阵发性房颤患者血栓前状态与左室舒张功能不全的关联  

Association between prothrombotic state and left ventricular diastolic dysfunction in patients with paroxysmal atrial fibrillation

作　　者：黄海怡[1] 殷兆芳[1] 胡美林 陈启稚[1] 谢起裕[1] 王长谦[1] 

机构地区：[1]上海交通大学医学院附属第九人民医院心内科,上海市200011 [2]云南省大理市第二人民医院内科

出　　处：《心血管康复医学杂志》2014年第6期615-619,共5页Chinese Journal of Cardiovascular Rehabilitation Medicine

摘　　要：目的：探讨阵发性房颤患者血栓前状态与左室舒张功能障碍之间的关系.方法：在198例新发的尚无临床相关心血管疾病的阵发性房颤患者中,测定血浆纤维蛋白原、D-二聚体水平,并常规进行超声心动图和组织多普勒成像（TDI）检查.结果：常规超声心动图和TDI共检测到105例有左心室舒张功能障碍.单因素分析显示,与舒张功能正常者比较,左室舒张功能障碍者年龄偏大[（56±9）岁比（59±12）岁],BMI更高[（27.4±4.6）kg/m2比（29.0±4.9） kg/m2],糖尿病（10.8％比26.7％）、吸烟（20.4％比24.8％）比例较高,血浆纤维蛋白原[（2.95±0.41） mg/dl比（4.29±0.62） mg/dl]和D-二聚体水平[（0.38±0.06） ng/ml比（0.65±0.10） ng/ml]也较高,均有显著差异（P＜0.05～＜0.01）;多元回归分析显示,超声心动图检测出的舒张功能不全独立于其他协变量,而与血浆纤维蛋白原、D-二聚体水平相关（r=0.365～0.421,P均＜0.001）.结论：血浆纤维蛋白原水平升高及血栓前状态与无临床相关心血管原发病的阵发性房颤患者的左心室舒张功能障碍相关,并可增加舒张性心力衰竭的风险.Objective： To explore the relationship between prethrombotic state and left ventricular diastolic dysfunc- tion in patients with paroxysmal atrial fibrillation （PAF）. Methods： A total of 198 new PAF patients without clini- cally re!evant cardiovascular diseases were enrolled. Plasma fibrinogen （Fg） and D-dimer levels were measured, and patients received routine eehocardiography and tissue Doppler imaging （TDI） examinations. Results： Routine echo- cardiography and TDI found 105 cases with left vcntricular diastolic dysfunction. Univariate analysis indicated that compared with those with normal diastolic function, there were significant rise in age E （56 ± 9） years vs. （59 ± 12） years, body mass index [- （27.4± 4.6） kg/m2 vs. （29.0 ± 4.9） kg/m2, percentages of diabetes mellitus （10.8% vs. 26.7%） and smoking （20. 4% vs. 24. 8%） , plasma levels of Fg [-（2.95 ± 0.41） mg/dl vs. （4.29 ± 0.62） mg/dland D-dimer [ （0.38 ± 0.06） ng/ml vs. （0. 65 ± 0.10） ng/ml] in patients with left ventricular diastolic dysfunction, P（0.05-〈0.01; multi-factor regression analysis indicated that diastolic dysfunction measured by echocardio- graphy was independent from other concomitant variable, and related to plasma Fg and D-Dimer levels in PAF pa- tients （r = 0. 365-0. 421, P〈0. 001 all）. Conelusiong Increased plasma fibrinogen level and prethrombotic state are related to left ventricular diastolic dysfunction in patients with paroxysmal atrial fibrillation without clinically relevant cardiovascular diseases, they could raise the risk of diastolic heart failure.

关 键 词：心房颤动 心力衰竭 舒张性 纤维蛋白原 

分 类 号：R541.750.9[医药卫生—心血管疾病]