经食管超声心动图对非瓣膜性房颤患者血栓形成危险因素的研究  

Evaluation of Risk Factors for Thrombosis in Patients with Nonvalvular Atrial Fibrillation by Transesophageal Echocardiography

作　　者：宋群霞 王丽红 Song Qunxia;Wang Lihong(Department of Ultrasound,Yantai Yuhuangding Hospital,Qingdao University,Yantai,Shandong 264000,China)

机构地区：[1]青岛大学附属烟台毓璜顶医院超声科,山东省烟台市264000

出　　处：《中国超声医学杂志》2021年第3期271-274,共4页Chinese Journal of Ultrasound in Medicine

摘　　要：目的对非瓣膜性房颤患者左心房/左心耳形成血栓的危险因素进行分析和预测。方法选取行左心耳封堵术的非瓣膜性房颤患者109例,将既往左心房或左心耳出现自发显影、泥浆样改变或血栓者分为血栓组39例,其余为非血栓组70例,比较两组患者基本临床资料,分析经胸、经食管超声及实时三维超声心动图检查获取的参数,评估血栓形成的危险因素。结果与非血栓组比较,血栓组患者PeAF,BNP增高,LAD增大,E增高,左心耳分叶增多,LAA-V减低(P<0.05),两组差异有统计学意义;两组患者CHA2DS2-VASc评分、年龄、性别、有吸烟史、血管栓塞、高血压、脑梗死病史比较差异无统计学意义(P>0.05)。多因素Logistic回归分析LAA-V减低是非瓣膜性房颤患者左心房或左心耳血栓形成的独立危险因表(P<0.05,OR=1.079,CI=1.033~1.127),ROC曲线表明LAA-V对血栓形成有良好的辨别能力(AUC 0.782,95%CI:0.692~0.872,P<0.001),LAA-V≤43.50 cm/s预测血栓形成的灵敏度为87.20%、特异度为62.90%。结论PeAF、BNP增高,LAD增大,左心耳分叶较多均增加NVAF患者的血栓风险。尤其LAA-V减低对左心房或左心耳血栓形成有预测作用,经食管超声心动图可以为NVAF患者的临床预防、治疗提供更多依据。Objective To analyze and predict the risk factors of left atrium/left atrial appendage thrombosis in patients with non-valvular atrial fibrillation.Methods The first group was the thromboembolic group,with 39 patients,including spontaneous echo contrast,muddy changes or thrombosis in the left atrium or left atrial appendage,the rest were in the non-thrombotic group.Transthoracic echocardiography(TTE)assessed cardiac structure and function.Transesophageal echocardiography(TEE)assessed diameter and depth of left atrial appendage with four different angles in all patients.Transesophageal echocardiography assesses the presence of thrombus in the left atrium or left atrial appendage.Left atrial appendage structure and lobes were evaluated by real-time three dimensional transthoracic echocardiography.The basic clinical data of the two groups of patients were evaluated,the parameters obtained by TTE,TEE and RT-3 DTEE were analyzed,and the risk factors of thrombosis were evaluated.Results Patients with thrombotic group had a significantly higher prevalence of persistent atrial fibrillation(PeAF,P=0.015),higher BNP values(P=0.025),higher E(P<0.05),Larger LAD(P<0.01),more left atrial appendage lobes(P=0.008),lower LAA-V(P<0.001).In a multivariate logistic analysis,LAA-V(OR=1.079,95%CI:1.033-1.127,P<0.001)was identified as an independent risk factor for presence of LAA thrombus.ROC results indicate that LAA-V has a good ability to assess the risk of thrombosis(Area under curve 0.782,95%CI:0.692-0.872,P<0.001)When LAA-V was less than or equal to 43.50 cm/s,it predicted the thrombosis of the sensitivity was 87.20%and the specificity was 62.90%.Conclusions PeAF,LAD,E,BNP,and left atrial appendage lobes are risk factors for spontaneous imaging,muddy changes,and thrombosis in the left atrium/left atrial appendage of patients with NVAF.Especially the reduction of LAA-V has a predictive effect on thrombosis and prethrombotic state.TEE can provide more evidence for clinical prevention and treatment of NVAF patients.

关 键 词：左心耳 血栓 经食道超声心动图 非瓣膜性房颤 实时三维超声心动图 

分 类 号：R540.45[医药卫生—心血管疾病] R541.75[医药卫生—内科学]