心房颤动患者血清炎症指标的意义及其对合并左心耳血栓形成的预测价值  

Significance of serum inflammatory markers and their predictive value for occurrence of left atrial appendagethrombosis in patients with atrial fibrillation

作　　者：李晓红[1] 胡亚民[1] 刘丽娜[1] 吴萍 李晓岚[1] 刘海霞[1] Li Xiaohong;Hu Yamin;Liu Lina;Wu Ping;Li Xiaolan;Liu Haixia(Department of Cardiology,Cangzhou Central Hospital,Cangzhou 061000,Hebei,China)

机构地区：[1]沧州市中心医院心内三科,河北沧州061000

出　　处：《中国中西医结合急救杂志》2018年第3期278-282,共5页Chinese Journal of Integrated Traditional and Western Medicine in Intensive and Critical Care

摘　　要：目的探讨血清C-反应蛋白（CRP）、外周血中性粒细胞／淋巴细胞（N／L）比值、血浆D-二聚体水平在不同类型心房颤动（房颤）巾的临床意义及其对合并左心耳血栓形成的预测价值。方法采用前瞻性研究方法，选择2013年5月至2016年12月在沧州市中心医院诊断为非瓣膜性房颤患者140例，其中阵发性房颤组57例，持续性房颤组83例；选择同期体检的正常窦性心律志愿者40例作为健康对照组。83例持续性房颤患者跟踪随访1年，经食管心脏超声心动图检查发现左心耳血栓形成患者（房颤合并血栓形成组）13例，未合并血栓形成患者（单纯房颤组）70例。于人组当日清晨取空腹静脉血，检测外周血N／L比值、血清CRP、血浆D-二聚体和B型钠尿肽（BNP）水平；采用经胸心脏超声心动图测量左心房直径（LAD）、左心房射血分数（LAEF）、收缩期左心房峰值应变率（LASRs）、舒张早期二尖瓣口血流速度峰值／二尖瓣环根部侧壁运动速度峰值（E／Ea）比值，比较各组上述指标的差异；采用多因素Logitic回归分析影响持续性房颤伴左心耳血栓形成的危险因素；采用受试者工作特征曲线（ROC曲线）分析血浆D-二聚体与BNP水平对持续性房颤合并左心耳血栓形成的预测价值。结果持续性房颤组和阵发性房颤组患者N／L比值（2．68±0．58、2．59±0．62比1．82±0．29）、CRP（mg／L：19．87±3．28、20．74±4．31比8．65±1．06）、13NP（ng／L：364．79±54．18、145．86±51．90比139．40±48．29）、LAD（mm：40．79±3．90、34．28±2．13比33．90±2．51）、LAEF（0．16±0．07、0．39±0．08比0．56±0．10）、LASRs（S-1：-1．65±0．23、-1．98±0．32比-3．49±0．53）以及E／Ea比值（4．38±0．48、4．29±O．52比4．09±0．64）均较健康对照组升高，且持续性房颤组BNP、LAD、LAEF均明显高于阵发性房颤组（均P〈0．05）。房Objective To investigate the clinical significance of the levels of serum C-reactive protein （CRP）, peripheral blood ratio of neutrophil to lymphocyte （N/L） and plasma D-dimer in patients with different types of atrial fibrillation （AF） and the predictive value of the above index levels in occurrence of complicated left atrial appendage thrombosis in such patients. Methods A prospective study was conducted, one hundred and forty patients with non-valvular AF admitted to Cangzhou Central Hospital from May 2013 to December 2016 were enrolled, including 57 patients with paroxysmal AF in paroxysmal AF group and 83 patients with persistent AF in persistent AF group; in the mean time, 40 healthy persons having passed physical examination with normal sinus rhythm were volunteers assigned in a healthy control group. 83 patients with persistent AF were followed up for 1 year, and by the esophageal echocardiography, 13 cases with left atrial appendage thrombosis （AF combined with thrombosis group） and 70 cases with non-thrombotic patients （simple AF group） were found. In the morning on the day of entrance into the respective group, fasting venous blood was taken from the patients, and the peripheral blood N/L ratio, serum CRP, plasma D-direct and B-type natriuretic peptide （BNP） levels were checked; the left atrial diameter （LAD）, left atrial ejection fraction （LAEF）, left atrial peak strain rate （LASRs） during left ventricular systolic phase, early diastolic peak blood flow velocity of mitral annulus/mitral annulus root side wall velocity peak value （E/Ea） ratio were measured by the trans-thoracic echocardiography, and the differences in above indexes were compared among various groups; the risk factors of persistent AF associated with left atrial appendage thrombosis were analyzed by multivariate Logistic regression; the receiver operation characteristic （ROC） curve was used to analyze the predictive value of D-dimer and BNP levels for persistent AF associated with left atrial

关 键 词：心房颤动 血栓形成 C-反应蛋白 D-二聚体 B型钠尿肽 

分 类 号：R730.3[医药卫生—肿瘤]