阵发性心房颤动患者P波指数与左心房/左心耳血栓形成的相关性分析  

Association between P-wave index and left atrium/left atrial appendage thrombosis in patients with paroxysmal atrial fibrillation

作　　者：伍焕平 丁倩 王景浩 邢晓芬[5] 母生梅 李峰 韩宇臣 曾汇庆 梁叶青 郭军[1] WU Huan-ping;DING Qian;WANG Jing-hao;XING Xiao-fen;MU Sheng-mei;LI Feng;HAN Yu-chen;ZENG Huiqing;LIANG Ye-qing;GUO Jun(Department of Cardiovascular,The First Affiliated Hospital of Jinan University,Guangzhou 510630,China;Department of Cardiovascular,The Shunde Affiliated Hospital of Jinan University,Foshan 528305,China;School of Pharmacy&State Key Laboratory of Quality Research in Chinese Medicine,Macao University of Science and Technology,Macao SAR 999078,China;Department of Pharmacy,The First Affiliated Hospital,Jinan University,Guangzhou 510630,China;School of Electronic and Information Engineering,South China University of Technology,Guangzhou 510641,China;Clinical Center,Group Research Institute,Shenzhen Salubris Pharmaceutical Co,LTD,Shenzhen 518000,China;Shenzhen Dawei Medical Technology Development limited company,Shenzhen 518000,China)

机构地区：[1]暨南大学附属第一医院心血管内科,广东省广州市510630 [2]暨南大学附属顺德医院心血管内科 [3]澳门科技大学药学院和国家中医药治疗研究重点实验室,中国 [4]暨南大学附属第一医院药学部,广东省广州市510630 [5]华南理工大学电子与信息学院 [6]深圳信立泰药业股份有限公司集团研究院临床中心 [7]深圳大微医疗科技开发有限公司

出　　处：《中国心血管病研究》2025年第1期9-14,共6页Chinese Journal of Cardiovascular Research

基　　金：暨南大学附属第一医院临床前沿新技术项目(JNU1AF-CFTP-2022-a01218);广州市科技计划项目(重点研发)[202103000010];广州地区临床高新和重大技术项目(重大联合建设)[2024PL-ZD09];广州市科技局市院联合项目(JNU1AF-CFTP-2022-a01218)。

摘　　要：目的研究阵发性心房颤动(AF)患者P波指数与左心房/左心耳血栓形成的相关性。方法回顾性分析2016年1月至2022年3月在暨南大学附属第一医院行经食管超声心动图检查的阵发性AF患者103例,其中合并左心房/左心耳血栓形成患者共31例(病例组),无左心房/左心耳血栓形成患者72例(对照组)。比较2组患者的临床资料、P波指数等。应用回归分析阵发性AF患者P波指数与左心房/左心耳血栓形成的相关性。多因素回归分析筛选出左心房/左心耳血栓形成的危险因素,与CHA2DS2-VASc评分结合形成新的评分系统,并评估其预测价值。结果病例组年龄较大,左心房内径较大,CHA2DS2-VASc评分较高,差异具有统计学意义(P<0.05)。单因素回归分析显示,年龄、左心房内径、CHA2DS2-VASc评分、P波时限异常、P波最大时限、P波最小时限、P波离散度、V1导联P波终末电势均为血栓形成的危险因素。多因素Logistic回归分析显示,V1导联P波终末电势、P波时限异常为阵发性AF患者左心房/左心耳血栓形成的独立危险因素(OR=1.103,95%CI 1.033~1.178,P=0.003;OR=14.037,95%CI 1.600~123.150,P=0.017),V1导联P波终末电势预测阵发性AF左心房/左心耳血栓形成的受试者工作特征曲线(ROC)下面积(AUC)为0.855(95%CI 0.757~0.953,P<0.001)。V1导联P波终末电势以28.26 mm·ms为最佳截断值预测阵发性AF左心房/左心耳血栓形成的敏感度为87.1%,特异度为87.5%;将V1导联P波终末电势、P波时限异常联合CHA2DS2-VASc评分形成CHA2DS2-VASc-P2-V评分,ROC曲线分析显示,CHA2DS2-VASc-P2-V评分的AUC高于CHA2DS2-VASc评分(0.826比0.654,P<0.001)。结论V1导联P波终末电势、P波时限异常为阵发性AF患者左心房/左心耳血栓形成的独立危险因素。P波时限≤89 ms或P波时限>120 ms均增加阵发性AF患者左心房/左心耳血栓形成的风险。两者与CHA2DS2-VASc评分形成的新评分对左心房/左心耳血栓形成的预测价值�Objective To explore the correlation between P-wave index and left atrial/left atrial appendage thrombosis in patients with paroxysmal atrial fibrillation(AF).Methods A total of 103 patients with paroxysmal AF admitted and received transesophageal echocardiography in our hospital from January 2016 to March 2022 were retrospectively analyzed.Among them 31 patients with left atrium/left atrial appendage thrombosis were as the case group,and the other 72 patients without thrombosis were as the control group.The baseline clinical data,P-wave index,transesophageal echocardiography and ultrasonic cardiogram were recorded and compared.P wave time duration≤89 ms or>120 ms was defined as abnormal P-wave duration.The univariate regression analysis was used to analyze the correlation between P-wave index and left atrial/left atrial appendage thrombosis in the patients.The risk factors for thrombosis were combined with the CHA2DS2-VASc score to form a new scoring system.The predictive value was evaluated using the receiver operating characteristic curve.Results The patients in the case group were older,with larger left atrial diameter and a higher CHA2DS2-VASc score(P<0.05).The univariate regression analysis showed that age,left atrial diameter,CHA2DS2-VASc score,abnormal P-wave duration,maximum P-wave duration,minimum P-wave duration,P-wave dispersion,and P-wave terminal force in lead V1 were all the risk factors for thrombosis.The multivariate Logistic regression analysis showed that P-wave terminal force in lead V1 and abnormal P wave duration were the independent risk factors for left atrium/left atrial appendage thrombosis in patients with paroxysmal AF(OR=1.103,95%CI 1.033-1.178,P=0.003;OR=14.037,95%CI 1.600-123.150,P=0.007).The area under the receiver operating characteristic curve of P-wave terminal force in lead V1 predicting left atrium/left atrial appendage thrombosis was 0.855(95%CI 0.757-0.953,P<0.001).The sensitivity of P-wave terminal force in lead V1 to predict left atrium/left atrial appendage thrombosis w

关 键 词：心房颤动 阵发性 心电描记术 心房重构 血栓形成 左心耳 

分 类 号：R541.7[医药卫生—心血管疾病]