非瓣膜性心房颤动患者发生左房血栓/自发显影的相关因素分析  

Analysis of correlated factors for left atrial thrombus/spontaneous echo contrast in patients with non-valvular atrial fibrillation

作　　者：江姝 葛志祥[1] 刘霞[1] 仇怡 Jiang Shu;Ge Zhixiang;Liu Xia;Qiu Yi(Department of Ultrasonic Cardiogram,Changzhou First People's Hospital,Changzhou,Jiangsu 213000,China;Department of Cardiovascular Medicine,Changzhou First People's Hospital,Changzhou,Jiangsu 213000,China;Department of Clinical Nutrition,Changzhou First People's Hospital,Changzhou,Jiangsu 213000,China)

机构地区：[1]常州市第一人民医院超声心动图科、心血管内科,江苏常州213000 [2]常州市第一人民医院临床营养科,江苏常州213000

出　　处：《齐齐哈尔医学院学报》2024年第2期171-174,共4页Journal of Qiqihar Medical University

摘　　要：目的研究可预测非瓣膜性心房颤动患者发生左房血栓(Left atrial thrombus,LAT)/自发显影(Spontaneous echo contrast,SEC)的相关因素,建立预测模型,探索模型对于LAT/SEC的预测价值。方法选择2019年4月—2022年4月于本院住院的294例非瓣膜性房颤患者作为研究对象,根据是否发生血栓/自发显影分为阴性组(209例)和阳性组(85例)两组。对比两组相关数据,筛选出差异有统计学意义的因素,进一步使用二元logistic回归分析多因素,得出独立危险因素,根据独立危险因素组成新的模型,使用ROC曲线评价新模型的预测效能。结果阳性组患者的年龄、尿酸、LAVI、PT、FIB显著高于阴性组,而高血压比例、LVEF、TAPSE显著低于阴性组,差异有统计学意义(P<0.05);回归分析显示尿酸、左房容积指数(Left atrial volume index,LAVI)、TAPSE、纤维蛋白原(Fibrinogen,FIB)均为非瓣膜性心房颤动发生LAT/SEC的独立危险因素;尿酸、LAVI、TAPSE、FIB组成的模型判断非瓣膜性心房颤动发生LAT/SEC的ROC曲线下面积为0.841(95%CI:0.786~0.896,P<0.001)。结论尿酸、LAVI、TAPSE、FIB是非瓣膜性心房颤动发生LAT/SEC独立危险因素,而其组成的模型可预测LAT/SEC,有助于筛选出需进一步行经食道超声检查的患者。Objective To investigate the correlated factors for predicting left atrial thrombus(LAT)/spontaneous echo contrast(SEC)in patients with non-valvular atrial fibrillation(NVAF),establish a prediction model,and explore the predictive value of the model for LAT/SEC.Methods A total of 294 patients with non-valvular atrial fibrillation who were admitted to our hospital from April 2019 to April 2022 were selected as the study objects.According to the presence or absence of LAT/SEC,they were divided into the positive group(n=209)and the negative group(n=85).The data of the two groups were compared,and the factors with statistical significant difference were selected.The independent risk factors were analyzed using binary logistic regression analysis,and a new model was formed according to the independent risk factors.ROC curve was used to evaluate the predictive efficiency of the new model.Results The age,uric acid,LAVI,PT and FIB of patients in positive group were significantly higher than those in negative group,while the proportion of hypertension,LVEF and TAPSE were significantly lower than those in negative group,the differences were statistically significant(P<0.05).Regression analysis showed that uric acid,left atrial volume index(LAVI),TAPSE and fibrinogen(FIB)were independent risk factors for the occurrence of LAT/SEC in non-valvular atrial fibrillation.The area under ROC curve for LAT/SEC in patients with non-valvular atrial fibrillation determined by models composed of uric acid,LAVI,TAPSE and FIB was 0.841(95%CI:0.786~0.896,P<0.001).Conclusions Uric acid,LAVI,TAPSE and FIB are independent risk factors for LAT/SEC development in patients with NVAF,and the composed model can predict LAT/SEC development,which is helpful to screen out patients requiring further transesophageal ultrasonography.

关 键 词：非瓣膜性心房颤动 左房血栓/自发显影 尿酸 左房容积指数 TAPSE 纤维蛋白原 

分 类 号：R541.7[医药卫生—心血管疾病]