扩张型心肌病患者合并左心室血栓的危险因素分析  

Analysis on risk factors of left ventricular thrombosis in patients with dilated cardiomyopathy

作　　者：王晓敏 徐亚威 毛云 郑璐[1] 杨海波[1] WANG Xiao-min;XU Ya-wei;MAO Yun;ZHENG Lu;YANG Hai-bo(Department of Cardiology,The First Affiliated Hospital of Zhengzhou University,Zhengzhou 450000,China)

机构地区：[1]郑州大学第一附属医院心内科,郑州450000

出　　处：《医药论坛杂志》2022年第22期26-30,共5页Journal of Medical Forum

摘　　要：目的探讨扩张型心肌病(dilated cardiomyopathy,DCM)患者合并左心室血栓(left ventricular thrombosis,LVT)的危险因素。方法采用回顾性病例对照研究方法,收集2019年1月—2021年5月于郑州大学第一附属医院心内科住院并患有DCM的病历资料,分为LVT组(n=69)和非LVT组(n=214),比较两组的一般临床资料、常规生化指标及心脏彩超指标,采用多因素logistic回归模型分析LVT的影响因素,并应用ROC曲线分析相关因素的预测价值。结果LVT组患者心功能分级、左室射血分数(LVEF)、左室舒张末期内径(LVEDd)、NT-proBNP、肌酐(Cr)、尿酸(UA)、谷草转氨酶(AST)、白蛋白(ALB)、直接胆红素(DBIL)、D-二聚体(D-Dimer)、红细胞分布宽度(RDW)、平均血小板体积(MPV)均高于非LVT组(P<0.05)。对有统计学差异的因素进一步行多因素logistic回归分析,影响DCM合并LVT的独立危险因素为LVEDd(OR=1.264,95%CI 1.166~1.370,P<0.001)、RDW(OR=1.797,95%CI 1.324~2.439,P<0.001)、MPV(OR=1.518,95%CI 1.100~2.096,P=0.011)。ROC分析提示LVEDd、RDW可作为预测LVT的指标,ROC曲线下面积分别为0.844、0.825,最佳诊断界值为65.5 mm、14.9%,其敏感度为85.5%、63.8%,特异度为73.8%、87.4%。LVEDd联合RDW的ROC曲线下面积为0.908。结论LVEDd、RDW、MPV是DCM合并LVT患者的独立危险因素,LVEDd及RDW联合对DCM患者发生LVT的预测价值较高。Objective To explore the risk factors of left ventricular thrombosis(LVT)in patients with dilated cardiomyopathy(DCM).Methods A retrospective case-control study was conducted.The medical data of patients with DCM from January 2019 to May 2021 in the First Affiliated Hospital of Zheng zhou University were collected.The patients were divided into LVT group(n=69)and non-LVT group(n=214).The general clinical data,routine biochemical indicators and echocardiography indicators were compared between the two groups.The multivariate logistic regression model was used to analyze the factors affecting LVT.The receiver operating curve(ROC curve)was uesd to analyze the predictive values of related factors.Results The NYHA grade,left ventricular ejection fraction,LVEDd,NT-proBNP,creatinine,uric acid,aspartate aminotransferase,albumin,direct bilirubin,D-Dimer,red blood cell distribution width and mean platelet volume were significantly higher in LVT group than those of non-LVT group(P<0.05).The multivariate logistic regression analysis was perfromed for the factors with statistical difference,the independent risk factors of LVT in patients with DCM were LVEDd(OR=1.264,95%CI 1.166~1.370,P<0.001),red blood cell distribution width(OR=1.797,95%CI 1.324~2.439,P<0.001)and mean platelet volume(OR=1.518,95%CI 1.100~2.096,P=0.011).The ROC curve showed that LVEDd and RDW could be used as predictors of LVT.The AUC were 0.844 and 0.825,the best diagnostic cut-off point were 65.5 mm and 14.9%,the sensitivity were 85.5% and 63.8%,andthe specificity were 73.8% and 87.4%.The AUC of LVEDd combined with RDW was 0.908.Conclusion LVEDd,red blood cell distribution width and mean platelet volume were independent risk factors of LVT in patients with DCM.Combination of LVEDd with RDW has higher predictive value for LVT patients with DCM.

关 键 词：扩张型心肌病 左心室血栓 左室舒张末期内径 红细胞分布宽度 

分 类 号：R542.2[医药卫生—心血管疾病]