非瓣膜性房颤继发左心耳血栓的诊疗现状及研究进展  

Current Status and Progress of Diagnosis and Treatment of Left Atrial Appendage Thrombosis Secondary to Nonvalvular Atrial Fibrillation

作　　者：蒲里沙(综述) 张丽叶 王云刚(审校) PU Li-sha;ZHANG Li-ye;WANG Yun-gang(Jinfang Community Health Service Cener of Anning City,Anning 650200,China;First People’s Hospital,Anning 650200,China)

机构地区：[1]安宁市金方社区卫生服务中心,安宁650200 [2]安宁市第一人民医院,安宁650200

出　　处：《微循环学杂志》2024年第4期105-112,119,共9页Chinese Journal of Microcirculation

摘　　要：心房颤动(简称房颤,AF)疾病负担逐年增加,非瓣膜性房颤(NVAF)发病率高,其血栓多源于左心耳,识别与干预左心耳血栓(LAAT)至关重要。本文介绍了AF卒中风险评分系统,如CHA2DS2-VASc评分系统及其局限性和CHA2DS2-VASc-60评分系统,还有HAS-BLED评分系统用于评估抗凝出血风险。阐述了LAAT发生率、形成机制及影像学评估方法。在抗凝治疗方面,对比了传统抗凝策略及新型口服抗凝药物(NOACs)的作用机制与溶解效果,分析了几种NOACs药物的异同及临床使用方法。对于LAAT持续存在或反复出现的抗凝管理及合并血栓时的左心耳封堵(LAAC)策略进行了探讨。研究表明NOACs是AF患者预防卒中的首选抗凝药,但仍需更多数据佐证,LAAC在特定情况下可行但存在争议。未来需深入探究不同治疗方法的长期疗效和安全性,临床医生应综合考虑制定个性化方案,以提高NVAF患者生活质量和预后。Atrial fibrillation(AF),as the most common arrhythmia disease in clinical practice,has an increasing disease burden year by year with the exposure of risk factors,population aging,and the extension of the survival period of patients with chronic diseases,and there are differences among different regions and populations.Among all types of atrial fibrillation,nonvalvular atrial fibrillation(NVAF)has the highest incidence.Almost 100%of the thrombi in NVAF patients originate from the left atrial appendage.Therefore,it is crucial to identify and reasonably intervene left atrial appendage thrombus.The commonly used atrial fibrillation stroke risk scoring systems include the CHA2DS2-VASc scoring system with its limitations and the CHA2DS2-VASc-60 scoring system.The HAS-BLED scoring system is used to evaluate the bleeding risk of anticoagulation.The incidence of left atrial appendage thrombosis(LAAT)varies in different studies.The formation mechanism of LAAT is related to the loss of regular contraction of the left atrial appendage when atrial fibrillation occurs.In anticoagulation treatment,non-vitamin K antagonist oral anticoagulants(NOACs)are the preferred anticoagulants for atrial fibrillation patients to prevent stroke,but more research data are needed.For the situation of persistent or recurrent LAAT,individualized anticoagulation management is important.Left atrial appendage closure(LAAC)is a potential alternative treatment,but its feasibility and safety need further exploration.In conclusion,more research is needed to improve the treatment and prognosis of patients with nonvalvular atrial fibrillation.

关 键 词：非瓣膜性房颤 左心耳血栓 抗凝治疗 左心耳封堵 

分 类 号：R541.7[医药卫生—心血管疾病]