| 霍家敏,李学文.非瓣膜性心房颤动患者左心耳结构与血栓形成的相关性[J].中华老年多器官疾病杂志,2022,21(8):561~566 |
| 非瓣膜性心房颤动患者左心耳结构与血栓形成的相关性 |
| Correlation between left atrial appendage structure and thrombus formation in patients with non-valvular atrial fibrillation |
| 投稿时间：2022-02-17 |
| DOI：10.11915/j.issn.1671-5403.2022.08.121 |
| 中文关键词: 非瓣膜性心房颤动 左心耳结构 血栓形成 CHA2DS2-VACs评分 |
| 英文关键词:non-valvular atrial fibrillation left atrial appendage structure thrombosis CHA2DS2-VASc score This work was supported by the National Natural Science Foundation of China |
| 基金项目:国家自然科学基金(82170398) |
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| 中文摘要: |
| 目的 探讨非瓣膜性心房颤动(NVAF)患者左心耳(LAA)结构与血栓形成的相关性。方法 选取2012年1月至2021年1月于山西医科大学第三医院因NVAF拟行射频消融术的患者283例。收集患者病历资料及影像学检查结果。依据经食管超声心动图将患者分为血栓组和非血栓组,分析血栓形成相关危险因素。采用SPSS 24.0软件进行数据分析。根据数据类型,组间比较分别采用t检验、Wilcoxon检验及χ2检验。采用单因素分析发现具有预测能力的变量,然后进行多因素分析探讨血栓形成的独立危险因素。构建受试者工作特征(ROC)曲线,评价各危险因素对血栓形成的预测价值。结果 血栓组与非血栓组间体质量指数、心房颤动病程、CHA2DS2-VASc评分、持续性心房颤动比例、尿酸、脑钠肽、左室射血分数、左房前后径(LAD)、左心耳容积(LAA-V)、左心耳长径(LAA-L)、左心耳第一弯曲度和左心耳叶数比较,差异均有统计学意义(均P＜0.05)。多因素logistic回归分析显示,CHA2DS2-VASc评分(OR=1.898,95%CI 1.223~2.944)、LAD(OR=1.214,95%CI 1.087~1.355)、LAA-V(OR=1.230,95%CI 1.023~1.480)、LAA-L(OR=1.154,95%CI 1.005~1.326)、左心耳第一弯曲度(OR=1.032,95%CI 1.003~1.063)及左心耳叶数(OR=2.024,95%CI 1.331~3.077)是血栓形成的独立危险因素。ROC曲线分析显示,当CHA2DS2-VASc评分≥4分(灵敏度 0.575,特异度 0.844),LAD≥39.5 mm(灵敏度 0.825,特异度 0.716),LAA-V≥7.155 cm3(灵敏度 0.850,特异度 0.724),LAA-L≥25.01 mm(灵敏度 0.775,特异度 0.938),LAA第一弯曲度≥121.5°(灵敏度 0.450,特异度 0.951)及LAA叶数≥3叶(灵敏度 0.900,特异度 0.646)时,LAA血栓形成风险显著增加。结论 LAA结构对血栓形成具有较好预测作用。提示临床上为NVAF患者提供抗凝治疗时,可在CHA2DS2-VASc评分基础上考虑LAA结构复杂性。 |
| 英文摘要: |
| Objective To analyze the relationship between left atrial appendage (LAA) structure and thrombus formation in patients with non-valvular atrial fibrillation (NVAF). Methods A total of 283 NVAF patients who are undergoing selective radiofrequency ablation in our hospital from January 2012 to January 2021 were enrolled in this study. The medical history and imaging results were collected. The patients were divided into thrombus and non-thrombosis groups based on the results of transesophageal echocardiography. The risk factors of thrombosis were analyzed. SPSS statistics 24.0 was used for statistical analysis. Data comparison between 2 groups was performed using student′s t test, Wilcoxon test or Chi-square test depending on data types. Univariate analysis was used to identify variables with predictive power, followed by multivariate analysis to explore independent risk factors for thrombosis. Receiver operating characteristic (ROC) curve was drawn to evaluate the predictive value of each risk factor for thrombosis. Results There were statistical differences in body mass index, course of atrial fibrillation, CHA2DS2-VASc score, proportion of persistent atrial fibrillation, uric acid and brain natriuretic peptide levels, left ventricular ejection fraction, left atrial diameter (LAD), left atrial appendage volume (LAA-V), left atrial appendage length (LAA-L), left atrial appendage first curvature and left atrial appendage lobes between the thrombus and non-thrombosis groups (P＜0.05). Multivariable logistic regression analysis indicated that CHA2DS2-VASc score (OR=1.898,95%CI 1.223-2.944), LAD (OR=1.214,95%CI 1.087-1.355), LAA-V (OR=1.230,95%CI 1.023-1.480), LAA-L (OR=1.154,95%CI 1.005-1.326), left atrial appendage first curvature (OR=1.032,95%CI 1.003-1.063) and left atrial appendage lobes (OR=2.024,95%CI 1.331-3.077) were independent risk factors for thrombosis. ROC curve analysis showed that CHA2DS2-VASc scores ≥4 (sensitivity 0.575, specificity 0.844), LAD ≥39.5 mm (sensitivity 0.825, specificity 0.716), LAA-V≥7.155 cm3(sensitivity 0.850, specificity 0.724), LAA-L≥25.01mm (sensitivity 0.775, specificity 0.938), LAA first curvature≥121.5°(sensitivity 0.450, specificity 0.951) and LAA lobes ≥3 (sensitivity 0.900, specificity 0.646) significantly increased the risk of LAA thrombosis. Conclusion LAA structure is a good predictor of thrombosis. In anticoagulation decision-making for NVAF patients, clinicians should take the complexity of LAA structure into consideration on the basis of CHA2DS2-VASc score. |
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