D-二聚体结合CHA_2DS_2-VASc评分对心房颤动左心房血栓的诊断价值研究  

Value of D-dimer combined with CHA_2DS_2-VASc scoring in predicting left atrial thrombus in patients with atrial fibrillation

作　　者：夏莺[1] 喻杰[1] 王红鸾[1] 郭韶梅[1] 蔡金莲[1] 汪俊[1] 彭景添[2] 殷然[2] 

机构地区：[1]江西省人民医院干部病房,江西南昌330006 [2]南昌大学第一附属医院心血管内科,江西南昌330001

出　　处：《中国实用内科杂志》2016年第1期64-67,共4页Chinese Journal of Practical Internal Medicine

基　　金：江西省卫计委科技计划项目(700431003)

摘　　要：目的探讨D-二聚体(DD)结合CHA_2DS_2-VASc评分对非瓣膜性心房颤动(NVAF)患者左心房血栓(LAT)的诊断价值。方法对2013年1月至2014年6月江西省人民医院临床怀疑LAT的NVAF患者205例进行回顾性分析,包括一般情况及病史、CHA_2DS_2-VASc评分、血生化检查及经食管超声心动图(TEE)检查。根据TEE检查结果分为左心房血栓形成组(LAT组)和无血栓形成组(非LAT组)。应用单因素分析及多因素Logistic回归分析确立LAT形成的独立危险因素,进而改良CHA_2DS_2-VASc评分方案。绘制受试者工作曲线(ROC),比较改良前后两种不同的评分方案对NVAF患者LAT的诊断价值。结果 DD阳性、CHA_2DS_2-VASc>2分是LAT形成的独立危险因素;依据Logistic回归分析结果,将DD阳性记为1分,加入CHA_2DS_2-VASc评分中,组成CHA_2DS_2-VAScDD评分方案。ROC曲线显示,CHA_2DS_2-VASc评分的曲线下面积(AUC)为0.663,最佳诊断点为2分,灵敏度为0.744,特异度为0.707;CHA_2DS_2-VASc-DD评分的AUC为0.811,最佳诊断点为3分,灵敏度为0.768,特异度为0.745。结论 DD结合CHA_2DS_2-VASc评分对NVAF患者LAT形成有更高的诊断价值。Objective To evaluate the value of D-dimer（DD） combined with CHA2DS2-VASc scoring in predicting left atrial thrombus（LAT） in patients with non-valvular atrial fibriUation（NVAF）. Methods A total of 205 NVAF patients suspected with LAT were evaluated concerning general condition, medical history, CHAzDS2-VASc scoring system, admission examination and transesophageal echocardiography（TEE） examination. LAT was detected by TEE in 40 patients（LAT group） and not detected in 165 patients（non-LAT group）. All data were subjected to univariate analysis and multivariate Logistic regression analysis to establish independent risk factors for LAT formation. Based on the results of Logistic regression analysis, a new CHAzDS2-VASc-DD scoring system was formed. ~lae receiver operating characteristic curve（ROC） was used to compare the values of CHA2DS2-VASc and CHAeDS2- VASc-DD scoreing for predicting LAT formation in NVAF patients. Results Based on the results of Logistic regression analysis, DD positive and CHA2DS2-VASc 〉2 were independent risk factors for LAT formation. A new CHA2DS2-VASc-DD scoring system was formed by combining DD, recording DD positive as 1 point, and CHA2DS2-VASc score. ROC curve analysis showed that CHA2DS2- VASc-DD score（hUE=0.811） had better predictive value for LAT formation compared with CHA2DS2-VASc score（AUC=0.663）. Sensitivity and specificity for CHA2DS2-VASc and CHA2DS2-VASc-DD scoring system were 0.744, 0.707 and 0.768, 0.745 respectively. Conclusion Combining DD with CIqA2DSz-VASc scoring has a better performance in predicting LAT in patients with NVAF.

关 键 词：心房颤动 左心房血栓 D-二聚体 CHA2DS2-VASc评分 

分 类 号：R541.7[医药卫生—心血管疾病]