脂蛋白(a)在评估慢性房颤患者左心房血栓形成中的临床价值

Clinical valuation of liporotein(a) in evalued left atrial thrombus of patients with chronic atrial fibrillation

目的 :探讨脂蛋白 (a) [Lp(a) ]在慢性房颤患者左心房血栓形成中的价值。方法 :对 6 2例慢性房颤患者实施经食道超声检查 (TEE)或二尖瓣置换术探查左心房血栓 ,同时检测血Lp(a)、D 二聚体 (D Dimer)和纤溶酶原活性 (PIg)等凝血指标 ,并对其结果进行对照性分析。结果 :(1)高Lp(a)水平患者左心房血栓检出率为 5 6 %明显高于低Lp(a)水平者血栓检出率 13 % (P =0 .0 0 13)。 (2 ) 45例慢性房颤患者经TEE检查发现左心房自发显影 (SEC)≥ 2级者 2 8例。其中 ,高Lp(a)水平者 5例 ,血栓发生率占 10 0 % ;低Lp(a)水平者 2 3例 ,发生血栓者 4例 ,血栓发生率占 17% (P =0 .0 0 135 )。 (3)血栓组D Dimer、Lp(a)水平明显高于非血栓组 ;高Lp(a)水平组D Dimer水平明显高于低Lp(a)水平组。结论 :高Lp(a)水平与左心房血栓形成高度相关 。

Objective: To explore the valutation of Lp(a) for left atrial thrombus in patients with chronic atrial fibrillation.Methods: 62 patients with chronic atrial fibrillation underwent transesophageal echocardiography(TEE) or mitral valve replacement surgery to detect left atrial thrombus,measure serum concentration of lipoprotein(a),D dimer,Plasminogen activity level etc,analysing their result contrastively.Results: (1)Left atrial thrombus was significantly more frequency in the high Lp(a) group(56%) than in the low Lp(a) group(13%) ( P =0.0013).(2)There are 28 patients with spontaneous echo contrast(SEC) of left atrium≥2 grade in the 45 patients detected by TEE,left artial thrombus were present in 5(100%) of 5 patiens with high Lp(a) and SEC.left atrial thrombus were present in 4(17%) of 23 patiens with low Lp(a) and SEC ( P = 0.00135) .(3)The levels of Lp(a) and D Dimer were highter in the patients with left atrial thrombus than the patients without left atrial thrombus.Conclusion: Elevated serum levels of Lp(a) relate to thrombosis and it is a risk factor for left atrial thrombosis in patiens with chronic atrial fibrillation.