尿酸联合中性粒细胞/淋巴细胞比值预测非瓣膜性心房颤动病人左心房血栓的价值分析  

The Predictive Value of Uric Acid and Neutrophil/lymphocyte Ratio Levels in Non-valvular Atrial Fibrillation Patients with Left Atrial Thrombus

作　　者：罗秋林 李民凤 LUO Qiulin;LI Minfeng(Chongqing General Hospital,Chongqing 400014,China)

机构地区：[1]重庆市人民医院,重庆400014

出　　处：《中西医结合心脑血管病杂志》2020年第3期473-477,共5页Chinese Journal of Integrative Medicine on Cardio-Cerebrovascular Disease

摘　　要：目的探讨尿酸联合中性粒细胞/淋巴细胞比值(NLR)对非瓣膜性心房颤动(NVAF)病人左心房血栓形成的预测价值。方法选取2013年1月—2018年1月我院收治的怀疑存在左心房血栓的NVAF病人350例作为研究对象,根据食管心脏超声(TEE)检查结果,分为血栓组(65例)和非血栓组(285例)。记录两组临床资料及相关实验室检查等指标,分析NVAF病人左心房血栓形成的独立危险因素,绘制受试者工作曲线(ROC)分析尿酸联合NLR对NVAF病人左心房血栓形成的预测价值。结果血栓组病人血清尿酸和NLR显著高于非血栓组病人,差异具有统计学意义(P<0.05)。多因素Logistic回归分析显示,充血性心力衰竭、房颤病程、CHADS 2评分、CHA 2DS 2-VASc评分、尿酸及NLR是病人左心房血栓形成的独立危险因素;相关性分析显示,血栓组病人尿酸水平与NL R呈正相关(r=0.752,P=0.017)。曲线分析显示,尿酸曲线下面积为0.812[95%CI(0.689,0.882)],其最佳工作点为449.6μmol/L,此时预测左心房血栓形成的敏感性和特异性分别为83.0%和66.7%;NLR曲线下面积为0.823[95%CI(0.721,0.897)],其最佳工作点为3.1 N/L,此时预测左心房血栓形成的敏感性和特异性分别为80.5%和83.3%,两项指标联合诊断敏感性及特异性分别为88.9%和85.0%,ROC曲线下面积为0.842[95%CI(0.748,0.932)],其明显高于单一尿酸和RDW指标检测。结论血清尿酸和NLR水平在NVAF并发左心房血栓形成病人中明显升高,可作为左心房血栓形成的独立危险因素,两者联合诊断对于评估NVAF并发左心房血栓形成,具有更高的临床运用价值。Objective To evaluate the predictive value of uric acid and neutrophil/lymphocyte ratio(NLR)on left atrial thrombus in patients with non-valvular atrial fibrillation(NVAF).Methods Three hundreds and fifty patients with NVAF suspected with left atrial thrombus who were admitted to our hospital from January 2013 to January 2018 were enrolled.According to the results of transesophageal echocardiography examination(TEE),these patients were divided into the thrombus group(n=65)and non-thrombus group(n=285).The clinical data and related laboratory examination of the patients were recorded,the independent risk factors of left atrial thrombosis were analyzed by logistic regression,and the predictive value of uric acid combined NLR on left atrial thrombosis in NVAF patients were assessed by receiver operator characteristic curve(ROC).Results The level of serum uric acid and NLR were significantly higher in thrombus group than that in non-thrombus group group(P<0.05).The multivariate logistic regression analysis showed that congestive heart failure,atrial fibrillation course,CHADS 2 score,CHA 2DS 2-VASc score,uric acid and NLR were independent risk factor for left atrial thrombosis in patients.The correlation analysis showed that uric acid level in thrombosis group were positively correlated with NLR(r=0.752,P=0.017).ROC curves analysis showed that the area under curve of uric acid level was 0.812[95%CI(0.689,0.882)],and optimal operating point(OOP)was 449.6μmol/L,which had 83.0%sensiticity and 66.7%specificity in predicting the left atrial thrombosis of NVAF patients.The area under curve of NLR level was 0.823[95%CI(0.721,0.897)],and optimal operating point(OOP)was 3.1(N/L),which had 80.5%sensiticity and 83.3%specificity.The AUC was 0.842[95%CI(0.748,0.932)],and the sensitivity was 88.9%,specificity was 85.0%when the two cutoff values were both achieved,which were higher than the single uric acid and RDW.Conclusion The serum uric acid and NLR levels could be used as an independent risk factor for left atrial thrombosis,a

关 键 词：非瓣膜性心房颤动 尿酸 中性粒细胞/淋巴细胞比值 左心房血栓 

分 类 号：R541.7[医药卫生—心血管疾病] R256.2[医药卫生—内科学]