左心房直径对非瓣膜病持续性心房颤动左心房血栓预测价值的研究  

Impact of left atrium size on left atrial thrombus in patients with non-valvular persistent atrial fibrillation

作　　者：汤日波[1] 董建增[1] 尚美生[1] 杜昕[1] 闫贤良[1] 龙德勇[1] 喻荣辉[1] 吴嘉慧[1] 白融[1] 刘念[1] 桑才华[1] 宁曼[1] 蒋晨曦[1] 姚艳[1] 李松南[1] 闻松男[1] 郭雪原[1] 马长生[1] 

机构地区：[1]首都医科大学附属北京安贞医院心内科北京市心肺血管疾病研究所,100029

出　　处：《中华医学杂志》2015年第14期1083-1087,共5页National Medical Journal of China

基　　金：国家自然科学基金（81241005）;北京市卫生系统高层次卫生技术人才培养计划（2013-3-007）;北京市自然科学基金（7102048）;北京市十百千卫生人才（百层次）

摘　　要：目的评价左心房直径对非瓣膜病持续性心房颤动（简称房颤）左心房血栓的预测价值。方法在前瞻性建立的数据库中，筛选2007年1月至2010年6月拟行房颤导管消融并完成经食管超声检查的房颤患者。排除标准：阵发性房颤、瓣膜病房颤、深静脉血栓、肺栓塞、服用华法林抗凝、多次消融。共筛选1524例，入选367例，其中男267例，女100例，年龄26—89岁，平均年龄（56±11）岁。根据食管超声检查将患者分为左心房血栓组和无血栓组，通过受试者工作特征性曲线（ROC）判断CHA2DS2Vasc评分和左心房直径对左心房血栓的预测价值。Logistic多因素分析确定左心房血栓的独立危险因素。结果左心房血栓32例（8．7％），左心房血栓组左心房直径、左心室舒张末径、左心室收缩末径大于无血栓组，左心房血栓组左心室射血分数低于无血栓组，两组CHA2DS2Vasc评分差异无统计学意义。左心房直径预测左心房血栓ROC曲线下面积为0．656（0．563～0．750），其预测左心房血栓的最佳界值为42．5min。150例左心房直径≥42．5mm患者血栓发生率14．0％，显著高于左心房直径〈42．5mm患者血栓发生率（5．1％，X^2=8．888，P=0．003）。单因素分析左心房直径≥42．5mm增加左心房血栓风险（比值比3．05，95％可信区间1．42～6．53，P=0．004）。左心房直径≥42．5mm预测左心房血栓敏感度为67．7％，特异度为61．5％。Logistic多因素分析，校正CHA2DS2Vasc评分、左心室舒张末径、左心室收缩末径、左心室射血分数，左心房直径≥42．5mm（比值比2．77，95％可信区间1．17-6．57，P=0．021）是左心房血栓独立预测因素。结论左心房增大是非瓣膜病持续性房颤左心房血栓的独立危险因素。Objective This study sought to investigate the impact of left atrium size on left atrial （LA） thrombus in patients with non-valvular persistent atrial fibrillation （AF）. Methods In a prospectively established database, patients with AF underwent transesophageal echocardiography prior to AF ablation were screened from January 2007 to June 2010. Exclusive criteria included paroxysmal AF, vavular AF, deep vein thrombus, pulmonary embolism, on warfarin, redo procedure. Of 1 524 patients, 367 patients （ male 267, female 100） with age 26 - 89 （ mean 56 ＋ 11 ） were enrolled. The patients were divided into LA thrombus group and non-thrombus group. Receptor-operating curves were used to test the value of CHA2DS2Vasc score and LA diameter predicting LA thrombus. Logistic analysis were used to find the independent predictor of LA thrombus. Results Thirty-two （8.7%） patients had LA thrombus. The LA diameter, left ventricular end diastolic diameter, left ventricular end systolic diameter were significantly larger in thrombus group than non-thrombus group. Left ventricular ejection fraction was significantly lower inthrombus group than non-thrombus group. CHA2DS2Vasc score did not differ between the two groups. The area under the receptor-operating curve for LA diameter predicting LA thrombus was 0. 656 （0. 563 - 0. 750）,the best cut-off point was 42. 5 mm. The incidence of LA thrombus was significantly higher in patients with LA diameter ≥42. 5 mm than those with LA 〈 42. 5 mm （ 14. 0% vs. 5.1% , X2 = 8. 888, P = 0. 003 ）. In univariate analysis, LA diameter ≥42. 5 mm increased the risk of LA thrombus with odds ratio 3.05 （95% confidence interval 1.42 -6. 53, P =0. 004. The sensitivity and specificity of LA diameter ≥42. 5 mm in predicting LA thrombus were 67.7% and 61.5%, respectively. In multivariate analysis, after adjustment of CHA2DS2Vasc score, left ventrieular end diastolic diameter, left ventrieular end systolic diameter, left ventrieular ejection fraction, LA diameter≥42. 5 m

关 键 词：心房颤动 血栓 左心房 

分 类 号：R541.75[医药卫生—心血管疾病]