vW因子联合D-二聚体预测非瓣膜性心房颤动患者抗凝治疗后发生血栓风险的研究  

von Willebrand factor and D-dimer to evaluate the thrombosis risk in patients with nonvalvular atrial fibrillation in anti-coagulant therapy

作　　者：张伯玮[1] 张珠博 任静[1] 李杨[1] 门剑龙[1] Zhang Bowei;Zhang Zhubo;Ren Jing;Li Yang;Men Jianlong(PreCIsion MediCIne Center,Tianjin Medical University General Hospital,Tianjin 300052,China)

机构地区：[1]天津医科大学总医院精准医学中心,天津300052

出　　处：《中华检验医学杂志》2020年第10期1014-1020,共7页Chinese Journal of Laboratory Medicine

摘　　要：目的研究血管性血友病因子抗原(vWF:Ag)含量和D-二聚体预测接受抗凝治疗的非瓣膜性心房颤动(NVAF)患者血栓风险的性能。方法收集2017年3月至2019年3月间就诊的NVAF患者256例,其中男152例,女104例,年龄(57.9±20.4)岁;根据随访期内终点事件情况,将患者分为无事件组227例,血栓事件组29例。选择同期健康体检者作为对照组共50名,其中男30名,女20名,年龄(45.0±5.3)岁。用血液凝固仪测定血浆vWF:Ag水平,采用荧光免疫分析仪测定血浆D-二聚体水平。任意两组间数据比对采用Mann-Whitney U检验,多组间数据比对采用Kruskal-Wallis H检验,用Logistic回归对分类资料做多元相关性分析获得优势比(OR);用受试者工作特征(ROC)曲线评价vWF:Ag和D-二聚体预测血栓事件的性能;用Kaplan-Meier曲线进行生存分析;用Cox比例风险回归模型获得风险比(HR)。结果对照组的vWF:Ag和D-二聚体为103%(86%~131%)和249(90~522)μg/L,患者组为234%(102%~623%)和744(100~3352)μg/L;在患者组中,无事件组为225%(102%~623%)和650(100~3281)μg/L,血栓事件组为333%(210%~494%)和1325(487~3352)μg/L;患者组的vWF:Ag和D-二聚体高于与健康对照组(P均<0.001),无事件组高于健康对照组(P均<0.001),血栓事件组高于无事件组(P均<0.001)。NVAF患者血浆vWF:Ag和D-二聚体水平均高于与对照组(P均<0.001)。无事件组患者的血浆vWF:Ag和D-二聚体水平高于健康对照组,差异有统计学意义(P均<0.001);血栓事件组患者的血浆vWF:Ag和D-二聚体水平均高于无事件组,差异有统计学意义(P均<0.001)。ROC显示,vWF:Ag预测NVAF患者3个月内血栓事件的临界值为229%时,曲线下面积为0.839(95%CI:0.784~0.894);D-二聚体的临界值为588μg/L时,曲线下面积为0.803(95%CI:0.745~0.861);vWF:Ag联合D-二聚体,曲线下面积为0.868(95%CI:0.826~0.909)。Logistic回归分析显示,NVAF患者血浆vWF:Ag水平与年龄(OR=10.240,95%CI 2.773~37.820)、慢性心力衰竭(OR=34.779,95%CI 8.Objective To investigate the performance of von willebrand factor antigen(vWF:Ag)and D-dimer in predicting thrombotic risk in nonvalvular atrial fibrillation(NVAF)patients with anticoagulant therapy.Methods From March 2017 to March 2019,256 patients were enrolled,including 152 males and 104 females,aged(57.9±20.4)years old;according to the end-point events during the follow-up period,the patient group was further divided into 227 cases in the no-event group and 29 cases in the thrombotic event group;50 cases in the control group,including 30 males and 20 females,aged(45.0±5.3)years old.vWF:Ag was detected by blood coagulation instrument and determination of D-dimer was done by fluor-euzyme linked immunoassay Analyzer.Mann-Whitney U test was used for data comparison between any two groups,Kruskal-Wallis H test was used for comparison among multiple groups and multivariate correlation analysis was done by Logistic regression to obtain odds ratio(OR).The prediction performance with thrombotic events of vWF:Ag and D-dimer was evaluated by ROC curve,Kaplan-Meier curve was used to analyze the survival curve and the hazard ratio(HR)was obtained by Cox proportional hazard regression model.Results The levels of vWF:Ag and D-dimer in the control group were 103%(86%-131%)and 249(90-522)μg/L,234%(102%-623%)and 744(100-3352)μg/L in the patient group;in the patient group,of which 225%(102%-623%)and 650(100-3281)μg/L in non-event group,333%(210%-494%)and 1325(487-3352)μg/L in thrombus event group;compared the healthy control,the levels of vWF:Ag and D-dimer were increased in patients group(P<0.001),of which non-event groups were higher than healthy controls(P<0.001),and the thrombotic event group was higher than that of the non-event group(P<0.001).Plasma vWF:Ag level and D-dimer level in NVAF patients were higher than those in the control group(P<0.001).Plasma vWF:Ag level and D-dimer level in the non-event group were significantly higher than those in the healthy control group(P<0.001).The plasma vWF:Ag and D-dimer leve

关 键 词：血管性血友病因子 D-二聚体 心房颤动 抗凝治疗 血栓形成 

分 类 号：R541.75[医药卫生—心血管疾病]