低CHA_(2)DS_(2)-VASc评分的非瓣膜性心房颤动患者左心房血栓形成危险因素分析  

Analysis of Risk Factors of Left Atrial Thrombosis in Patients with Non-valvular Atrial Fibrillation with Low CHA_(2)DS_(2)-VASc Score

作　　者：姬旺龙 黄晏[2] 李宏凤 刘怡 安军钰 李万鹏[2] JI Wanglong;HUANG Yan;LI Hongfeng(The First Clinical Medical College of Gansu University of Chinese Medicine(Gansu Provincial Hospital),Gansu 730000,China)

机构地区：[1]甘肃中医药大学第一临床医学院(甘肃省人民医院),兰州730000 [2]甘肃省人民医院心内二科,兰州730000

出　　处：《医学研究杂志》2022年第3期113-117,共5页Journal of Medical Research

基　　金：甘肃省人民医院院内重点学科科研项目(20GSSY1-7)。

摘　　要：目的探讨低CHA_(2)DS_(2)-VASc评分(男性≤1分,女性≤2分)非瓣膜性心房颤动(non-valvular atrial fibrillation,NVAF)患者左心房自发显影(left atrial spontaneous echocardiographic contrast,LASEC)和(或)血栓(left atrial thrombus,LAT)形成的危险因素。方法选取2014年8月~2021年8月在甘肃省人民医院就诊的296例低CHA_(2)DS_(2)-VASc评分NVAF患者,根据经食管超声心动图(transesophageal echocardiography,TEE)将之分为血栓组[包括LASEC和(或)LAT]及非血栓组(无LASEC或LAT)。通过分析两组患者资料,探讨低CHA_(2)DS_(2)-VASc评分NVAF患者血栓形成的危险因素。结果与非血栓组比较,血栓组患者左心室射血分数及高密度脂蛋白胆固醇(high density lipoprotein cholesterol,HDL-C)更低,而左心房前后径(left atrial diameter,LAD)增大更明显、持续性心房颤动及合并心力衰竭比例更大,血浆同型半胱氨酸及红细胞分布宽度水平更高,差异均有统计学意义(P<0.05)。多因素Logistic回归显示LAD增大(OR=1.087,95%CI:1.024~1.154,P=0.006)及HDL-C降低(OR=0.175,95%CI:0.032~0.949,P=0.043)是低CHA_(2)DS_(2)-VASc评分患者LASEC和(或)LAT形成的独立危险因素。结论LAD增大和HDL-C降低是低CHA_(2)DS_(2)-VASc评分NVAF患者LASEC和(或)LAT形成的独立危险因素,对LAD增大、HDL-C降低的低评分NVAF患者,应考虑启动抗凝治疗以降低脑卒中发生率。Objective To investigate the risk factors of left atrial spontaneous development(left atrial spontaneous echocardiographic contrast,LASEC)and/or thrombus(left atrial thrombus,LAT)in patients with non-valvular atrial fibrillation(non-valvular atrial fibrillation,NVAF)with low CHA_(2)DS_(2)-VASc score(male≤1,female≤2).Methods 296 NVAF patients with low CHA_(2)DS_(2)-VASc score in Gansu Provincial Hospital from August 2014 to August 2021 were divided into thrombus group(including LASEC and/or LAT)and non-thrombus group(without LASEC or LAT)according to transesophageal echocardiography(transesophageal echocardiography,TEE).To explore the risk factors of thrombosis in NVAF patients with low CHA_(2)DS_(2)-VASc score by analyzing the data of two groups of patients.Results compared with the non-thrombus group,the left ventricular ejection fraction and high density lipoprotein cholesterol(high density lipoprotein cholesterol,HDL-C)in the thrombus group were lower,while the increase of left atrial anteroposterior diameter(left atrial diameter,LAD)was more obvious,the proportion of persistent atrial fibrillation and heart failure was higher,and the levels of plasma homocysteine and erythrocyte distribution width were higher in the thrombus group.Multivariate Logistic regression showed that increased LAD(OR=1.087,95%CI:1.024-1.154,P=0.006)and decreased HDL-C(OR=0.175,95%CI:0.032-0.949,P=0.043)were independent risk factors for the formation of LASEC and/or LAT in patients with low CHA_(2)DS_(2)-VASc score.Conclusion The increase of LAD and the decrease of HDL-C are independent risk factors for the formation of LASEC and/or LAT in NVAF patients with low CHA_(2)DS_(2)-VASc score.Anticoagulant therapy should be initiated as soon as possible to reduce the incidence of stroke in patients with low LAD and low HDL-C.

关 键 词：非瓣膜性心房颤动 低CHA_(2)DS_(2)-VASc评分 左心房自发显影 左心房血栓 危险因素 

分 类 号：R541.7[医药卫生—心血管疾病]