老年高血压并存心房颤动患者左心房内径和血栓前状态研究

Study of left fibrillation Geriatrics, atrial diameters and prothrombotic state in senile patients with hypertension and atrial

目的探讨老年高血压并存心房颤动（房颤）患者左心房内径（LAD）的变化及其与血栓前状态各指标的相关性。方法高血压患者105例，其中65例并存房颤（房颤组），40例无房颤（非房颤组），30例健康体检无高血压和房颤为对照组。用M型心脏超声测定LAD，同时检测其纤维蛋白原（Fg）、D-二聚体（D-Dimer）、血浆假性血友病因子（vwF）及红细胞压积（HCT），并进行比较。再将房颤患者分为阵发性房颤组和持续性房颤组，比较其LAD、Fg、D-Dimer、vwF、HCT。然后以LAD为因变量，Fg、D-Dimer、vwF、HCT为自变量，进行直线相关分析。结果房颤组与对照组和非房颤组比较，LAD为（43．56±6．72）mm与（31．63±4．32）mm和（36．28±5．83）mm（均P〈0．05），Fg为（4．24±0．59）g／L与（2．80±0．46）g／L和（3．09士0．49）g／L（均P〈0．05），D-Dimer为（0．43±0．13）mg／L与（0．18±0．08）mg／L和（0．28±0．10）mg／L（均P〈0．05）；房颤组vwF、HCT分别为（290．44±29．02）％、0．46±0．07，与对照组（84．15士20．26）％、0．34±0．03比较，差异有统计学意义（均P〈0．05）。非房颤组与对照组比较，LAD、D-Dimer差异有统计学意义（P〈0．05）。持续房颤组与阵发房颤组比较，LAD、Fg、D-Dimer、vwF、HCT差异有统计学意义（均P〈0．05），LAD与Fg（r=0．683）、D-Dimer（r=0．735）、vwF（r=0．763）、HCT（r=0．759）呈正相关（均P〈0．01）。结论LAD增大为房颤发生的危险因素，房颤患者存在血栓前状态，且LAD越大，血栓风险越大。

Objective To explore the relationship between left atrial diameters （LAD） and prothrombotic state in senile patients with hypertension （HT） and atrial fibrillation （AF）. Methods Totally 105 patients with essential hypertension were divided into 65 patients with atrial fibrillation and 40 cases without atrial fibrillation, and then patients with atrial fibrillation were subgrouped into paroxysmal and persistent atrial fibrillation groups. 30 healthy people without hypertension and atrial fibrillation were used as control group. LAD was determined by M type ultrasound cardiogram. Fibrinogen （Fg）, D-Dimer（D-Dimer）, yon willebrand （vwF） and haematocrit （HCT） were also measured as prothrombotic state and compared among the groups. Results In groups of HT with AF versus HT without AF versus control, LAD[（43.56 ± 6.72） mm vs. （36.28 ± 5.83） mm vs. （31.63±4.32）mm3, Fg[（4.24±0.59）g/L vs. （3.09 ±0.49）g/L vs. （2.80 ±0.46）g/L3, D-Dimer （（0.43±0.13）mg/L vs. （0.28±0.10）mg/L vs. （0.18±0.08）mg/L3,vwF（（290.44±29.02）% vs. （101.32±21.36）% vs. （84.15±20.26）%], HCT[（0.46±0.07）vs. （0.37±0.05）vs. （0.34±0.03）3 were significantly higher in HT patients with atrial fibrillation than those without atrial fibrillation and control （ all P〈 0.05）, and there were differences in LAD and D-Dimer （P〈0.05）, but not in Fg, vwF and HCT （all P〉0.05） between patients without atrial fibrillation and control. LAD[（46.75± 7.32）ram vs. （40.82±6.21）mm], Fg （（4. 68±0. 65）g/L vs. （3.85±0.53）g/L3, D-Dimer [（0.48± 0.16）mg/L vs. （0.40±0.12）mg/L3, vwF [（384.96±29.75）] vs. （209.43±28.63）%3 and HCT [（0.49±0.08）vs. （0.43±0.06）3 in persistent atrial fibrillation group were increased than those in paroxysmal atrial fibrillation group （P〈0.05）. Fg （r=0.683）, D-Dimer（r=0.735）, vwF（r= 0. 763） and HCT（r=0. 759）were correlated with LAD （all P〈0.01）. Conclusions Increased LAD might be one of the elevated risks of atrial fibrillation and a higher prothrombotic state is increasing with larger LAD in senile hypertension.