预测非瓣膜性心房颤动左房血栓/自发显影的新模型探究——单中心回顾性研究  

New scores for prediction of left atrial thrombus/spontaneous echo contrast in patients with nonvalvular atrial fibrillation:A single-center retrospective analysis

作　　者：李倩[1] 刘志月[1] 黄鹤[1] 刘梅[1] 唐卓琴 梁士楚 阮晓苗 LI Qian;LIU Zhiyue;HUANG He;LIU Mei;TANG Zhuoqin;LIANG Shichu;RUAN Xiaomiao(Department of Cardiology,West China Hospital of Sichuan University,Chengdu,610041,China)

机构地区：[1]四川大学华西医院心内科,成都610041

出　　处：《临床心血管病杂志》2022年第11期888-894,共7页Journal of Clinical Cardiology

摘　　要：目的:探索预测左房血栓(left atrial thrombus,LAT)/自发显影(spontaneous echo contrast,SEC)的新因素,比较CHADS_(2)/CHADS_(2)-VASc加入新的危险因素后,新的模型预测LAT/SEC的能力是否提升;并探索新因素对于CHADS_(2)/CHADS_(2)-VASc模型中的低风险患者LAT/SEC的预测。方法:回顾过去10年我院接受经食管超声检查的非瓣膜性心房颤动患者,筛选LAT/SEC的患者,以年龄及性别1∶1匹配左房未见LAT/SEC的患者。使用二元logistic回归分析识别影响LAT/SEC的危险因素。将新的因素纳入CHADS_(2)及CHADS_(2)-VASc模型,利用ROC曲线评价模型预测LAT/SEC的能力是否有所提升。并在低风险患者中(CHADS_(2)-VASc男性0分,女性1分),利用ROC曲线评价新因素对这部分患者LAT/SEC的预测能力。结果:研究共纳入了1270例非瓣膜性房颤患者,其中LAT/SEC 635例,左房未见LAT/SEC 635例。回归分析提示左房增大(LAE)、血尿酸增高(HSUA)及血纤维蛋白原(FIB)是LAT/SEC的独立危险因素。CHADS_(2)+LAE、CHADS_(2)+HSUA、CHASD2+FIB、CHADS_(2)+LAE+HSUA+FIB预测LAT/SEC的ROC曲线下面积(AUC)分别为:0.739、0.647、0.654、0.767,较原模型CHADS_(2)(AUC=0.614)提高(P^(*)<0.05)。CAHDS2-VASc+LAE、CHADS_(2)-VASc+HSUA、CHADS_(2)-VASc+FIB、CHADS_(2)-VASc+LAE+HSUA+FIB预测LAT/SEC的ROC AUC分别为0.785、0.719、0.710、0.801,较原模型CHADS_(2)-VASc(AUC=0.695)提高(P^(*)<0.05)。在整组患者中,LAE+HSUA+FIB预测LAT/SEC的ROC AUC为0.756(P<0.05),在CHADS_(2)-VASc评分为0(男性)或1(女性)分患者中,LAE+HSUA+FIB^(*)预测LAT/SEC的ROC AUC为0.752(P<0.05)。结论:(1)LAE、HSUA、FIB是LAT/SEC的独立危险因素。(2)分别加入LAE、HSUA、FIB后,CHADS_(2)及CHADS_(2)-VASc模型预测能力均有提升。其中,以单独加入LAE带来的提升最显著;三者均加入时,模型预测更准确。(3)LAE、HSUA、FIB三者可预测CHADS_(2)-VASc评分为0(男)或1分(女)患者中LAT/SEC的发生,有助于筛选真正的低风险患者。Objective:To explore new risk factors for predicting left atrial thrombus(LAT)/Spontaneous echo contrast(SEC),to compare whether the ability of CHADSand CHADS-VASc plus new risk factors to predict LAT/SEC was improved,and explore new factors for the prediction of LAT/SEC in low-risk patients in the CHADS/CHADS-VASc model.Methods:We reviewed patients who had undergone a transesophageal echocardiography exam over the past 10 years,with those descriptions contained“echo contrast”.The patients without LAT/SEC were matched 1:1 by age and sex.Binary logistic regression analysis was used to identify risk markers.The new markers were incorporated into the CHADSand CHADS-VASc scales,and the ROC curve was used to evaluate the predictive power of those new scales.And in patients with a CHADS-VASc score of 0(male)or 1(female),the ability of new factors to predict LAT/SEC was evaluated.Results:A total of 1270 patients were included in the study,635 of them had LAT/SEC.Regression analysis revealed left atrial enlargement(LAE),high serum uric acid level(HSUA),and fibrinogen level(FIB)were the independent risk markers for LAT/SEC.Receiver operating characteristic analysis showed that area under the curve(AUC)of CHADS+LAE,CHADS+HSUA,CHADS+FIB and CHADS+LAE+ISUA+FIB scores were 0.739,0.647,0.654 and 0.767,respectively,compared with CHADS(AUC=0.614),all P^(*)<0.05.And the AUC of CHADS-VASc+LAE,CHADS-VASc+HSUA,CHADS-VASc+FIB and CHADS-VASc+LAE+HSUA+FIB scores were 0.785,0.719,0.710 and 0.801,respectively,compared with CHADS-VASc(AUC=0.695),all P^(*)<0.05.In all patients,the AUC of LAE+HSUA+FIB scores was 0.756,compared with null hypothesis:true area=0.5,P<0.05,and in patients with CHADS-VASc score of 0(male)or 1(female),the receiver operating characteristic curve analysis showed that area under the curve(AUC)of LAE+ISUA+FIB^(*)scores were 0.752,compared with null hypothesis:true area=0.5,P<0.05.Conclusion:(1)LAE,HSUA,FIB were independent risk markers for LAT/SEC.(2)After adding LAE,HSUA and FIB respectively,the prediction power

关 键 词：非瓣膜性心房颤动 左房血栓/自发显影 危险因素 模型 预测价值 

分 类 号：R541.7[医药卫生—心血管疾病]