非瓣膜病心房颤动患者血浆D-二聚体与左房功能异常的关联性及对其诊断价值  

Relationship between serum D-dimer levels and risks of thromboembolism in patients with persistent nonvavular atrial fibrillation

作　　者：杨沙宁[1,2] 金立军[1,2] 王玉璟[1,2] 彭水先[1,2] 黄从新[3,4] 

机构地区：[1]长江大学医学院附属医院 [2]湖北省荆州第一人民医院心内科,湖北荆州434000 [3]武汉大学人民医院 [4]湖北省人民医院,湖北武汉430060

出　　处：《心脏杂志》2010年第6期893-896,共4页Chinese Heart Journal

摘　　要：目的:以经食道心脏超声(transesophageal echocardiography,TEE)为判断标准,分析非瓣膜病持续性心房颤动患者血浆D-二聚体水平与左房功能异常的关联性及其对左房功能异常的诊断价值。方法:52例持续性心房颤动患者,病因排除瓣膜性心脏病。依据TEE结果分为两组:左房功能异常组(栓塞高危组,n=17);其余患者为左房功能正常(对照组,n=35)。单因素分析比较两组间基础临床资料、经胸超声(TTE)结果和凝血指标,多因素Logistics回归分析栓塞高危患者的危险因素并按诊断试验评价方法计算真实性指标。结果:栓塞高危组和对照组在年龄、既往栓塞史、左房内径、左室射血分数、血浆D-二聚体水平方面差异具有显著性(均P<0.05)。Logistics回归分析,仅左室射血分数(P<0.05)和血浆D-二聚体浓度(P<0.01)是栓塞高危状态的相关因素。以300μg/L为阈值,D-二聚体诊断左心房功能异常的灵敏度为88%,特异度为83%,准确度为85%。结论:非瓣膜病持续性心房颤动患者外周血液D-二聚体水平与左房功能异常(栓塞高危状态)有关联,它对左房功能异常有一定诊断价值。AIM ： To determine the relationship between the serum D-dimer level and risk of thromboem- bolism in patients with nonvalvular persistent atrial fibrillation. METHODS： According to results of transesophageal echocardiography （TEE） examination, 52 patients with nonvalvular persistent atrial fibrillation were divided into two groups： 1 ） thromboembolism （THR） group that included patients who met one or more of the following criteria： spontaneous echo contrast and/or embolism in left atrium as well as left atrial appendage-peak emptying velocity 〈 20 cm/sec and 2） CON group. Clinical variables, transthoracic echocardiographic parameters and coagulation results were compared. Furthermore, multiva- riate logistic regression was performed to investigate independent risk factors for the occurrence of a thrombogenic milieu in TEE examination. RESULTS： Age, prior thromboembolism history, left atrial diameter, left vcntricular ejection fraction （LVEF） and serum D-dimer in THR group were significantly different from those in CON group （P 〈 0. 05, respectively）. Logistic regression analysis showed that LVEF （P 〈 0.05 ） and serum D-dimer （ P 〈 0.01 ） were the only independent predictors of a thrombogenic milieu in TEE examination. With a threshold limit of 300μg/L, D-dimer showed a sensitivity of 88% and a specificity of 83% in predicting elevated risks of thromboembolism in TEE examination. CONCLUSION： Similar to LVEF, D-dimer may also serve as a predictor of high risk of thromboembolism in patients with nonvavular persistent atrial fibrillation.

关 键 词：心房颤动 左房功能 D-二聚体 左室射血分数 

分 类 号：R541.71[医药卫生—心血管疾病]