非瓣膜性心房颤动患者C反应蛋白与左心房自发显影的关系  

Relationship between C-reactive protein level and incidence of left atrial spontaneous echocardiographic contrast in patients with nonvalvular atrial fibrillation

作　　者：罗志峰 孔祥怡 蒋超[1] 朱浩杰 张帅 崔晶[1] 戴天医[1] 杜昕[1] 董建增[1] 马长生[1] Luo Zhifeng;Kong Xiangyi;Jiang Chao;Zhu Haojie;Zhang Shuai;Cui Jing;Dai Tianyi;Du Xin;Dong Jianzeng;Ma Changsheng(Department of Cardiology,Beijing Anzhen Hospital,Capital Medical University,Beijing 100029,China)

机构地区：[1]首都医科大学附属北京安贞医院心内科,100029

出　　处：《中华心血管病杂志》2020年第3期223-227,共5页Chinese Journal of Cardiology

基　　金：国家重点研发计划课题(2016YFC0900901,2016YFC1301002,2017YFC0908803,2018YFC1312501);国家自然科学基金(81530016)。

摘　　要：目的探讨高敏C反应蛋白(hs-CRP)与非瓣膜性心房颤动(房颤)患者左心房自发显影(LASEC)的关系。方法连续入选自2018年1月1日至6月30日于首都医科大学附属北京安贞医院心内科病房首次行射频消融术的非瓣膜性房颤患者490例,根据术前经食管超声心动图检查结果将研究人群分为无LASEC组(n=338)和LASEC组(n=152)。采用胶乳增强免疫比浊法测定hs-CRP;用单因素及多因素logistic分析探讨非瓣膜性房颤患者hs-CRP与LASEC的相关性。结果490例患者中有152例(31%)检测到LASEC。LASEC组的年龄、房颤类型、既往栓塞事件、纤维蛋白原定量、D-二聚体、左心房前后径及CHA2DS2VASc评分与无LASEC组比较,差异均有统计学意义(P均<0.05),LASEC组hs-CRP水平明显高于无LASEC组[3.16(1.30,5.23)mg/L比0.67(0.37,1.48)mg/L,P<0.001]。多因素logistic回归分析发现hs-CRP(OR=1.136,95%CI 1.060~1.217,P<0.001)和D-二聚体(OR=1.040,95%CI 1.011~1.070,P=0.007)是LASEC的独立相关因素。结论hs-CRP升高是非瓣膜性房颤患者LASEC的独立相关因素,炎症反应可能参与非瓣膜性房颤血栓前状态的形成。Objective To investigate the relationship between high sensitivity C-reactive protein(hs-CRP)level and incidence of left atrial spontaneous echocardiographic contrast(LASEC)in the patients with nonvalvular atrial fibrillation(AF).Methods Four hundred and ninety consecutive patients with nonvalvular atrial fibrillation who underwent radiofrequency ablation for the first time from January 1,2018 to June 30,2018 in the Department of Cardiology,Beijing Anzhen Hospital were enrolled.According to the results of transesophageal echocardiography before radiofrequency ablation,patients were divided into the group without LASEC(n=338)and the group with LASEC(n=152).hs-CRP was determined by latex enhanced immunoturbidimetry.The relationship between hs-CRP and LASEC in patients with nonvalvular atrial fibrillation was investigated by univariate and multivariate logistic analysis.Results LASEC was detected in 152(31%)of 490 patients.Significant differences in age,type of atrial fibrillation,previous embolic events,fibrinogen,D-dimer,the left atrial anteroposterior diameter and CHA2DS2-VASc scores were found between patients with and without LASEC(all P<0.05).Compared with the group without LASEC,the serum hs-CRP level was significantly higher in the group with LASEC(3.16(1.30,5.23)mg/L vs.0.67(0.37,1.48)mg/L,P<0.001).Multivariate logistic regression analysis showed that hs-CRP(OR=1.136,95%CI 1.060-1.217,P<0.001)and D-dimer(OR=1.040,95%CI 1.011-1.070,P=0.007)were independent determinants for LASEC in this patient cohort.Conclusions hs-CRP is an independent determinant for LASEC in patients with nonvalvular atrial fibrillation.Inflammation may thus be involved in the formation of prethrombotic state in patients with nonvalvular atrial fibrillation.

关 键 词：心房颤动 经食管超声心动图 左心房自发显影 C反应蛋白 

分 类 号：R541[医药卫生—心血管疾病]