心房颤动患者高凝状态研究

Study of hypercoagulation state in patients with atrial fibrillation

目的 研究心房颤动（房颤）患者高凝相关指标及影响因素，探讨其临床意义。方法 根据房颤患者是否有心力衰竭分为两组：房颤1组为无心力衰竭者（30例），房颤2组为有心力衰竭者（30例）。具器质性心脏病且心功能正常的窦性心律患者（40例）为窦性心律组，另选33例正常健康者为正常对照组。在慢性房颤患者、心脏病无房颤患者和健康正常人中，用酶联免疫法测定血浆D-二聚体、用全自动血凝分析仪测定血浆纤维蛋白原（fibrinogen，Fg）。结果 房颤1组患者D-二聚体为474．5μg／L（220．0～843．9μg／L），房颤2组患者血浆D-二聚体为657．9心／L（365．8～1448，6μg／L），明显高于窦性心律组271．6μg/L（186.6～426．2μg／L）和正常对照组179．5μg／L（131．4～235．1μg／L），（P〈0．05）。房颤1组患者血菜Fg（3．74±0．76）g／L和房颤2组患者血浆Fg（4．25±0．95）g／L明显高于窦性心律组（3．26±0．80）g／L和正常对照组（2．97±0．72）g／L，（P〈0．05）。与房颤1组比，房颤2组患者D-二聚体、Fg显著升高（P〈0.05）。与左房内径〈40mm的房颤患者比，左房内径≥401Tim的房颤患者D-二聚体、Fg升高（P〈0．05）。结论 房颤患者存在着高凝状态，并且心力衰竭和左房扩大增加房颤的高凝状态，这些异常可能与房颤患者血栓形成和（或）栓塞事件相关。

Objective To investigate the hypercoagulation state markers in patients with atrial fibrillation and their clinical significance. Methods Sixty patients with chronic atrial fibrillation were divided into two groups, one group having no heart failure （group one, n=30） and the other having heart failure （group two, n=30）. There were two age-matched and sex-matched control groups, the normal sinus rhythm group including 40 patients with cardiovascular disease but in sinus rhythm and normal heart function, the health control group including 33 healthy subjects. The plasma fibrin D-dimer was assayed using enzyme linked immunoassay. Fibrinogen（Fg） was measured. Results Compared with the healthy control group and the normal sinus rhythm group, patients with atrial fibrillation （group one） had significant increase of fibrin D-dimer 474.5 μg/L （220.0-843.9 μg/L） and Fg（3. 74±0. 76） g/L, patients with atrial fibrillation and heart failure（group two） had significant increase of fibrin D - dimer 657.9 μg/L （365.8-1448.6 μg/L） and Fg（4.25±0.95） g/L,（ P 〈0.05）. Plasma Fg and D-dimer level were higher in group two than that in group one, （ P 〈 0.05）. In atrial fibrillation patients with left atrial diameter≥40 mm, Plasma Fg and D-dimer level were higher than those with left atrial diameter〈40 mm （ P〈0.05）. Conclusion Patients with atrial fibrillation show evidence of hypercoagulation, which may be correlated with the atrial thrombogenesis. In patients with atrial fibrillation, heart failure and left atrial diameter effect the levels of plasma D- dimer and Fg.