高出血风险患者左心耳封堵术后静脉血栓栓塞发生风险的临床研究  

Clinical study of left atrial appendicular closure for reducing the risk of venous thromboembolism in patients with high bleeding risk

作　　者：田双 黄晓莉[2] 周翌[2] 金贤 Tian Shuang;Huang Xiaoli;Zhou Yi;Jin Xian(CCU,Cardiac Center,Shanghai Sixth People's Hospital,Shanghai 200030,China;Department of Cardiology,Cardiac Center,Shanghai Sixth People's Hospital,Shanghai 200030,China)

机构地区：[1]上海市第六人民医院心脏中心CCU,上海200030 [2]上海市第六人民医院心脏中心心外科,上海200030

出　　处：《血管与腔内血管外科杂志》2024年第12期1506-1510,1523,共6页Journal of Vascular and Endovascular Surgery

基　　金：上海市第六人民医院院级管理类科研基金项目(lygl202210)。

摘　　要：目的探讨高出血风险(HBR)患者左心耳封堵术后发生静脉血栓栓塞(VTE)的影响因素。方法收集2021年9月至2023年4月上海市第六人民医院收治的252例左心耳封堵术HBR患者的临床资料,按照VTE发生情况将其分为发生组(n=38)与未发生组(n=214)。收集所有患者的临床特征,采用二元Logistic回归模型分析HBR患者左心耳封堵术后发生VTE的影响因素并构建预测模型,同时采用受试者工作特征(ROC)曲线评估模型的预测价值。结果发生组患者D-二聚体(D-D)、左心房内径(LAD)、红细胞体积分布宽度(RDW)水平均高于未发生组患者,差异均有统计学意义(P﹤0.05)。多因素分析结果显示,D-D、LAD、RDW水平均是左心耳封堵术后HBR患者发生VTE的独立影响因素(P﹤0.05)。构建预测模型Y=0.791×D-D+0.140×LAD+1.058×RDW-30.998。ROC曲线显示D-D、LAD、RDW的曲线下面积(AUC)分别为0.833、0.739、0.731,具有较好预测价值。结论LAD、D-D、RDW水平均是HBR患者左心耳封堵术后发生VTE的影响因素。Objective To investigate the influencing factors of venous thromboembolism(VTE)after left atrial appendage closure in patients with high blood risk(HBR).Method The clinical date of 252 patients with HBR treated in Shanghai Sixth People's Hospital from September 2021 to April 2023 were collected.According to the occurrence of VTE,they were divided into occurrence group(n=38)and without occurrence group(n=214).The clinical characteristics of all patients were collected,and the influencing factors of VTE after left atrial aural occlusion in HBR patients were analyzed by binary Logistic regression model and a predictive model was constructed.Meanwhile,receiver operating characteristics(ROC)curve was used to evaluate the predictive value of the model.Result The levels of D-dimer(D-D),left atrial diameter(LAD)and red blood cell volume distribution width(RDW)in patients with occurrence group were higher than those in patients without occurrence group,the differences were statistically significant(P<0.05).The results of multi-factor analysis showed that D-D,LAD and RDW levels were independent influencing factors for VTE in HBR patients after left atrial appendage closure(P<0.05).The prediction model Y=0.791×D-D+0.140×LAD+1.058×RDADW-30.998 was constructed.The ROC curve showed that the area under the curve(AUC)of D-D,LAD and RDW were 0.833,0.739 and 0.731,respectively,which had good prediction value.Conclusion LAD,D-D and RDW levels were all influential factors for VTE after left atrial appendage closure in HBR patients.

关 键 词：左心耳封堵术 预测模型 D-二聚体 左心房内径 红细胞分布宽度 

分 类 号：R543[医药卫生—心血管疾病]