慢性心房颤动患者心房自发声学显影与血流动力学和凝血标记物关系的研究

Hemostatic and hemodynamic abnormalities associated with left atrial spontaneous echo contrast in patients with chronic atrial fibrillation

目的 研究瓣膜性心房颤动 (房颤 )和非瓣膜性房颤患者左心房自发声学显影 (SEC)的形成机制。方法 患者 6 1例分为 3组 ,其中健康对照组 17例 ,非瓣膜性房颤组 2 3例和瓣膜性房颤组 2 1例。测定血浆纤维蛋白原 (Fg)、血管性血友病因子 (vWF)、D 二聚体 (DD)、血小板颗粒膜糖蛋白 14 0 (GMP 14 0 )、凝血酶抗凝血酶Ⅲ复合物 (TAT)和纤溶酶原激活物抑制物 1(PAI 1) ;应用经食管超声心动图技术测量房颤患者左心耳和肺静脉血流速度 ;应用背向散射积分 (IBS)技术定量测定左心耳SEC。结果 与对照组比较 ,房颤患者血浆Fg、vWF、DD、TAT和PAI 1显著升高 (P <0 0 5 ) ,GMP 14 0差异无显著性 (P >0 0 5 ) ;房颤两组间差异无显著性。相关分析结果 ,瓣膜性房颤组左心房SEC与TAT正相关 (r =0 6 4 ,P =0 0 0 2 6 ) ,与肺静脉血流D波平均流速负相关 (r =-0 4 9,P =0 0 4 4 ) ,其余无相关性 ;非瓣膜性房颤组左心房SEC与左心耳排空血流流速积分负相关 (r= - 0 4 3,P =0 0 4 5 ) ,与肺静脉血流D波平均流速负相关 (r =- 0 4 3,P =0 0 4 8) ,其余无相关性。结论 血液高凝状态和局部血流淤滞可能是瓣膜性房颤左心房SEC形成的主要机制 ;局部血流动力学紊乱可能是非瓣膜性房颤左心房SEC形成的主要机制 ,血浆凝血?

Objective To investigate the mechanism of left atrial spontaneous echo contrast(SEC)in patients with nonvalvular atrial fibrillation(NVAF)and valvular atrial fibrillation(VAF).Methods Seventeen normal subjects(as control group),23 patients with NVAF and 21 patients with VAF were included.Plasma fibrinogen(Fg),vov Willebrand factor(vWF),D-dimer(DD),P-selectin、thrombin-antithrombin complexes(TAT)and plasminogen activator inhibitor-1(PAI-1)were measured.Left atrial appendage flow,pulmonary venous flow and left atrial SEC were detected by transesophageal echocardiography.Results Fg,vWF,DD,TAT and PAI-1 were increased significantly in patients with atrial fibrillation compared with control(P<0.05～0.001),but no significant difference between patients with NVAF and those with VAF.Left atrial SEC correlated positively with plasma level of TAT(r=0.64,P=0.0026),and negatively with mean velocity of diastolic pulmonary venous flow in patients with VAF(r=-0.49,P=0.044).Left atrial SEC correlated negatively with the mean velocity of diastolic pulmonary venous flow(r=-0.43,P=0.048)and with the velocity time integral of left atrial appendage empty flow(r=-0.43,P=0.045),and no significant correlation with hemostatic markers in patients with NVAF.Conclusions Hemostatic and hemodynamic abnormalities are associated with left atrial SEC in patients with VAF.Reduced left appendage and pulmonary venous flow velocity is a major determinant for the left atrial SEC in patients with NVAF.Further studies of predictive value of hemostatic markers for left atrial SEC in patients with NVAF are needed. [