左心房内径、红细胞分布宽度与非瓣膜性心房颤动患者发生缺血性脑卒中的关系研究  

Relationship between Left Atrial Dimension,Red Blood Cell Distribution Width and Ischemic Stroke in Patients with Non-valvular Atrial Fibrillation

作　　者：黄海霞[1] 张艳梅[1] 梁媛[1] 朱峰[1] 黄金定[1] HUANG Haixia;ZHANG Yanmei;LIANG Yuan;ZHU Feng;HUANG Jinding(Department of Cardiology,Union Hospital,Tongji Medical College,Huazhong University of Science and Technology,Wuhan 430000,China)

机构地区：[1]华中科技大学同济医学院附属协和医院心内科,湖北省武汉市430000

出　　处：《实用心脑肺血管病杂志》2021年第10期58-64,共7页Practical Journal of Cardiac Cerebral Pneumal and Vascular Disease

基　　金：国家自然科学基金面上项目(81570348)。

摘　　要：背景心房颤动(AF)尤其是非瓣膜性心房颤动(NVAF)患者缺血性脑卒中(IS)发生风险较高。左心房内径(LAD)增大是左心房血栓形成的病理基础,与IS关系密切,但其对NVAF患者发生IS的预测价值尚存在争议。红细胞分布宽度(RDW)已被证实是多种心脑血管疾病患者预后的独立影响因素,但其与NVAF患者发生IS关系的研究较少。目的探讨LAD、RDW与NVAF患者发生IS的关系。方法选取2017年2月至2020年2月华中科技大学同济医学院附属协和医院诊治的NVAF患者378例,根据患者随访1年IS发生情况将其分为NVAF+IS组68例和NVAF组310例。比较两组患者的临床资料,采用多元Cox比例回归分析探讨NVAF患者发生IS的影响因素;绘制受试者工作特征(ROC)曲线以评估相关指标对NVAF患者发生IS的预测价值,计算曲线下面积(AUC)。结果NVAF+IS组患者年龄>60岁者占比、持续性AF发生率、收缩压、RDW、N末端脑钠肽前体(NT-proBNP)高于NVAF组,左心耳封堵术治疗者占比、左心室射血分数(LVEF)低于NVAF组,LAD、左心室收缩末期内径(LVESD)、CHA2DS2-VASc评分大于NVAF组(P<0.05)。多元Cox比例风险回归分析结果显示,年龄>60岁〔HR=1.219,95%CI(1.002,1.483)〕、左心耳封堵术〔HR=0.386,95%CI(0.188,0.790)〕、RDW〔HR=1.621,95%CI(1.074,2.446)〕、LAD〔HR=1.802,95%CI(1.119,2.902)〕、CHA2DS2-VASc评分〔HR=1.937,95%CI(1.167,3.183)〕是NVAF患者发生IS的独立影响因素(P<0.05)。ROC曲线分析结果显示,LAD联合RDW预测NVAF患者发生IS的AUC大于LAD联合CHA2DS2-VASc评分预测NVAF患者发生IS的AUC(P<0.001)。结论LAD、RDW是NVAF患者发生IS的独立影响因素,且二者联合对其具有较高的预测价值。Background Patients with atrial fibrillation(AF),especially non-valvular atrial fibrillation(NVAF),have a significantly higher risk of ischemic stroke(IS).Increased left atrial dimension(LAD)is the pathological basis of left atrial thrombosis,and is closely related to IS,but its predictive value for IS in patients with NVAF is still controversial.Red blood cell distribution width(RDW)has been proven to be an independent influencing factor for prognosis of a variety of cardiovascular and cerebrovascular disease,but there are few studies on its relationship with IS in patients with NVAF.Objective To explore the relationship between LAD,RDW and IS in patients with NVAF.Methods From February 2017 to February 2020,378 patients with NVAF were selected in Union Hospital,Tongji Medical College,Huazhong University of Science and Technology,and they were divided into NVAF+IS group with 68 cases and NVAF group with 310 cases according to incidence of IS during 1-year follow-up.The clinical data of the two groups were compared.Multivariate Cox proportional regression analysis was used to investigate the influencing factors of IS in patients with NVAF.Receiver operating characteristic(ROC)curve was used to evaluate the predictive value of relevant indicators for IS in patients with NVAF,and the area under curve(AUC)was calculated.Results The proportion of patients with age>60 years old,incidence of persistent AF,systolic blood pressure,RDW and N-terminal pro-brain natriuretic peptide(NT-proBNP)in NVAF+IS group were higher than those in NVAF group,proportion of patients treated with left atrial appendage occlusion,left ventricular ejection fraction(LVEF)were lower than those in NVAF group,LAD,left ventricular end systolic diameter(LVESD),CHA2DS2-VASc score were greater than those in NVAF group(P<0.05).Multivariate Cox proportional hazard regression analysis showed that,age>60 years old[HR=1.219,95%CI(1.002,1.483)],left atrial appendage occlusion[HR=0.386,95%CI(0.188,0.790)],RDW[HR=1.621,95%CI(1.074,2.446)],LAD[HR=1.802,95%CI(1

关 键 词：心房颤动 卒中 非瓣膜性心房颤动 缺血性脑卒中 左心房内径 红细胞分布宽度 

分 类 号：R541.75[医药卫生—心血管疾病] R743[医药卫生—内科学]