风湿性二尖瓣狭窄患者左心耳血栓形成的超声预测因素  

Ultrasound Prognostic Factors of Left Atrial Appendage Thrombosis in Patients with Rheumatic Mitral Stenosis

作　　者：覃诗耘[1] 吴棘[1] 曾德才 王芬[1] 苏春晓[1] 王茜[1] 贝玉琼 Qin Shiyun;Wu Ji;Zeng Decai;Wang Fen;Su Chunxiao;Wang Qian;Bei Yuqiong(Department of Ultrasound,The First Affiliated Hospital of Guangxi Medical University,Nanning 530021,China)

机构地区：[1]广西医科大学第一附属医院超声科,南宁市530021

出　　处：《中国超声医学杂志》2023年第5期515-519,共5页Chinese Journal of Ultrasound in Medicine

基　　金：广西壮族自治区卫生健康委员会自筹经费项目(No.Z20210135)。

摘　　要：目的探讨风湿性二尖瓣狭窄(RMS)患者左心耳血栓形成的超声预测因素。方法79例RMS患者分为左心耳有血栓组和无血栓组,采用成组t检验及Mann-Whitney U非参数检验,比较超声心动图评价参数。对两组间存在显著差异的参数进行单因素及多因素Logistic回归分析,探讨血栓形成独立危险因素,并构建受试者工作特征(ROC)曲线,评价各独立危险因素对血栓形成的预测价值,进一步拟合各独立危险因素进行评分,通过ROC曲线明确评分截断值。结果①血栓组与非血栓组左心耳充盈速度、左心耳排空速度、左心耳壁收缩运动速度Sa、左心耳壁舒张运动速度Ea、二尖瓣口面积、二尖瓣口反流量、二尖瓣口狭窄程度、持续性房颤、左房血流自发声学显影比较,差异均具有统计学意义(P<0.05);②单因素及多因素Logistic回归分析,左心耳壁舒张运动速度Ea[比值比(OR)=1.687,95%置信区间(95%CI):1.035~2.749]、持续性房颤与否(OR=7.209,95%CI:1.022~50.853)、左房血流自发声学显影3级(OR=0.144,95%CI:0.046~0.499)为左心耳血栓形成独立危险因素;③ROC曲线分析,左房血流自发声学显影(SEC)≥2.5级(灵敏度0.914、特异度0.591)、持续性房颤(灵敏度0.912、特异度0.409)、左心耳壁舒张运动速度Ea≤4.5cm/s(灵敏度0.706、特异度0.500)时,左心耳血栓形成风险显著增加;④各独立危险因素累计分数进行ROC曲线分析,分数≥2.5分为预测RMS患者左心耳血栓形成截断值,其曲线下面积(AUC)为0.829(灵敏度0.629、特异度0.932)。结论超声心动图可通过对左房血流SEC分级、持续性房颤、左心耳壁舒张运动速度Ea综合评价,对RMS患者左心耳血栓形成进行有效预测,为临床治疗提供超声影像学依据。Objective To investigate the ultrasonic prognostic factors of left atrial appendage thrombosis in patients with rheumatic mitral stenosis(RMS).Methods 79patients with RMS were divided into the left atrial appendage thrombus group and the non-thrombus group.Independent-sample t test and Mann-Whitney U nonparametric test were used to compare the evaluation parameters of echocardiography.Univariate and multivariate logistic regression analysis were performed with the parameters which had significant differences between the two groups,to explore the independent risk factors for left atrial appendage thrombosis.And receiver operating characteristic(ROC)curves were constructed to evaluate the predictive value of each independent risk factor for thrombosis,and scores were further fitted for each independent risk factor,and the score cut-off values was also determined by ROC curves.Results①There were significant differences between the thrombus group and the non-thrombus group in the filling and emptying velocity of the left atrial appendage,the contractile and diastolic motion velocity of the left atrial appendage(LAA-Sa and LAA-Ea),the mitral valve area,the mitral regurgitation,the degree of mitral stenosis,persistent atrial fibrillation(p-Af)and the left atrial spontaneous echo contrast(SEC)(P<0.05).②Univariate and multivariate Logistic regression analyses showed that LAA-Ea[odds ratio(OR)=1.687,95%confidence interval(CI):1.035-2.749],p-Af(OR=7.209,95%CI:1.022-50.853),and SEC grade 3(OR=0.144,95%CI:0.046-0.499)were independent risk factors for left atrial appendage thrombosis.③ROC curve analyses showed that when left atrial SEC≥2.5(sensitivity 0.914,specificity 0.591),p-Af(sensitivity 0.912,specificity 0.409),and LAA-Ea≤4.5cm/s(sensitivity 0.706,specificity 0.500),the risk of left atrial appendage thrombosis was significantly increased.④ROC curve analysis of accumulated scores of independent risk factors showed that scores≥2.5was the cut-off value for predicting left atrial appendage thrombosis in patien

关 键 词：风湿性二尖瓣狭窄 左心耳血栓 血栓形成预测 超声心动图 

分 类 号：R445.1[医药卫生—影像医学与核医学] R542.51[医药卫生—诊断学]