Ward of the Department of Cardiology,the First Affiliated Hospital of Anhui Medical University,Hefei 230000,Anhui,China
关键词:
房颤; 左心耳血栓; 经食道超声心动图; 红细胞分布宽度
Keywords:
Atrial fibrillation; Left atrial appendage thrombosis; Transesophageal echocardiography; Red blood cell distribution width
分类号:
R541.7
DOI:
10.3969/j.issn.1006-1959.2021.18.022
文献标志码:
A
摘要:
目的 探讨非瓣膜性房颤患者左心耳血栓形成及血栓形成前期相关的临床危险因素。方法 回顾性分析2018年7月-2020年9月安徽医科大学第一附属医院经食道超声心动图（TEE）检查连续性住院的663例非瓣膜病房颤患者临床资料，根据TEE检查结果分为左心耳异常组和左心耳正常组，比较两组临床资料差异，应用单因素及多因素Logistic回归分析左心耳异常的独立预测因素，并将筛选出的独立预测因素赋值添加到CHADS2及CHA2DS2-VASc评分中构建新的临床评分，通过ROC曲线分析各评分的曲线下面积（AUC）、特异性及敏感性。结果 TEE检查出左心耳异常者30例，左心耳正常者633例。两组年龄、血清尿酸水平（UA）、估算的肾小球滤过率（eGFR）、红细胞宽度标准差（RDW-SD）、国际标准化比值（INR）、活化部分凝血酶原时间（APTT）、纤维蛋白原含量（FIB）及充血性心力衰竭、高血压、CHADS2及CHA2DS2-VASc评分比较，差异有统计学意义（P＜0.05）；两组性别、身高、体重、BMI、血清肌酐水平（Cr）、血红蛋白水平（HB）、血小板计数（PLT）、血小板分布宽度（PDW）、白细胞计数（WBC）、血管疾病、糖尿病、既往卒中比较，差异无统计学意义（P＞0.05）。单因素及多因素Logistic回归分析显示，RDW-SD是左心耳异常的独立预测因素。ROC曲线分析显示，曲线下面积（AUC）为0.640（95%CI：0.602~0.677，P=0.014），RDW-SD的Youden指数为0.2951，当RDW-SD=43.8 fl时，诊断患者存在左心耳异常的敏感性为69.51%，特异性为60.00%。将RDW-SD赋值添加到CHADS2评分及CHA2DS2-VASc评分中开发出新的评分较原评分的AUC值均有所提高，当CHADS2、CHA2DS2-VASc、RDW-CHADS2评分为0或RDW-CHA2DS2-VASc评分＞1分时，其敏感性均为100.00%，且RDW-CHA2DS2-VASc评分特异性最大，达到35.23%。结论 RDW-SD是非瓣膜病房颤患者左心耳异常的独立预测因子，RDW-SD稍微提高了CHADS2及CHA2DS2-VASc评分对房颤患者的血栓形成的预测能力。
Abstract:
Objective To investigate the clinical risk factors related to left atrial appendage thrombosis and prethrombosis in patients with non-valvular atrial fibrillation.Methods A retrospective analysis of the clinical data of 663 patients with non-valvular atrial fibrillation who were hospitalized with continuous transesophageal echocardiography (TEE) in the First Affiliated Hospital of Anhui Medical University from July 2018 to September 2020.According to the results of TEE examination, they are divided into left atrial appendage abnormal group and left atrial appendage normal group.To compare the differences in clinical data between the two groups, apply single factor and multivariate Logistic regression to analyze the independent predictors of left atrial appendage abnormality, and add the selected independent predictive factor assignments to the CHADS2 and CHA2DS2-VASc scores to construct a new clinical score.The area under the curve (AUC), specificity and sensitivity of each score were analyzed by ROC curve.Results TEE detected 30 cases with abnormal left atrial appendage and 633 cases with normal left atrial appendage. Two groups of age, serum uric acid level (UA), estimated glomerular filtration rate (eGFR), red blood cell width standard deviation (RDW-SD), international normalized ratio (INR), activated partial prothrombin time (APTT),comparison of fibrinogen content (FIB) and congestive heart failure, hypertension, CHADS2 and CHA2DS2-VASc scores were statistically significant (P<0.05);Comparison of gender, height, weight, BMI, serum creatinine level (Cr), hemoglobin level (HB), platelet count (PLT), platelet distribution width (PDW), white blood cell count (WBC), vascular disease, diabetes, and previous stroke between the two groups, the difference was not statistically significant (P>0.05).Univariate and multivariate Logistic regression analysis showed that RDW-SD was an independent predictor of left atrial appendage abnormality.ROC curve analysis showed that the area under the curve (AUC) was 0.640 (95%CI: 0.602-0.677, P=0.014),The Youden index of RDW-SD was 0.2951. When RDW-SD=43.8 fl, the sensitivity of diagnosing left atrial appendage abnormality was 69.51% and the specificity was 60.00%.Adding the RDW-SD assignment to the CHADS2 score and the CHA2DS2-VASc score to develop a new score that had improved the AUC value of the original score.And when the CHADS2, CHA2DS2-VASc, RDW-CHADS2 score was 0 or the RDW-CHA2DS2-VASc score>1, the sensitivity was 100.00%, and the RDW-CHA2DS2-VASc score had the greatest specificity, reaching 35.23%.Conclusion RDW-SD is an independent predictor of left atrial appendage abnormalities in patients with non-valvular atrial fibrillation. RDW-SD slightly improves the predictive ability of CHADS2 and CHA2DS2-VASc scores for thrombosis in patients with atrial fibrillation.

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更新日期/Last Update: 1900-01-01