经颅多普勒微栓子监测评估心房颤动患者抗栓疗效  

The evaluation of antithrombotic therapy effect with micro-embolic signals by transcranial Doppler in non-valvular atrial fibrillation patients

作　　者：徐云[1] 王兵[1] 蒋丽娇[1] 陆小平[1] 赵晓英[1] 王芳[1] 惠杰[2] 

机构地区：[1]苏州市吴中人民医院心内科,江苏苏州2151282 [2]苏州大学附属第一医院心内科

出　　处：《中国心脏起搏与心电生理杂志》2017年第1期38-40,共3页Chinese Journal of Cardiac Pacing and Electrophysiology

基　　金：苏州市科技局指令性项目(项目编号SYS201305)

摘　　要：目的评价经颅多普勒监测微栓子评估心房颤动(简称房颤)患者抗栓疗效的价值。方法持续性房颤患者96例,其中40例给予华法林抗凝治疗(华法林组),56例给予阿斯匹林抗血小板治疗(阿斯匹林组),每例患者治疗前后分别行微栓子监测,比较治疗前后两组结果差异,两组治疗前后同时检测血浆D-二聚体水平作为微栓子监测的平行对照观察。结果华法林组治疗前,微栓子阳性14例,阴性26例,治疗后微栓子阳性5例,阴性35例,治疗后微栓子检出率显著降低(35.0%vs 12.5%,P﹤0.05);阿斯匹林组治疗前,微栓子阳性21例,阴性35例,治疗后微栓子阳性17例,阴性39例,治疗前后微栓子检出率降低无显著性差异(37.5%vs 30.4%,P=0.42);华法林组治疗后微栓子检出率显著低于阿司匹林组(P﹤0.05)。治疗前所有微栓子阳性患者血浆D-二聚体水平显著高于阴性患者[(353±71)μg/L vs(261±58)μg/L,P﹤0.05];两组治疗前后血浆D-二聚体水平均有显著降低[分别为(313±81)μg/L vs(170±67)μg/L、(327±73)μg/L vs(235±61)μg/L,P﹤0.05];华法林组治疗后血浆D-二聚体水平降低更明显(P<0.05)。结论研究初步表明,微栓子可以作为房颤患者抗栓治疗的一个指标。Objective To evaluate the value of micro-embolic signals by transcranial Doppler in atrial tibrillation（AF） patients who underwent antithrombotic therapy. Method Forty persistent AF patients （group Warfarin） underwent anti- coagulation treatment with warfarin, and 56 patients （group Asprin） underwent antiplatelet treatment with asprin. Micro- embolic signals （MES） were compared before and after both treatments. Meanwhile, D-dimer levels were detected as paral- lel control. Results In group Warfarin, 14 patients with positive MES before warfarin treatment and 5 patients with pos- itive MES after warfarin treatment were obtained, the positive rate of MES after warfarin treatment was significantly de- creased （35.0% vs 12.5% ,P^0.05）;In group Asprin,21 patients with positive MES before asprin treatment and 17 pa- tients with positive MES after asprin treatment were obtained, the positive rate of MES after asprin treatment had no signif- icantly decrease （37.5% vs 30.4% ,P=0.42）; the positive rate of MES after warfarin treatment was significantly lower than those of asprin treatment（P〈0.05）. The level of D-dimer in patients with positive MES was significantly higher than those in patients with no MES before antithrombotic therapy[（353±71）μg/L vs（261±58）μg/L,P 〈 0.05]; the level of D-dimer was significantly decreased after both warfarin treatment and asprin treatment [ （313±81）μg/L vs （ 170 ± 67）μg/ L,（327±73）μg/L vs （235±61）μg/L,respectively,P 〈 0.05]; the level of D-dimer after warfarin treatment was further significantly decreased than those after asprin treatment （P〈0.05）. Conclusion The research preliminarily indicates that MES may be regarded as one of the markers of antithrombotic therapy in AF patients.

关 键 词：心血管病学 心房颤动 微栓子 D-二聚体 

分 类 号：R541.75[医药卫生—心血管疾病]