经食道超声心动图评价的非瓣膜性房颤左心房血栓形成与脑钠肽相关性分析  

Usefulness of Brain Natriuretic Peptide for Predicting Left Atrial Thrombus Detected by Transesophageal Echocardiography(TEE)in Patients with Nonvalvular Atrial Fibrillation

作　　者：汤裕华[1] 顾新刚[1] 陈锦霞 王大英[2] Tang Yuhua;Gu Xingang;Chen Jinxia;Wang Daying(Department of Ultrasound, Putuo District Center Hospital, Shanghai, 200062, Chin)

机构地区：[1]上海市普陀区中心医院超声科,上海市200062 [2]上海市普陀区中心医院心内科,上海市200062

出　　处：《中国超声医学杂志》2018年第2期187-189,共3页Chinese Journal of Ultrasound in Medicine

摘　　要：目的探讨血浆脑钠肽(BNP)与非瓣膜性房颤左心房血栓形成的相关性。方法回顾性分析拟行房颤射频消融术的非瓣膜性房颤患者191例,按经食道超声心动图检查结果分为左房血栓组和左房无血栓组,比较组间血浆BNP水平、CHA2DS2-VASc评分、临床及心脏结构参数的差异。结果 11例(5.7%)患者检出左心房血栓,左房血栓组平均血浆BNP水平显著高于左房无血栓组(396.7±282.2vs236.9±179.9,P=0.019)。BNP预测房颤患者左心房血栓形成的ROC曲线下面积为0.71(95%CI:0.58~0.84,P=0.019)。多元回归分析示BNP水平不是左心房血栓形成的独立危险因素(OR=1.002,95%CI:0.999~1.005,P=0.119)。左房内径(OR=1.342,95%CI:1.131~1.593,P=0.001)和既往脑卒中或者短暂性脑缺血病史(OR=4.439,95%CI:1.001~19.68,P=0.05)是左心房血栓形成的独立危险因素。结论左房血栓形成患者血浆BNP水平增高,但BNP尚不是左房血栓形成的独立危险因素。Objective To evaluate the value of brain natriuretic peptide（BNP） predicting left atrial thrombus （LAT） in patients with nonvalvular atrial fibrillation. Methods This retrospective study reviewed records in 191 consecutive nonvalvular atrial fibrillation patients undergoing atrial fibrilla transcatheter ablation. Patients were divided into two groups according to whether left atrial thrombus were present on TEE. Baseline clinical features, score,BNP level, transthoracic echocardiography were compared. Results Among 191 subjects 11（5.7%） had LAT. Mean BNP level was significantly higher in patients with LAT（396.7 ± 282.2 vs 236.9 ± 179.9, P =0. 019）. Receiver operator characteristics analysis demonstrated that BNP has a good discriminatory capacity for LAT （area under the curve, 0.71, 95%confidence interval [CI], 0. 58-0.84, P=0. 019）. Multivariate logistic regression analysis demonstrated that BNP was not independently associated with LAT （OR ：1. 002,95% ： CI： 0. 999- 1. 005, P = 0. 119） ,left atrial dimension and stroke or transient ischemic attack were independently associated with LAT. Conclusions BNP level was significantly higher in patients with LAT, but it does not provide significant incremental value in the prediction of LAT.

关 键 词：脑钠肽 房颤 左房血栓 经食道超声心动图 

分 类 号：R540.45[医药卫生—心血管疾病] R541.75[医药卫生—内科学]