住院心力衰竭患者左心室血栓面积与临床变量的相关性  

Association Between Left Ventricular Thrombus Area and Clinical Characteristics in Hospitalized Heart Failure Patients

作　　者：黄丽燕 翟玫[1] 赵雪梅[1] 黄燕[1] 周琼[1] 梁琳 田鹏超 赵朗 冯佳禹 张宇辉[1] 张健[1] HUANG Liyan;ZHAI Mei;ZHAO Xuemei;HUANG Yan;ZHOU Qiong;LIANG Lin;TIAN Pengchao;ZHAO Lang;FENG Jiayu;ZHANG Yuhui;ZHANG Jian(Heart Failure Center,National Center for Cardiovascular Diseases and Fuwai Hospital,CAMS and PUMC,Beijing(100037),China)

机构地区：[1]中国医学科学院北京协和医学院国家心血管病中心阜外医院心力衰竭中心,北京市100037

出　　处：《中国循环杂志》2022年第8期817-823,共7页Chinese Circulation Journal

基　　金：国家重点研发计划项目(2017YFC1308300)。

摘　　要：目的:探究住院心力衰竭患者左心室血栓面积与临床变量之间的关系。方法:2008年10月至2018年5月期间在我院心力衰竭中心重症监护病区住院,且诊断为心力衰竭合并左心室血栓的患者被纳入本研究。根据平方根变换后的血栓面积中位数将整体人群分为大面积组和小面积组,比较两组基线特征。采用相关性分析和均值比较研究左心室血栓面积与临床指标之间的关系。采用逐步回归分析进一步确定左心室血栓面积的独立相关因素。结果:共纳入322例患者,大面积组161例、小面积组161例。大面积组的体重指数、血浆大内皮素水平、左心室舒张末期内径均高于小面积组(P均<0.05)。Pearson或Spearman相关性分析结果显示,年龄(r=0.110,P=0.048)、体重指数(r=0.113,P=0.051)、高敏C反应蛋白(r=0.153,P=0.007)、血清氯(r=0.098,P=0.078)、丙氨酸氨基转移酶(r=-0.125,P=0.025)、天门冬氨酸氨基转移酶(r=-0.107,P=0.056)、大内皮素(r=0.132,P=0.032)、血糖(r=0.112,P=0.044),血清肌酐(r=0.123,P=0.027)、内生肌酐清除率(r=-0.119,P=0.032)、促甲状腺素(r=-0.118,P=0.043)和左心室舒张末期内径(r=0.094,P=0.094)与左心室血栓面积相关。逐步回归分析表明,年龄(β=0.067,P=0.020),左心室舒张末期内径(β=0.084,P=0.032)和高敏C反应蛋白(β=0.211,P=0.022)与左心室血栓面积相关。在显著性水平α=0.05的前提下,没有证据显示糖尿病患者和非糖尿病患者的左心室血栓面积差异存在统计学意义(P=0.054)。结论:住院心力衰竭患者年龄、左心室舒张末期内径和高敏C反应蛋白水平与左心室血栓面积相关。此结论有待在大样本的前瞻性研究中得到证实。Objectives:We aim to evaluate the association between left ventricular thrombus(LVT)area and clinical variables in patients hospitalized with heart failure(HF).Methods:Patients diagnosed with HF and LVT,who were hospitalized in Heart Failure Center,Fuwai Hospital,CAMS and PUMC between October 2008 and May 2018,were enrolled in this study.According to the median of the square root transformed LVT area,patients were divided into large LVT group and small LVT group.Baseline characteristics were compared between the two groups.Correlation analysis was performed to analyze the association between LVT area and clinical characteristics.Stepwise regression analysis was used to further identify the independent factors of LVT area.Results:A total of 322 patients were included in the study,among which 161 were included into large LVT group,and 161 into small LVT group.Patients in the large LVT group tended to have higher body mass index(BMI),higher big endothelin,and larger left ventricular end-diastolic diameter(LVEDD)compared to patients in the small LVT group(P<0.05).Results from Pearson or Spearman correlation analysis revealed that age(r=0.110,P=0.048),BMI(r=0.113,P=0.051),high-sensitivity C-reactive protein(hs-CRP,r=0.153,P=0.007),serum chlorine(r=0.098,P=0.078),alanine aminotransferase(r=-0.125,P=0.025),aspartate aminotransferase(r=-0.107,P=0.056),big endothelin(r=0.132,P=0.032),blood glucose(r=0.112,P=0.044),serum creatinine(r=0.123,P=0.027),creatinine clearance(r=-0.119,P=0.032),thyrotropin(r=-0.118,P=0.043),and LVEDD(r=0.094,P=0.094)were associated with LVT area.In the stepwise regression analysis,age(β=0.067,P=0.020),LVEDD(β=0.084,P=0.032),and hs-CRP(β=0.211,P=0.022)were independently associated with LVT area.Comparison of LVT area between patients with and without diabetes mellitus barely failed to attain statistical significance at a 5%significance level(P=0.054).Conclusions:Age,LVEDD,and hs-CRP are independently associated with LVT area in patients hospitalized with HF.These findings need to be confirmed in

关 键 词：左心室血栓 心力衰竭 高敏C反应蛋白 心室重构 

分 类 号：R54[医药卫生—心血管疾病]