非瓣膜性房颤合并动脉粥样硬化患者的高凝状态研究

Study on hypercoagulation profiles in nonvavular persistent atrial fibrillation combined with atherosclerosis

目的观察持续性非瓣膜性房颤合并动脉粥样硬化患者凝血相关指标的变化。方法选择符合入选标准患者143例,其中持续性非瓣膜性房颤患者89例,窦性心律患者54例,根据有无房颤和动脉粥样硬化分为房颤合并动脉粥样硬化、房颤不合并动脉粥样硬化、窦性心律合并动脉粥样硬化和窦性心律不合并动脉粥样硬化组。所有患者记录一般临床资料,检测凝血酶原时间(PT)、活化的部分凝血活酶时间(APTT)、纤维蛋白原(FG)、D-二聚体(DDI)水平,由专人进行颈动脉彩超检查判断动脉粥样硬化。结果房颤合并动脉粥样硬化组PT、APTT明显低于房颤不合并动脉粥样硬化和窦性心律组;房颤合并动脉粥样硬化组FG、DDI水平明显高于房颤不合并动脉粥样硬化和窦性心律组。分别以DDI和FG为自变量,多个临床因素为因变量进行Logistic回归分析发现,房颤、左室射血分数和左房内径是DDI的预测因素,房颤、动脉粥样硬化和左房内径是FG的预测因素。结论非瓣膜性房颤合并动脉粥样硬化患者明显处于高凝状态,应加强抗凝治疗。

Objective To observe the prothrombotic state in patients with nonvavular persistent atrial fibrillation and atherosclerosis.Methods 143 patients with nonvavular persistent AF and 89 patients in SR who did not received anticoagulant therapy constituted the study group.The subjects＇ general characteristics were recorded and all participants received coagulation indices examination,including PT,APTT,Fibrinogen（FG） and D-dimer（DDI）.In addition,B-ultrasound was applied to scan carotid artery by designated person to judge atherosclerosis.Results PT and APTT in AF with atherosclerosis were shorter than in those without atherosclerosis or in SR.Levels of FG and DDI were significantly higher in AF patients with atherosclerosis than in those without atherosclerosis or in SR.Binary logistic regression showed that AF,LEVF and LAD were predictive factors of DDI,and AF,atherosclerosis and LAD were predictive factors of FG.Conclusion The patients with AF and atherosclerosis might be in a prothrombotic state,and could benefit from intensive anticoagulative therapy.