抗凝血酶Ⅲ在非瓣膜性房颤人群血栓风险评估中的应用  

Application of antithrombinⅢin risk assessment of thrombosis in non-valvular atrial fibrillation

作　　者：关坤萍[1] 王婧 张娜[1] 程高娃 许强 王锡鸣 张洋 Guan Kunping;Wang Jing;Zhang Na;Cheng Gaowa;Xu Qiang;Wang Ximing;Zhang Yang(Department of Clinical Laboratory,the Second Hospital of Shanxi Medical University,Taiyuan 030001,China;Center for Experimental Diagnosis,Fuwai Hospital of Chinese Academy of Medical Sciences,Beijing 100037,China)

机构地区：[1]山西医科大学第二医院检验科,太原030001 [2]中国医学科学院阜外医院实验诊断中心,北京100037

出　　处：《中华健康管理学杂志》2020年第3期265-269,共5页Chinese Journal of Health Management

摘　　要：目的分析抗凝血酶Ⅲ(AT-Ⅲ)水平与评估非瓣膜性房颤人群血栓栓塞风险的CHA2DS2-VASc评分间的关系,探讨AT-Ⅲ在非瓣膜性房颤人群血栓风险评估中的价值。方法收集2018年10月至2019年6月在中国医学科学院阜外医院住院诊断为非瓣膜性房颤人群(观察组)和同期住院非房颤人群(对照组)的抗凝血酶Ⅲ(AT-Ⅲ)、蛋白S、蛋白C及血脂[包括脂蛋白(a)、三酰甘油(TG)、总胆固醇(TC)、高密度脂蛋白胆固醇(HDL-C)、低密度脂蛋白胆固醇(LDL-C)]水平。根据CHA2DS2-VASc评分将非瓣膜性房颤人群分为2分以下的低中危组与2分及以上的高危组。用ROC分析AT-Ⅲ的诊断性能,采用Logistic回归分析高CHA2DS2-VASc评分的风险因素。结果观察组206例,其中女性54例(26%),年龄(59.9±11.1)岁,对照组76例,女性19例(25%),年龄(59.3±9.8)岁,两组性别(χ²=0.043,P=0.836)、年龄(t=0.352,P=0.725)相匹配。观察组AT-Ⅲ活性[(98.68±11.37)%]明显低于对照组[(110.87±13.91)%],差异有统计学意义(t=-6.841,P<0.001)。非瓣膜性房颤人群中CHA2DS2-VASc评分高危组102例(49.5%),低中危组104例(50.5%),高危组AT-Ⅲ活性[(93.67±9.92)%]低于低中危组[(103.60±10.56)%],差异有统计学意义(t=6.953,P<0.001)。高危组蛋白C[(94.34±26.61)%比(102.63±22.74)%]、TC[(4.09±1.02)mmol/L比(4.69±0.97)mmol/L]和LDL-C[(2.18±0.83)mmol/L比(2.74±0.88)mmol/L]水平均低于低中危组,差异有统计学意义(P均<0.05)。非瓣膜性房颤人群血栓风险筛查的AT-Ⅲ预警界值为96.5%,ROC曲线下面积为0.746(95%CI:0.681~0.812,P<0.001)。Logistic回归分析表明年龄(OR=44.339,95%CI:15.207~129.276)越大,AT-Ⅲ(OR=7.282,95%CI:3.098~17.117)、TC(OR=4.349,95%CI:1.739~10.875)水平越低,非瓣膜性房颤人群CHA2DS2-VASc评分越高,P均<0.05。结论高龄、低AT-Ⅲ活性水平、低TC水平与CHA2DS2-VASc评分正相关,对评估非瓣膜性房颤者血栓发生具有较高的参考价值。Objective To investigate the relationship between antithrombinⅢ(AT-Ⅲ)levels and CHA2DS2-VASc scores to assess the thromboembolism risk in patients with non-valvular atrial fibrillation(NVAF),and to explore the value of AT-Ⅲin the risk assessment of thrombosis in these patients.Methods We enrolled patients diagnosed with NVAF(observation group)and non-atrial fibrillation(control group),hospitalized in Fuwai Hospital of Chinese Academy of Medical Sciences from October 2018 to June 2019,and assessed the two groups for AT-Ⅲ,protein C,protein S,and lipid levels including lipoprotein(a),three acyl glycerin(TG),total cholesterol(TC),high-density lipoprotein cholesterol(HDL-C),and low-density lipoprotein cholesterol(LDL-C).Based on the CHA2DS2-VASc score,patients with NVAF and a score of less than 2 were assigned to the low-and middle-risk groups;the high-risk group consisted of patients with a score of 2 or more.The diagnostic performance of AT-Ⅲwas evaluated using receiver operating characteristic(ROC)curve analysis,and the risk factors for high CHA2DS2-VASc scores were analyzed using logistic regression.Results Overall,206 cases were enrolled in the observation group,including 54 women(26%;aged 59.85±11.06 years).The control group consisted of 76 cases,with 19 women(25%;aged 59.34±9.84 years).The two groups were gender(χ^2=0.043,P=0.836)and age(t=0.352,P=0.725)matched.In the observation group,AT-Ⅲactivity(98.68%±11.37%)was significantly lower than that in the control group(110.87%±13.91%),demonstrating a statistically significant difference(t=-6.841,P<0.001).In total,102 cases(49.5%)were assigned to the high-risk group,with 104 cases(50.5%)in the low-and medium-risk groups.In the high-risk group,the AT-Ⅲactivity(93.67%±9.92%)was significantly lower than that in the low-and middle-risk groups(103.60%±10.56%),with a statistically significant difference observed(t=6.953,P<0.001).In the high-risk group,protein C[(94.34±26.61)%vs.(102.63±22.74)%],TC[(4.09±1.02)mmol/L vs.(4.69±0.97)mmol/L],and LDL-C

关 键 词：房颤 抗凝血酶 CHA2DS2-VASc评分 血栓 风险评估 

分 类 号：R541.75[医药卫生—心血管疾病]