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《天津医科大学学报》[ISSN:1006-8147/CN:12-1259/R]

卷:

21卷

期数:

2015年02期

页码:

130-133

栏目:

临床医学

出版日期:

2015-03-20

文章信息/Info

Title:

Related factors of left atrial or left atrial appendage thrombus formation in  patients with non-valvular atrial fibrillation

文章编号:

1006-8147（2015）02-0130-04

作者:

王爱芬; 崔利军; 马向红

(天津医科大学第二医院心脏科,天津 300211)

Author(s):

WANG Ai-fen;  CUI Li-jun;  MA Xiang-hong

(Department of Caridiology,The Second Hospital, Tianjin Medical University, Tianjin 300211, China)

关键词:

心房颤动; 经食管心脏超声; CHADS₂评分; 左心房血栓; 左心耳血栓

Keywords:

atrial fibrillation;  transesophagel echocardiography;  CHADS₂ score;  left atrial thrombus;  left atrial appendage thrombus

分类号:

R541.7

DOI:

-

文献标志码:

A

摘要:

目的：探讨非瓣膜性心房颤动（房颤）患者左心房（LA）/左心耳(LAA)血栓形成的相关危险因素。方法：连续纳入行经食道心脏超声检查的非瓣膜性房颤患者204例，删除不符合条件的11例，分为血栓组22例和非血栓组171例。详细记录患者既往病史、实验室检验结果、经胸心脏彩超及经食管心脏超声(TEE)结果，根据患者一般资料，计算其CHADS2评分，比较两组资料的差别，多因素Logistic回归分析探讨LA/LAA血栓形成的危险因素。结果：（1）入选的193例患者中男116例、女77例，平均年龄 (61.38±9.58) 岁，阵发性房颤150例（77.9%），持续性/永久性房颤43例 ( 22.1%)，经3D食道超声心动图检查确诊LA/LAA血栓22例（11.4%），非血栓组171例（88.6%）。（2）两组患者年龄、BMI、饮酒史、高血压病、糖尿病、冠心病、脑卒中/TIA病史、房颤病程差异均无统计学意义（P＞0.05）。血栓组男性、吸烟史、持续性/永久性房颤、左房云雾影比例、左房内径（LAD）、尿酸（UA）水平明显高于对照组（P＜0.05）；两组CHADS2评分无明显差异（P＞0.05）。（3）多因素Logistic回归分析显示，LAD（OR＝1.115，95%CI: 1.011～1.011，P＝0.029）、持续性/永久性房颤(OR＝0.319，95%CI: 0.108～0.938，P=0.038)及左房云雾影（OR＝0.200，95%CI: 0.066～0.602，P＝0.004）是LA/LAA血栓形成的独立危险因素。结论：LAD扩大、持续性/永久性房颤及左房云雾影是LA/LAA血栓形成的高危因素。

Abstract:

Objective: To investigate risk factors to predict left atrial or left atrial appendage thrombus in non-valvular atrial fibrillation patients. Methods: The study was a retrospective cohort study in which 204 consecutive non-valvular AF patients were enrolled, 11 patients in mismatch condition were abandoned, and all patients were divided into LA/LAA thrombus group（n=22）and non LA/LAA thrombus group（n=191). Patients’ medical history, general conditions, laboratory test results, transthoracic echocardiography(TTE) and transesophagel echocardiography(TEE) results were recorded in detail, and then CHADS2 score was calculated. Results:（1）One hundred and ninety three patients were enrolled, male 116 cases, female 77 cases, with an average age of (61.38 ± 9.58) years. Paroxysmal atrial fibrillation(AF) 150 cases (77.9%), persistent / permanent AF 43 cases (22.1% ), the LA/LAA thrombus confirmed by 3D transesophageal echocardiography were 22 cases (11.4%), non-thrombotic group 171 cases (88.6%). (2) No significant differences were found between two groups at age, BMI, drinking history, hypertension, diabetes mellitus, stroke or TIA, course of AF(P＞0.05). The proportion of male, smoking history, persistent and permanent AF, left atrial spontaneous echo contrast(SEC), left atrial diameter (LAD), uric acid (UA) levels were significantly higher in thrombosis group（P＜0.05）.However,the CHADS2 score had no significant difference between two groups（P＞0.05）. (3)Multivariate Logistic regression analysis demonstrated that LAD（OR＝1.115，95%CI: 1.011～1.011，P＝0.029）, persistent and permanent AF(OR＝0.319，95%CI: 0.108～0.938，P=0.038), SEC（OR＝0.200，95%CI: 0.066～0.602，P＝0.004）were independent risk factors for LA/LAA thrombus. Conclusion: LAD expansion, persistent and permanent AF and SEC are high-risk factors for LA / LAA thrombus formation.

 

参考文献/References:

[1]Chugh S S, Havmoeller R, Narayanan K, et al. Worldwide epidemiology of atrial fibrillation a global burden of disease 2010 study[J].Circulation,2014,129(8):837
[2]Fang M C, Go A S, Chang Y, et al. Comparison of risk stratification schemes to predict thromboembolism in People with nonvalvular atrial fibrillation[J]. J Am Coll Cardiol,2008,51(8):810
[3]Stollberger C, Chnupa P, Kronik G, et al. Transesophageal echocardiography to assess embolic risk in patients with atrial fibrillation. ELAT Study Group.Embolism in Left Atrial Thrombi[J]. Ann Intern Med,1998,128(8):630
[4]Camm A J, Kirchhof P, Lip G Y, et al. Guidelines for the management of atrial fibrillation The Task Force for the Management of Atrial Fibrillation of the European Society of Cardiology (ESC)[J]. Europace, 2010,12(10):1360
[5]Demir K, Can I, Koc F, et al. Atorvastatin given prior to electrical cardioversion does not affect the recurrence of atrial fibrillation in patients with persistent atrial fibrillation who are on antiarrhythmic therapy[J]. Med Princ Pract, 2011,20(5):464
[6]Go A S, Hylek E M, Phillips K A, et al. Prevalence of diagnosed atrial fibrillation in adults: National implications for rhythm management and stroke prevention: the AnTicoagulation and Risk Factors in Atrial Fibrillation (ATRIA) Study[J]. JAMA,2001,285(18):2370
[7]Di Angelantonio E, Ederhy S, Benyounes N, et al.Comparison of transesophageal echocardiographic identification of embolic risk markers in patients with lone versus non-lone atrial fibrillation[J].Am J Cardiol,2005,95(5):592
[8]朱梦云,于学靖,彭文辉,等.经食道超声心动图对心房颤动围手术期脑卒中临床价值的研究[J]. 同济大学学报:医学版,2012,33(3):100
[9]Calvo N, Mont L, Vidal B, et al. Usefulness of transoesophageal echocardiography before circumferential pulmonary vein ablation in patients with atrial fibrillation: is it really mandatory?[J]. Europace, 2011,13(4):486
[10]Scherr D, Dalal D, Chilukuri K, et al. Incidence and predictors of left atrial thrombus prior to catheter ablation of atrial fibrillation[J]. J Cardiovasc Electrophysiol, 2009,20(4):379
[11]王志荣, 张超群, 程仁力,等. 心房颤动患者血小板活化与左心房血栓形成关系的研究[J].中国循环杂志, 2008,23(4):253
[12]Rampling M W, Meiselman H J, Neu B, et al. Influence of cell-specific factors on red blood cell aggregation[J]. Biorheology, 2004,41(2):91
[13]Conway D S, Buggins P, Hughes E, et al. Prognostic significance of raised plasma levels of interleukin-6 and C-reactive protein in atrial fibrillation[J]. Am Heart J, 2004,148(3):462
[14]汤日波,刘畅,马长生,等.年龄对非瓣膜病心房颤动患者左心房血栓的影响[J]. 中华老年心脑血管病杂志, 2010,12(3):212
[15]Yarmohammadi H, Klosterman T, Grewal G, et al. Efficacy of the CHADS? scoring system to assess left atrial thrombogenic milieu risk before cardioversion of non-valvular atrial fibrillation[J]. Am J Cardiol, 2013,112(5):678

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备注/Memo

备注/Memo:

作者简介 王爱芬（1975-），女，主治医师，硕士在读，研究方向：冠心病，心律失常等；通信作者：马向红，E-mail: ma_xianghong@163.com。

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更新日期/Last Update: 2015-03-24