年龄校正D-二聚体联合HDL-C对心房颤动患者左心房血栓形成的预测价值  

Predictive value of age-adjusted D-dimer combined with high-density lipoprotein cholesterol for left atrial thrombosis in patients with atrial fibrillation

作　　者：林碧玉 牛小伟[2,3,4] 何涛涛[1] 杨振荣 姚亚丽 张钲[2,3,4] LIN Bi-yu;NIU Xiao-wei;HE Tao-tao;YANG Zhen-rong;YAO Ya-li;ZHANG Zheng(The First Clinical Medical College,Lanzhou University,Lanzhou 730000,Gansu,China;Heart Center,First Hospital,Lanzhou University,Lanzhou 730000,Gansu,China;Cardiovascular Clinical Research Center of Gansu Province,Lanzhou 730000,Gansu,China;Key Laboratory for Cardiovascular Disease of Gansu Province,Lanzhou 730000,Gansu,China)

机构地区：[1]兰州大学第一临床医学院,甘肃兰州730000 [2]兰州大学第一医院心脏中心,甘肃兰州730000 [3]兰州大学甘肃省心血管病临床医学研究中心,甘肃兰州730000 [4]兰州大学甘肃省心血管疾病重点实验室,甘肃兰州730000

出　　处：《心脏杂志》2022年第1期18-22,共5页Chinese Heart Journal

基　　金：国家自然科学基金项目资助(82000277,82060807);甘肃省科技计划项目资助(21JR1RA100);甘肃卫生行业科研计划资助(GSWSKY2020-64);中央高校基本科研业务费专项资金资助(lzujbky-2021-kb34);兰州市科技计划项目资助(2020-2D-T2);兰州大学第一医院院内基金项目资助(ldyyyn2019-46)。

摘　　要：目的确定年龄校正D-二聚体(DDage)联合高密度脂蛋白胆固醇(HDL-C)对心房颤动患者左心房血栓(LAT)的预测价值。方法纳入2016年1月~2020年10月就诊于兰州大学第一医院的心房颤动患者290例。根据经食管超声心动图检查结果将患者分为LAT(n=23)组和无LAT组(n=267)。记录患者入院时D-二聚体、血脂水平,根据年龄计算DDage。比较两组间DDage及HDL-C水平的差异。应用单因素及多因素logistic回归分析确定LAT的危险因素。绘制ROC曲线分析DDage联合HDL-C对LAT的诊断价值。结果无LAT组DDage阳性患者为37例(14%),LAT组中为15例(65%),组间差异有统计学意义(P<0.01)。LAT组HDL-C水平显著低于无LAT组患者(0.99±0.26vs.1.15±0.34,P<0.05)。多因素logistic回归分析显示:DDage(OR=9.541,95%CI:3.413-26.667,P<0.01)、HDL-C(OR=0.067,95%CI:0.007-0.636,P<0.05)、CHA_(2)DS_(2)-VASc≥2(OR=3.043,95%CI:1.019-9.090,P<0.05)、LVEF(OR=0.932,95%CI:0.880-0.987,P<0.05)是存在LAT的独立危险因素。DDage联合HDL-C的曲线下面积(AUC=0.842)均高于DDage(AUC=0.757)、HDLC(AUC=0.674),差异具有统计学意义(P<0.05)。结论DDage联合HDL-C能够预测LAT的形成,在临床中可用于识别发生LAT的高危心房颤动患者。AIM To evaluate the predictive value of age-adjusted D dimers(DDage)combined with high-density lipoprotein cholesterol(HDL-C)for left atrial thrombosis(LAT)in patients with atrial fibrillation.METHODS Patients with atrial fibrillation admitted to the First Hospital of Lanzhou University from January 2016 to October 2020 were enrolled.The patients were divided into LAT group and non-LAT group according to the results of transesophageal echocardiography,The HDL-C and Ddimer levels were recorded,and the DDage was calculated based on their age,The differences of DDage and HDL-C between the two groups were compared.All data were subjected to univariate analysis and multivariate logistic regression analysis to establish the risk factors of LAT.The ROC curve was used to analysis the predictive value of DDage combined with HDL-C for LAT.RESULTS The number of patients with DDage(positive)in LAT group(n=23)was 15(65.2%)and in non-LAT group(n=267)was37,with statistically significant difference(P<0.01).The level of HDL-C in LAT group was significantly lower than that in non-LAT group(0.99±0.26 vs.1.15±0.34,P<0.05).Logistic regression analysis showed that DDage(OR=9.541,95%CI=3.413-26.667,P<0.01),HDL-C(OR=0.067,95%CI 0.007-0.636,P<0.05),CHA_(2)DS_(2)-VASc≥2(OR=3.043,95%CI 1.019-9.090,P<0.05)and LVEF(OR=0.932,95%CI 0.880-0.987,P<0.05)were all independent risk factors for LAT.The area under the ROC curve showed that the predictive value of DDage combined with HDL-C(AUC=0.842)was better than DDage(AUC=0.757)or HDL-C(AUC=0.674)alone,and the differences were statistically significant(P<0.05).CONCLUSION DDage combined with HDL-C has good predictive value for LAT in patients with atrial fibrillation and they can be used to identify LAT in clinical practice.

关 键 词：心房颤动 D-二聚体 高密度脂蛋白胆固醇 左心房血栓 

分 类 号：R541.75[医药卫生—心血管疾病]