三维超声联合NLR、D-二聚体对老年非瓣膜性心房颤动的预测价值研究

The Predictive Value of Three-Dimensional Ultrasound Combined with NLR and D-dimer in Elderly Patients with Non-Valvular Atrial Fibrillation

目的:探析三维超声联合中性粒细胞/淋巴细胞比值(NLR)、D-二聚体对老年非瓣膜性心房颤动的预测价值。方法:选择2020年1月—2021年12月,本院收治的102例老年非瓣膜性心房颤动患者(观察组)和同期100例健康体检者(对照组)作为研究对象,用实时三维超声检查仪进行心动图检查,用全自动血细胞分析仪进行NLR表达水平的检测,用酶联免疫吸附法进行D-二聚体的检测。比较两组的三维超声心动图、NLR、D-二聚体检测结果差异,应用Logistic回归分析法探析三维超声心动图、NLR、D-二聚体与非瓣膜性心房颤动预后不良的关系,绘制受试者工作特征(ROC)曲线,分析三维超声心动图、NLR、D-二聚体在非瓣膜性心房颤动预后预测中的应用价值。结果:观察组、预后不良者的LVEDV、LVESV、RVEDV、RVESV、NLR、D-二聚体检测值显著高于对照组、预后良好者,观察组、预后不良者的LVEF、RVEF检测值显著低于对照组、预后良好者,差异有统计学意义(P<0.05)。Logistic回归分析结果显示,三维超声(LVEDV、LVESV、RVEDV、RVESV高表达)、NLR(高表达)、D-二聚体(高表达)是非瓣膜性心房颤动预后不良的影响因素(P<0.05)。绘制受试者工作特征(ROC)曲线结果显示,三维超声、NLR、D-二聚体三项指标联合预测非瓣膜性心房颤动预后情况的AUC(0.855,95%CI:0.768~0.942)最大,灵敏度、特异度分别为92.65%、91.18%(P<0.05)。结论:三维超声(LVEDV、LVESV、RVEDV、RVESV高表达)、NLR(高表达)、D-二聚体(高表达)是非瓣膜性心房颤动预后不良的影响因素,这三项指标可为非瓣膜性心房颤动的预后预测提供量化参考依据。

Objective:To investigate the predictive value of three-dimensional ultrasound combined with neutrophil/lymphocyte ratio(NLR)and D-dimer in elderly patients with non-valvular atrial fibrillation.Methods:From January 2020 to December 2021,102 elderly patients with non-valvular atrial fibrillation(observation group)and 100 healthy subjects(control group)admitted to our hospital during the same period were selected as the research objects.Cardiac examination,NLR expression level was detected by automatic blood cell analyzer,and D-dimer was detected by enzyme-linked immunosorbent assay.The differences in the detection results of three-dimensional echocardiography,NLR,and D-dimer between the two groups were compared,and the relationship between three-dimensional echocardiography,NLR,D-dimer and poor prognosis of non-valvular atrial fibrillation was analyzed by Logistic regression analysis.Receiver operating characteristic(ROC)curve analysis of three-dimensional echocardiography,NLR,and D-dimer in the prognosis prediction of non-valvular atrial fibrillation.Results:The detection values of LVEDV,LVESV,RVEDV,RVESV,NLR,and D-dimer in the observation group and patients with poor prognosis were significantly higher than those in the control group.Patients with good prognosis,while the detection values of LVEF and RVEF in the observation group and patients with poor prognosis were significantly lower than those in the control group.There was a statistically significant difference between the two groups and those with good prognosis(P<0.05).Logistic regression analysis showed that three-dimensional ultrasound(high expression of LVEDV,LVESV,RVEDV,and RVESV),NLR(high expression),and D-dimer(high expression)were the influencing factors of poor prognosis in non-valvular atrial fibrillation(P<0.05).The results of drawing receiver operating characteristic(ROC)curve showed that the combination of three-dimensional ultrasound,NLR,and D-dimer had the highest AUC(0.855,95%CI:0.768~0.942)in predicting the prognosis of non-valvular atrial fibrllation.The sensitivity and specificity were 92.65%and 91.18%respectively(P<0.05).Conclusion:Three-dimensional ultrasound(LVEDV,LVESV,RVEDV,RVESV high expression),NLR(high expression),and D-dimer(high expression)are the influencing factors of poor prognosis in non-valvular atrial fibrillation,which can provide quantitative reference for predicting the prognosis of non-valvular atrial fibrillation.