非瓣膜性心房颤动左心房和左心耳血栓形成的危险因素分析

Predictors of occurrence of left atrium and left appendage thrombosis in patients with nonvalvular atrial fibrillation

目的研究≤65岁非瓣膜病性心房颤动（AF）患者左心房（LA）和心耳（LAA）内血栓形成的危险因素，为临床干预提供依据。方法选择2005年1月至2008年4月广东省心血管病研究所住院的208例非瓣膜性AF患者，根据食管超声（TEE）结果分为两组：LA和LAA血栓组（23例）和无血栓组（185例）。对患者既往病史、烟酒嗜好、临床检验指标和超声影像学指标等相关因素进行单因素及多因素Logistic回归分析。结果血栓组和无血栓组左心房内径为（42．2±6．5）mm比（34．9±4．4）mm，P=0．000）；左室舒张末内径为（48．5±5．7）mm比（45．7±4．1）mm，P=0．000；左室射m分数为（59．3±1．3）mm比（65．1±6．6）mFfl，P=0．050；纤维蛋白原为（3．5±1．0）g／L比（3．0±0．7）g／L，P=0．000；脑梗死和短暂性脑缺血史分别为6／23、7／185，P=0．000；胸片心胸比增大分别为20／23、60／185（P=0．000）。Logistic回归分析发现左心房内径（OR：1．211，95％CI1．062～1．381），胸片心胸比（OR=5．242，95％CI1．138～24．144），脑梗死和短暂性脑缺血发作史（OR=5．881，95％CI1．152—30．008）和纤维蛋白原量（OR=2．242，95％CI1．152～4．805）是LA和LAA内血栓形成独立危险因素（P〈0．05）。结论当≤65岁非瓣膜性AF患者有血栓形成的独立危险因素时应该加强抗凝治疗，以预防左心房血栓。

Objective To determine the predictors of thrombosis in left atrium （LA） or left atrial appendage （LAA） in patients with nonvalvular atrial fibrillation. Methods Two hundred and eight patients under 65 year old with atrial fibrillation （AF） were included and all of them received examination of transesophageal echocardiography （TEE）. Thrombus formation in LA/LAA was found in 23 patients （thrombus group） but absent in the remaining 185 patients （nonthrombus group）. All patients were analyzed by univariate regression and binary logistic regression to investigate the relationship between the occurrence of LA/LAA thrombosis and these factors （such as case history, smoking/drinking preference, indicators of clinical blood examination and ultrasound imaging study, etc ） Results Univariate analysis revealed that diameter of LA[ （34. 9 ±4.4）mm vs （42.2 ±6. 5）mm, P =0. 000], ratio of chest and heart （60/185 vs 20/23 P = 0. 000）, brain infarction/transient ischemic attack （TAI） （7/185 vs 6/23 P = 0.000）, smoking （30/185 vs8/23, P=0.030）, fibrinogen （FIB） [（3.0±0.7）g/Lvs （3.5±1.0） g/L, P =0. 000], coronary artery disease （CAD） （ 10/185 vs 6/23, P =0. 000） and LVDd[ （45.7 ±4. 1 ） mm vs （48.5±5.7）mm, P=0.000]andLVEF[ （65.1 ±6.6）mmvs （59.3±1.3）mm, P=0.050]were significant between nomhrombus group and throrrthus group （ P 〈 0.05 ）. However binary logistic regression analysis identified that only LAD, ratio of chest and heart, brain infarction/TAI and FIB were the significant and independent predictors of LA/LAA thrombosis. Conclusion Diameter of LA, ratio of chest and heart, brain infarction/TAI and FIB are independent risk factors of thrombosis in patients under 65 year old with nonvalvular atrial fibrillation. These patients need a better anticoagulation.