红细胞分布宽度与老年非瓣膜性心房颤动患者左心房血栓形成的相关性研究  

Relationship between red blood cell distribution width and left atrial thrombosis in elderly nonvalvular AF patients

作　　者：雷志博 张智文 曹选超 徐金义 黄改荣 Lei Zhibo;Zhang Zhiwen;Cao Xuanchao;Xu Jinyi;Huang Gairong(Department of Geriatrics,Henan Provincial People's Hospital,Zhengzhou University People's Hospital,Henan University People's Hospital,Zhengzhou 450003,Henan Prvince,China)

机构地区：[1]河南省人民医院老年医学科(郑州大学人民医院,河南大学人民医院),450003

出　　处：《中华老年心脑血管病杂志》2021年第8期819-822,共4页Chinese Journal of Geriatric Heart,Brain and Vessel Diseases

摘　　要：目的探讨红细胞分布宽度(red blood cell distribution width, RDW)与老年非瓣膜性心房颤动(nonvalvular atrial fibrillation, NVAF)患者左心房血栓形成的关系及其对左心房血栓形成的预测价值。方法选取2018年1月~2019年6月河南省人民医院老年医学科住院的老年NVAF患者158例,通过经食管心脏超声,按照是否有左心房血栓分为血栓组36例和对照组122例。收集所有患者一般临床资料和实验室检查结果,比较2组各项指标的差异。采用多因素logistic回归分析老年NVAF患者左心房血栓形成的相关因素,用ROC曲线评价RDW对于判断左心房血栓形成的价值。结果血栓组持续性心房颤动、脑卒中/短暂性脑缺血发作、高敏C反应蛋白、RDW、左心房内径、心房颤动病程明显高于对照组,差异有统计学意义(P<0.05,P<0.01)。多因素logistic回归分析显示,心房颤动类型、RDW、高敏C反应蛋白、左心房内径是老年NVAF患者左心房血栓形成的独立预测因素(P<0.05,P<0.01)。ROC曲线分析显示,RDW预测左心房血栓形成的曲线下面积为0.784(95%CI:0.712~0.846,P<0.01)。当RDW取最佳临界值为13%时,预测老年NVAF患者左心房血栓形成的敏感性为77.78%,特异性为72.95%。结论高RDW水平可能与老年NVAF患者左心房血栓形成密切相关,临床工作中应监测RDW水平,降低脑卒中事件发生率。Objective To study the relationship between red blood cell distribution width and left atrial thrombosis and its value for predicting left atrial thrombosis in elderly nonvalvular AF patients.Methods One hundred and fifty-eight elderly nonvalvular AF patients admitted to our hospital from January 2018 to June 2019 were divided into thrombosis group(n=36) and control group(n=122).Their general clinical data and laboratory testing parameters were recorded and compared.Left atrial thrombosis-related factors in elderly nonvalvular AF patients were analyzed by multivariate logistic regression analysis.The value of red blood cell distribution width for predicting left atrial thrombosis in elderly nonvalvular AF patients was assessed by ROC curve analysis.Results The incidence of persistent AF,cerebral stroke, transient cerebral ischemia and serum hs-CRP level were significantly higher, the red blood cell distribution width, left atrial diameter and duration of AF were significantly longer in thrombosis group than in control group(P<0.05,P<0.01).Multivariate logistic regression analysis showed that AF, red blood cell distribution width, hs-CRP and left atrial diameter were the independent predictors of left atrial thrombosis in elderly nonvalvular AF patients(P<0.05).ROC curve analysis displayed that the AUC for red blood cell distribution width in predicting left atrial thrombosis in elderly nonvalvular AF patients was 0.784(95%CI:0.712-0.846,P<0.01) with a sensitivity of 77.78% and a specificity of 72.95% when the optimal cut-off value of red blood cell distribution width was 13%.Conclusion Elevated red blood cell distribution width is closely related with left atrial thrombosis in elderly nonvalvular AF patients and should thus be measured in clinical practice in order to reduce the incidence of cerebral stroke.

关 键 词：红细胞 心房颤动 心房功能 左 血栓形成 C反应蛋白质 卒中 脑缺血发作 短暂性 

分 类 号：R541.75[医药卫生—心血管疾病]