非瓣膜性心房颤动患者左心房血栓形成的危险因素分析及PLR预测其左心房血栓形成的临床意义  

Risk Factors of Left Atrial Thrombosis in Patients with Nonvalvular Atrial Fibrillation and the Clinical Significance of the PLR in Predicting Left Atrial Thrombosis

作　　者：黄莉莉[1] 胡光玲[1] 张智文 杨海涛[1] HUANG Lili;HU Guangling;ZHANG Zhiwen;YANG Haitao(Cardiovascular Medicine Department,Heart Center of Henan Province People’s Hospital/Fuwai Central China Cardiovascular Hospital/Fuwai Central China Hospital of Zhengzhou University,Zhengzhou 450003,China)

机构地区：[1]河南省人民医院心脏中心/华中阜外心血管病医院/郑州大学华中阜外医院心血管内科,河南郑州450003

出　　处：《河南医学研究》2021年第24期4430-4433,共4页Henan Medical Research

基　　金：河南省科技攻关计划项目(182102310175);河南省医学科技攻关计划项目(LHGJ20190784)。

摘　　要：目的探讨非瓣膜性心房颤动(NVAF)患者左心房血栓(LAT)形成的危险因素,并评价血小板与淋巴细胞比值(PLR)预测NVAF患者LAT形成的临床意义。方法纳入2015年1月至2019年1月于华中阜外心血管病医院接受经食道超声心动图检查的116例NVAF患者的临床资料,按照左心房是否有血栓,将患者分为血栓组(n=30)和非血栓组(n=86)。分析两组患者的一般临床资料,使用多因素logistic回归方程分析NVAF患者左心耳血栓形成的相关因素,使用受试者工作特征(ROC)曲线评价PLR预测NVAF患者LAT形成的价值。结果单因素分析结果显示,两组患者在基线资料方面相比,血栓组患者心房颤动病程长于非血栓组(P<0.05),而在性别、年龄、抽烟、饮酒、高血压、冠心病、心功能不全、肾功能不全、糖尿病和体质量指数(BMI)等方面差异无统计学意义(P>0.05);两组患者实验室检测指标方面相比,血栓组C反应蛋白(CRP)、血小板计数(PLT)和PLR水平高于非血栓组(P<0.05),淋巴细胞和国际标准化比值(INR)则低于非血栓组(P<0.05),而在甘油三酯(TG)、总胆固醇(TC)、血肌酐(SCR)、血尿酸(UA)和血红蛋白(Hb)等指标方面差异无统计学意义(P>0.05);超声心动图指标方面相比,血栓组左心房内径(LAD)长于非血栓组(P<0.05),而左心室舒张末期内径(LVEDD)和左心室射血分数(LVEF)与非血栓组相比差异无统计学意义(P>0.05);多因素logistics回归方程显示,心房颤动病程(OR=1.381,95%CI:1.081~1.765,P<0.05)、CRP(OR=2.113,95%CI:1.152~3.875,P<0.05)、LAD(OR=1.147,95%CI:1.005~1.308,P<0.05)和PLR(OR=1.025,95%CI:1.004~1.047,P<0.05)是NVAF患者LAT形成的独立危险因素;INR(OR=0.233,95%CI:0.087~0.622,P<0.05)是NVAF患者LAT形成的独立保护因素。ROC曲线分析结果显示,PLR预测LAT形成的曲线下面积为0.653(95%CI:0.559~0.739,P<0.05)。结论PLR、心房颤动病程、CRP和LAD是NVAF患者LAT形成的独立危险因素,INR是NVAF患者LAT形成的独立保Objective To explore the risk factors of left atrial thrombosis(LAT)in patients with nonvalvular atrial fibrillation(NVAF),and to evaluate the clinical significance of platelet to lymphocyte ratio(PLR)in predicting the formation of LAT in patients with NVAF.Methods The clinical datas of 116 patients with NVAF who underwent transesophageal echocardiography at Fuwai Central China Cardiovascular Hospital from January 2015 to January 2019 were included,and the patients were divided into thrombus groups(n=30 cases)and non-thrombotic group(n=86 cases)according to whether there were thrombosis in the left atrium.The general clinical datas of the two groups of patients were analyzed,and the multivariate logistic regression equation was used to analyze the related factors of left atrial appendage thrombosis in NVAF patients.The receiver operating characteristic(ROC)curve was used to evaluate the value of PLR in predicting LAT formation in NVAF patients.Results The results of univariate analysis showed that compared with the baseline datas of the two groups of patients,the duration of atrial fibrillation in the thrombosis group was longer than that in the non-thrombosis group(P<0.05).There were no significant differences in dysfunction,renal insufficiency,diabetes,and body mass index(BMI)(P>0.05).The two groups of patients were compared in terms of laboratory indicators,and the results showed that C reactive protein(CRP)and platelet count in thrombus group(PLT)and PLR were higher than the non-thrombotic group(P<0.05).The lymphocyte and international normalized ratio(INR)were lower than the non-thrombotic group(P<0.05),and the triglyceride(TG),total cholesterol(TC),blood creatinine(SCR),blood uric acid(UA)and hemoglobin(Hb)were not statistically differents(P>0.05).The two groups of patients were compared in terms of echocardiographic indicators,and the results showed that the left atrial diameter(LAD)of the thrombus group was longer than the non-thrombotic group(P<0.05),while the left ventricular end-diastolic diameter(LVED

关 键 词：血小板/淋巴细胞比值 炎症反应 非瓣膜性心房颤动 血栓形成 

分 类 号：R364.15[医药卫生—病理学]