CHA2DS2-VASc评分非高危的心房颤动患者左心耳血栓形成的危险因子分析  

Risk factors of left atrial appendage thrombosis in patients with non-high-risk nonvalvular atrial fibrillation by using CHADS-VASc score

作　　者：赵义冬 霍照美 杨龙[2] 何炯红[2] 田野[2] 刘启方[2] 蒋智[2] 田水[2] 田龙海[2] 黄晶[2] ZHAO Yidong;HUO Zhaomei;YANG Long;HE Jionghong;TIAN Ye;LIU Qifang;JIANG Zhi;TIAN Shui;TIAN Longhai;HUANG Jing(Guizhou Medical University,Guiyang,550025,China;Department of Cardiology,Guizhou Provincial People’s Hospital)

机构地区：[1]贵州医科大学,贵阳550025 [2]贵州省人民医院心内科

出　　处：《临床心血管病杂志》2020年第8期730-734,共5页Journal of Clinical Cardiology

基　　金：贵州省科技支撑计划(No:黔科合支撑[2017]2885);贵州省科学技术厅临床研究中心项目(No:黔科合平台人才[(2017)5405])。

摘　　要：目的:分析CHA2DS2-VASc评分非高危的非瓣膜性心房颤动(AF)患者左心耳(LAA)血栓形成的相关危险因子。方法:连续入选拟行射频消融术治疗的CHA2DS2-VASc评分低、中危的AF患者320例,收集病例资料和实验室检查结果。通过经食管超声心动图(TEE)判断有无LAA血栓形成,并据此将患者分为血栓组和无血栓组,分析LAA血栓形成的相关危险因素。结果:320例AF患者中,16例(5.0%)存在LAA血栓。血栓组患者平均年龄大于无血栓组[(62.7±12.1)岁∶(53.1±11.0)岁,P=0.005],AF病程长于无血栓组[48(12~84)个月∶12(3~36)个月,P=0.001],非阵发性AF(NPAF)、饮酒和充血性心力衰竭患者比例均高于无血栓组(62.5%∶14.1%,P<0.001;81.3%∶11.7%,P<0.001;18.8%∶3.3%,P=0.022)。多因素Logistic回归分析显示,校正混杂因素后,年龄(OR=0.939,95%CI:0888~0.993,P=0.035)、AF病程(OR=1.023,95%CI:1.005~1.042,P=0.014)、NPAF(OR=9.251,95%CI:2.494~34.320,P=0.001)和饮酒(OR=16.015,95%CI:3.727~69.590,P<0.001)为LAA血栓形成的独立危险因素。结论:对于CHA2DS2-VASc评分非高危的AF患者,年龄、AF病程、NPAF和饮酒为LAA血栓形成的独立危险因素,该评分体系以外的卒中危险因子预测LAA血栓形成的价值更大。Objective:To analyze the risk factors of left atrial appendage(LAA)thrombosis in patients with non-high-risk nonvalvular atrial fibrillation(AF)by using CHA2 DS2-VASc score.Method:A total of 504 AF patients with a low or moderate risk CHA2 DS2-VASc score undergoing first radiofrequency catheter ablation who were enrolled consecutively in this study.The medical history and laboratory examination results were collected.By transesophageal echocardiography,the patients were divided into the thrombus group and non-thrombus group according to whether LAA has thrombosis.The risk factors of LAA thrombosis were statistically analyzed.Result:Of the 320 patients studied,16(5.0%)had LAA thrombus.The mean age of patients in thrombus group was older than that in non-thrombus group[(62.7±12.1)years vs(53.1±11.0)years,P=0.005],the AF course was longer than that in non-thrombus group[48(12-84)months vs 12(3-36)months,P=0.001],the proportion of patients with non-paroxysmal atrial fibrillation(NPAF),drinking,and congestive heart failure were higher than that in the non-thrombus group(62.5%∶14.1%,P<0.001;81.3%∶11.7%,P<0.001;18.8%∶3.3%,P=0.022).Multivariate logistic regression analysis showed that age(OR=0.939,95%CI:0888-0.993,P=0.035),AF course(OR=1.023,95%CI:1.005-1.042,P=0.014),NPAF(OR=9.251,95%CI:2.494-34.320,P=0.001)and drinking(OR=16.015,95%CI:3.727-69.590,P<0.001)were independent risk factors for LAA thrombosis.Conclusion:In AF patients with non-high-risk CHA2 DS2-VASc score age,AF course,NPAF and alcohol consumption are independent risk factors for LAA thrombosis,and the stroke risk factors other than CHA2 DS2-VASc score system are more valuable in predicting LAA thrombosis.

关 键 词：左心耳 血栓形成 非瓣膜性心房颤动 危险因子CHA2DS2-VASc评分 

分 类 号：R541.75[医药卫生—心血管疾病]