心房颤动患者血小板活化与左心房血栓形成关系的研究  

The Relationship Between Activated Platelet and Left Atrial Thrombosis in Patients With Atrial Fibrillation

作　　者：王志荣[1] 张超群[1] 程仁力[1] 吴建东[1] 徐晤[1] 杨煜[1] 夏勇[1] 李东野[1] 

机构地区：[1]徐州医学院附属医院心内科,江苏省徐州市221000

出　　处：《中国循环杂志》2008年第4期253-255,共3页Chinese Circulation Journal

摘　　要：目的:探讨持续性心房颤动(房颤)患者血小板活化与左心房血栓形成的关系。方法:选择持续性房颤患者(房颤组)84例,窦性心律(窦律组)和正常对照组各20例,其中房颤组39例患者通过经食道超声心动图检查又分为血栓阳性者(22例)和血栓阴性者(17例)。所有对象均用流式细胞仪检测全血中血小板膜活化糖蛋白(GP)Ⅱb/Ⅲa水平。结果:左心房内径和血中 GPⅡb/Ⅲa水平比较:与正常对照组、窦律组比较,房颤组的左心房内径、GPⅡb/Ⅲa活化阳性血小板的百分率明显增高,差异有统计学意义(P<0.05)。进一步分析结果发现,与正常对照组、窦律组比较,血栓阴性者和血栓阳性者的左心房内径、GPⅡb/Ⅲa活化阳性血小板的百分率明显增高,差异有统计学意义(P<0.05);且血栓阳性者的左心房内径、GPⅡb/Ⅲa活化阳性血小板的百分率明显高于血栓阴性者,差异有统计学意义(P<0.05)。多元线性回归分析:发现 GPⅡb/Ⅲa活化阳性血小板的百分率(t=4.07,P=0.000)是房颤患者左心房血栓形成的独立危险因素,而左心房内径无明确的预测价值(t=1.78,P=0.084)。相关性分析:使用直线相关分析方法,分析房颤患者血中 GPⅡb/Ⅲa水平同左心房内径的关系,发现 GPⅡb/Ⅲa水平同左心房内径两者具有相关性(r=0.57,R^2=0.33,P<0.01)。结论:持续性房颤患者存在血小板活化程度增加,且同左心房血栓形成有密切关系。Objective：To investigate the relationship between platelet activation and left atrial thrombosis in patients with atrial fibrillation （AF）. Methods： Among 84 patients with persistent AF, 39 patients were divided into thrombosis positive group 22 cases） and thrombosis negative group （17 cases） according to the result of transthoracic and transesophageal echocardiography. As the control, sinus rhythm group（20 patients with various heart disease） and normal group （20 healthy subjects）were included in this study. The whole blood platelet membrane glycoprotein Ⅱ b/Ⅲ a （ GP Ⅱ b/Ⅲ a） level was examined by flow cytometry analysis in all patients and both control groups as well. Results ： The level of GP Ⅱ b/Ⅲ a in AF group was higher than that in sinus rhythm group and normal group （ 33.64 ± 3.59% vs 8.71 ± 1.76% ,7.45 ± 1.89% ,P 〈0. 05）, however, there was no statistic meaning between the sinus rhythm group and normal group. In addition, the level of GP Ⅱ b/Ⅲ a in thrombosis positive group was higher than that in thrombosis negative group （43.89 ±3.42% vs 22.61 ± 14. 78% , P 〈0. 05）. The statistic analysis found that the percentage of GP Ⅱ b/Ⅲa activation was the independent risk factor for left atrial thrombosis in patients with AF;and GP Ⅱ b/Ⅲa had a correlation with the diameter of left atrium. Conclusion： Platelet activation increased in the patients with persistent AF,it plays an important role in left atrium thrombosis.

关 键 词：心房颤动 血栓 血小板膜活化糖蛋白Ⅱb/Ⅲa 

分 类 号：R541[医药卫生—心血管疾病]