非瓣膜性心房颤动患者血尿酸对左心耳血栓预测价值研究  

The predictive value of uric acid in left atrial appendage thrombus in patients with non-valvular atrial fibrillation

作　　者：王文倩[1] 袁如玉[1] 刘彤[1] 

机构地区：[1]天津医科大学第二医院心脏科,天津300211

出　　处：《中国实用内科杂志》2015年第10期839-842,共4页Chinese Journal of Practical Internal Medicine

基　　金：国家自然科学基金资助项目(81270245)

摘　　要：目的探讨血尿酸(SUA)对不同CHA2DS2-VASc积分心房颤动(AF,简称房颤)患者左房(LA)或左心耳(LAA)血栓或浓密自发性显影(SEC)的预测价值。方法根据有无LA或LAA血栓或浓密SEC将2011年4月至2015年5月在天津医科大学第二医院就诊的147例AF患者分入阳性组和阴性组,对组间基线特征进行比较分析,并进行多因素分析及诊断价值评估。结果持续性AF比例、LA内径和SUA水平在两组间差异有统计学意义(P<0.001);多因素分析显示,SUA仅与CHA2DS2-VASc≤1分患者的LA或LAA血栓或浓密SEC独立相关(OR 1.040,95%CI 1.012-1.069,P=0.006);其ROC曲线下面积为0.862(95%CI 0.763-0.961,P<0.001);CHA2DS2-VASc≤1分患者SUA的最佳诊断界值为337.65μmol/L,阴性预测值为97.22%。结论非瓣膜性AF患者,尤其是CHA2DS2-VASc≤1分的患者,SUA对LA或LAA血栓或浓密SEC的独立预测价值中等;SUA<337.65μmol/L的阴性预测值较高,有助于优化CHA2DS2-VASc≤1分AF患者卒中风险分层。Objective To investigate the predictive value of serum uric acid （SUA） in left atrial （LA）/left atrial appendage （LAA） thrombus/dense spontaneous echo contrast （SEC） in patients with non-valvular atrial fibrillation （AF） at different clinically risks stratified by CHA2DS2-VASc score. Methods 147 non-valvular AF patients were divided into two groups, LA/LAA thrombus/dense SEC positive group and negative group. We analyzed the baseline characteristics between the two groups and then evaluated the results of multivariate analysis and the predictive efficiency. Results The study found an extremely significant difference between the two groups in the proportion of persistent atrial fibrillation, LA diameter and SUA levels （P〈0.001）. Multivariable analysis showed that SUA was independently associated with LA/LAA thrombus/dense SEC in patients at CHA2DS2-VASc- 1 （OR 1.040, 95%CI 1.012-1.069, P=0.006）, and ROC curve showed that AUC of SUA to predict LA/LAA thrombus/dense SEC was 0.862（95% CI 0.763-0.961, P〈0.001）. The optimal cutoff point determined according to the ROC curve for SUA predicting LA/LAA thrombus/dense SEC was 337.65 μmol/L and had negative predictive value of 97.22% in patients at CHA2DS2-VASc ≤ 1. Conclusion The independently predictive efficiency of SUA is moderate in patients with non-valvular atrial fibrillation, especially in patients at CHA2DS2-VASc ≤ 1. When SUA〈337.65μmol/L, it has fine negative predictive value of LA/LAA thrombus/dense SEC in patients at CHA2DS2-VASc ≤ 1 and may help to refine the risk stratification of stroke.

关 键 词：心房颤动 CHA2DS2-VASc 尿酸 左房/左心耳血栓/自发性显影 

分 类 号：R541.75[医药卫生—心血管疾病]