D-二聚体对风湿性心脏病二尖瓣狭窄患者左心耳血栓的预测价值  

Role of D-dimer in prediction of left atrial appendage thrombus in patients with rheumatic mitral stenosis

作　　者：李延林 巩雪 潘文志 潘翠珍 葛均波 

机构地区：[1]上海德达医院心内科,上海201702 [2]复旦大学附属中山医院心血管病研究所

出　　处：《上海医学》2017年第12期740-743,共4页Shanghai Medical Journal

摘　　要：目的评价D-二聚体对风湿性心脏病二尖瓣狭窄患者左心耳血栓的预测价值。方法连续入选2012—2015年间至复旦大学附属中山医院就诊,行食管超声检查的风湿性心脏病二尖瓣狭窄患者96例,根据超声结果将患者分为血栓组(25例)和无血栓组(71例)。常规心脏超声测量左心房内径、左心室舒张末内径、左心室收缩末内径、左心室射血分数、二尖瓣瓣口面积,测定D-二聚体、N-末端脑钠肽前体(NT-proBNP)、白蛋白、肌酐、CRP水平。结果血栓组男性患者构成比、NT-proBNP和肌酐水平均显著高于无血栓组(P<0.01、0.05),左心房内径显著大于无血栓组(P<0.01),左心室射血分数、二尖瓣瓣口面积均显著小于无血栓组(P值均<0.05),白蛋白水平显著低于无血栓组(P<0.05)。血栓组D-二聚体水平为(1.78±2.58)mg/L,显著高于无血栓组的(0.22±0.30)mg/L(P<0.01)。ROC曲线发现,D-二聚体水平取0.4mg/L为最佳截断值时,预测左心耳血栓形成的敏感度为0.640,特异度为0.887(AUC=0.75);取0.7mg/L时,预测左心耳血栓形成的敏感度为0.520,特异度为0.958。Logistic回归分析示,OR值为6.26,P=0.012;表明D-二聚体水平每升高1mg/L,血栓形成的风险增加6倍。结论 D-二聚体可作为左心耳血栓的预测指标用于监测高危患者并指导抗凝治疗。当D-二聚体水平>0.7mg/L的时候,高度怀疑患者有左心耳血栓。Objective To assess the predictive value of D-dimer level for the occurrence of left atrial appendage （LAA） thrombus in patients with rheumatic mitral stenosis. Methods A total of 96 patients with rheumatic mitral stenosis underwent transesophageal echocardiography （TEE） from 2012 to 2015 in Zhongshan Hospital of Fudan University were enrolled in this study. The patients were divided into thrombus group （n = 25） and non-thrombus group （n = 71 ） according to the TEE findings. Transthoracic echocardiography （TTE） was performed in all the patients before TEE for the measurement of the left atrial diameter, left ventricular end diastolic diameter, left ventricular end systolic diameter, left ventricular ejection fraction and mitral valve orifice area. D- dimer level and N-terminal pro-B-type natriuretic peptide （NT-proBNP） were analyzed before TEE. Albumin, creatinine and C reactive protein （CRP） were evaluated. Results Compared with the non-thrombosis group, the thrombus group had higher proportion of males, larger left atrial diameter, smaller orifice area, lower ejection fraction and albumin, and higher NT-proBNP and creatinine （P 〈 0. 05 or 0. 01）. Serum D-dimer level of thrombosis group was significantly higher than that of non-thrombus group （[1.78 ± 2. 581 mg/L vs. [0.22 ± 0. 301 mg/L, P〈0.01）. For a cut-off value of 0.4 mg/L D-dimer, the sensitivity was 64,0% and specificity was 88.7 % for prediction of LAA thrombus （AUC = 0.75）. For a cut-off value of 0.7 mg/L D-dimer, the sensitivity was 0. 520 and specificity was 0. 958 for prediction of LAA thrombus. Logistic analysis of regression showed that the risk of thrombosis would increase by 6 times when D-dimer raised 1 mg/L （OR=6.26, 0. 012）. Conclusion D- dimer level can be used as a predictive factor of LAA thrombus to monitor high risk of thrombosis and guideanticoagulation therapy. LAA thrombus should be strongly suspected when D-dimer is more than 0. 7 mg/ L.

关 键 词：风湿性心脏病 二尖瓣狭窄 D-二聚体 血栓形成 左心耳 

分 类 号：R541.2[医药卫生—心血管疾病]