基于新型分类系统的左心形态与非瓣膜性心房颤动患者卒中的关系  

Relationship between left atrial appendage morphology and stroke based on a new classification system

作　　者：陈文 梁易 张莉婷 何其舟 赵立志 CHEN Wen;LIANG Yi;ZHANG Li-ting;HE Qi-zhou;ZHAO Li-zhi(College of Integration of Traditonal Chinese and Western Medicine to Southwest Medical University,Luzhou 646000,China;Department of Traditional Chinese Medicine,Yuehua Town Health Center,Dazhu County,Luzhou 646000,China;Department of Radiology,Affiliated Traditonal Chinese Medicine Hospital of Southwest Medical University,Luzhou 646000,China;Department of Cardivascular Medicine,Affiliated Traditonal Chinese Medicine Hospital of Southwest Medical University,Luzhou 646000,China)

机构地区：[1]西南医科大学中西医结合学院,四川省泸州市646000 [2]大竹县月华镇卫生院中医内科 [3]西南医科大学附属中医医院放射科 [4]西南医科大学附属中医医院心血管内科

出　　处：《中国心血管病研究》2022年第5期450-456,共7页Chinese Journal of Cardiovascular Research

基　　金：西南医科大学-西南医科大学附属中医医院联合课题(2020XYLH-028)。

摘　　要：目的探讨新型分类系统的左心耳形态与非瓣膜性心房颤动(房颤)患者卒中的关系及形态与功能的关系的特点。方法回顾性分析2018年2月至2020年4月于西南医科大学附属中医医院住院治疗的非瓣膜性房颤患者的临床资料,根据既往是否出现缺血性卒中分为卒中组(35例)和非卒中组(125例),采用单因素和多因素logistic回归分析确定卒中的独立危险因素,并调整多因素回归模型,比较两种分类系统评价非瓣膜房颤患者卒中的差别,采用Sperman秩相关分析左心耳形态特点与功能参数之间的关系。结果相比于非卒中组,卒中组CHA2DS2-VASc评分更高,左心房前后径(LAD)、左心耳口部面积较大[(4.74±1.20)比(4.17±1.31),P=0.02;(39.20±4.48)mm比(37.11±3.47)mm,P=0.004;(3.46±0.70)cm^(2)比(3.09±0.68)cm^(2),P<0.0001],但是左心耳流速较非卒中组更低(47.60±8.30)cm/s比(53.37±7.79)cm/s,P<0.0001。单因素和多因素logistic回归分析显示,左心耳流速、左心耳口部面积、CHA_(2)DS_(2)-VASc评分和高卒中风险左心耳(LAA-H)型是卒中的独立危险因素,但调整回归模型后,左心耳形态并非卒中的危险因素。Sperman秩相关分析显示,左心耳形态(LAA-H/L)与流速呈正相关(r=0.227,P=0.004),与左心耳口部面积呈负相关(r=-0.182,P=0.022)。结论LAA-H与非瓣膜性房颤患者缺血性卒中密切相关,且LAA-H包含了较大的左心耳口部面积、较低左心耳流速等卒中高风险因素,这可能表明新型左心耳分类系统在非瓣膜心房颤的卒中风险分层具有潜在价值。Objective To explore the correlation between the LAA-H/L and stroke in patients with nonvalvular atrial fibrillation,and the characteristics of the relationship between left atrial appendage morphology and function.Methods A retrospective analysis of the clinical data of patients with non-valvular atrial fibrillation admitted to the Affiliated Traditional Chinese Medicine Hospital of Southwest Medical University from February2018 to April 2020 was performed and the patients were divided into the stroke group(35 cases)and non-stroke group(125 cases)according to whether they had an ischemic stroke in the past.Univariate and multivariate logistic regression analysis was performed to determine the independent risk factors for stroke.And the multivariate regression models were adjusted to compare the differences between the two classification systems in evaluating stroke in patients with nonvalvular atrial fibrillation.Sperman rank correlation analysis were used to explore the associations between the morphological characteristics of the left atrial appendage and the functional parameters.Results Compared with the non-stroke group,the stroke group had a higher CHA_(2)DS_(2)-VASc score,a larger left atrial anterior-posterior diameter(LAD)and left atrial appendage orifice area[(4.74±1.20)vs.(4.17±1.31),P=0.02;(39.20±4.48)mm vs.(37.11±3.47)mm,P=0.004;(3.46±0.70)cm^(2)vs.(3.09±0.68)cm^(2),P<0.0001],but left atrial appendage flow velocity was slower[(47.60±8.30)cm/s vs.(53.37±7.79)cm/s,P<0.0001].Univariate and multivariate analysis revealed that left atrial appendage flow velocity,left atrial appendage orifice area,CHA_(2)DS_(2)-VASC score and high stroke risk left atrial appendage(LAA-H)were the independent risk factors for stoke,but left atrial appendage morphology was not a risk factor for stroke after adjusting for multivariate regression model.The Sperman rank correlation analysis showed that the left atrial appendage morphology(LAA-H/L)was positively correlated with the flow velocity(r=0.227,P=0.004),but nega

关 键 词：左心耳形态 卒中 非瓣膜性心房颤动 

分 类 号：R541.4[医药卫生—心血管疾病]