并发心房血栓的不同类型心房颤动患者的临床特点分析  

Clinical characteristics in different kinds of patients with atrial fibrillation complicated with atrial thrombosis

作　　者：胡志成[1] 刘尚雨 沈利水 涂斌[1] 吴灵敏[1] 刘立旻[1] 丁立刚[1] 郑黎晖[1] 姚焰[1] HU Zhi-cheng;LIU Shang-yu;SHEN Li-shui;TU Bin;WU Ling-min;LIU Li-min;DING Li-gang;ZHENG Li-hui;YAO Yan(Arrhythmia Center,Chinese Academy of Medical Sciences and Peking Union Medical College,National Center for Cardiovascular Diseases,Finwai Hospital,Bejing 100037,China)

机构地区：[1]中国医学科学院北京协和医学院国家心血管病中心阜外医院心律失常中心,北京市100037

出　　处：《中国心血管病研究》2020年第8期713-718,共6页Chinese Journal of Cardiovascular Research

基　　金：国家自然科学基金(81970285)。

摘　　要：目的总结并发心房血栓的不同类型心房颤动(房颤)患者的临床特点以及治疗方式.方法回顾性收集2015年1月至2019年5月阜外医院并发心房血栓的房颤住院患者临床资料.根据房颤类型分为瓣膜性房颤(VAF)和非瓣膜性房颤(NVAF)两组,对患者一般情况、实验室检查以及影像学检查和治疗方案等内容进行分析.结果共有符合诊断标准的病例621例,其中VAF患者233例(37.5%).与NVAF患者相比,VAF患者更年轻[(57.3±9.9)岁比(60.1±13.1)岁,P<0.01],女性比例更高(63.5%比37.1%,P<0.01)、房颤病程≥5年的比例更高(59.2%比35.3%,P<0.01)、永久性房颤患者比例更高(74.7%比30.2%,P<0.01)、NYHA心功能Ⅲ级患者比例更高(55.8%比19.1%,P<0.01).VAF患者D-二聚体阳性患者比例高于NVAF患者(73.0%比37.6%,P<0.01).VAF患者左心房前后径大于NVAF患者[(50.9±10.5)mm比(46.1±9.2)mm,P<0.01].左心耳为最常见的心房血栓形成部位,其中VAF及NVAF分别81.1%和79.4%(P>0.05).经胸超声心动图(TTE)和增强CT在VAF患者中心房血栓检出比例高于NVAF患者(37.3%比16.0%,P<0.01;97.3%比84.3%,P<0.01).74.7%的VAF患者主要在行其他心脏外科手术的同时进行了心房血栓清除术,95.6%的NVAF患者接受了抗凝治疗.两组患者接受不恰当治疗的比例差异无统计学意义(3.8%比3.4%,P>0.05).结论VAF患者较NVAF患者更年轻,女性、房颤病程大于5年、永久性房颤比例更高,NYHAⅢ级患者比例更高,TTE和增强CT在VAF中心房血栓检出比例更高.VAF患者主要接受外科手术治疗,而NVAF患者主要接受抗凝治疗.绝大多数患者治疗规范.Objective To analyze the clinical characteristics in different kinds of patients with atrial fibrllation(AF)complicated with atrial thrombus.Methods The clinical data of inpatients with AF complicated with atrial thrombus in Fuwai Hospital from January 2015 to May 2019 were ollcted.Patients were divided into valvular AF(VAF)groups and non-valvulbr(NVAF)groups.Basic characteristics,lab tests,imaging tests and treatment schemes were summarized and analyzed retrospectively.Results A total of 621 patients met the criteria and 233(37.5%)were VAF patients.Compared with patients with NVAF,VAF patients were younger[(57.3+9.9)years old vs.(60.1+13.1)years old,P<0.01].Female patients(63.5%vs.37.1%,P<0.01),AF duration over 5 years(59.2%vs.35.3%,P<0.01).permanent AF(74.7%vs.30.2%,P<0.01)and NYHA class Ⅲ(55.8%vs.19.1%,P<0.01)were more common in VAF group.The proportion of d-dimer positive patients with VAF was higher than that of patients with NVAF(73.0%vs.37.6%,P<0.01).The left atrial appendage was the most common site of atrial thrombus in both groups(81.1%vs.79.4%,P>0.05).The detection rate of atrial thrombus in VAF patients was higher than that in patients with NVAF by transthoracic echocardiography and enhanced CT(37.3%vs.16.0%,P<0.01;97.3%vs.84.3%,P<0.01).The proportion of patients with VAF receiving surgical treatment was 74.7%0 and the proportion of patients with NVAF underwent anticoagulation was 95.6%.No difference of the rate of inappropriate therapy were discovered in patients with valvular AF and ones with non-valvular(3.8%vs.3.4%,P>0.05).Conclusion Compared with patients with NVAF,there were higher percentage of young patients,women,permanent AF and NYHA class Il heart failure in patients with VAF.Atrial thrombosis is more likely to be detected in patients with VAF.Majority of patients with VAF underwent surgery treatment and large part of patients with NVAF received anticoagulant.The majority of patients received standard treatment.

关 键 词：心房血栓 心房颤动 临床特点 

分 类 号：R541.7[医药卫生—心血管疾病]