基于血栓栓塞风险对不同病因所致血瘀证非瓣膜性房颤患者临床信息的评价研究

Evaluation of Clinical Information of Non-valvular Atrial Fibrillation Patients with Blood Stasis Syndromes Caused by Different Etiological Factors Based on Thromboembolic Risk

[目的]探究不同病因所致血瘀证非瓣膜性房颤(atrial fibrillation, AF)血栓栓塞风险与凝血及血小板相关指标、炎症指标和超声心动图参数等临床信息的相关性。[方法]纳入血瘀证AF患者100例,根据AF血瘀证病因分型标准分为气滞血瘀、气虚血瘀、痰浊血瘀、寒凝血瘀等4个血瘀证型,分别比较分析各证型血栓栓塞风险、血瘀证积分、房颤卒中风险(CHA2DS2-VASc)评分、D-二聚体(D-Dimer, D-D)、纤维蛋白原(fibrinogen,FIB)、组织因子(tissue factor,TF)、血小板平均容积(mean platelet volume,MPV)、可溶性P-选择素(sP-selectin,sP-S)、C反应蛋白(C-reactive protein,CRP)、中性粒细胞/淋巴细胞绝对值比值(neutrophil to lymphocyte ratio,NLR)和左心房内径(left atrium diameter,LA)、左心室舒张末期内径(left ventricular internal diastolic diameter,LVIDd)、左心室射血分数(left ventricular ejection fraction,LVEF)等临床信息在不同证型间的差别及相关性。[结果]寒凝血瘀证及痰浊血瘀证血栓栓塞风险明显较高。各证型间血瘀证积分排序从高到低为:寒凝血瘀>痰浊血瘀>气虚血瘀>气滞血瘀,与CHA2DS2-VASc评分的排序结果一致。D-D、FIB、TF、MPV、sP-S、CRP、NLR等指标在寒凝血瘀证及痰浊血瘀证患者中水平相对较高。LA、LVIDd、LVEF等超声心动图参数在各证型间比较无统计学差异(P>0.05)。回归分析示血瘀证积分与血栓栓塞事件具有显著相关性(P=0.015)。D-D、CRP与血瘀证积分呈正相关(P=0.000、P=0.018)。[结论]寒凝血瘀证及痰浊血瘀证AF患者血栓栓塞风险较高,为AF血栓栓塞"高危血瘀证型"。血瘀证积分或可作为AF血栓栓塞事件的独立预测因素。在筛选AF血栓栓塞事件高危患者时,D-D、CRP具有重要的参考价值。同时凝血及血小板相关参数(D-D、FIB、TF、MPV、sP-S)和炎症指标(CRP、NLR)或可为高危血瘀证型AF患者中医辨证提供客观依据。

[Objective] To investigate the relationships among the thromboembolic risk and coagulation parameters, inflammatory indexes, echocardiography parameters in atrial fibrillation(AF) patients with blood stasis syndromes caused by different etiological factors. [Methods] One hundred cases of AF were divided into four groups in accordance with the standard of blood stasis syndromes caused by different etiological factors. The thromboembolic risk, blood stasis syndrome score, CHA2DS2-VASc score,D-Dimer(D-D),fibrinogen(FIB),tissue factor(TF),mean platelet volume(MPV),sP-selectin(sP-S),C-reactive protein(CRP),neutrophil to lymphocyte ratio(NLR) and left atrium diameter(LA),left ventricular internal diastolic diameter(LVIDd),left ventricular ejection fraction(LVEF) and other clinical information were compared between different syndromes to find the correlation among the indexes. [Results] The thromboembolic risk in blood stasis syndromes caused by cold coagulation and phlegm coagulation was obviously higher. Blood stasis syndrome scores in each syndrome were from high to low: cold coagulation and blood stasis → phlegm coagulation and blood stasis → Qi deficiency and blood stasis → Qi stagnation and blood stasis, which was consistent with the ranking results of CHA2DS2-VASc scores. Levels of D-D, FIB, TF, MPV, sP-S, CRP and NLR were higher in the blood stasis syndromes caused by cold coagulation and phlegm coagulation. There is no statistical difference in echocardiographic parameters such as LA, LVIDd and LVEF(P >0.05). Regression analysis showed that the blood stasis syndrome score was significantly correlated with thromboembolism(P=0.015). And D-D, CRP were positively correlated with blood stasis syndrome score( P=0.000, P=0.018, respectively). [Conclusion]Thromboembolic risk is higher in AF patients with blood stasis syndromes caused by cold coagulation and phlegm coagulation, which can be regarded as the "high risk blood stasis syndromes" of AF thromboembolism. Blood stasis syndrome score can be used as an independent predictor of AF thromboembolism. D-D and CRP have important reference values in screening high risk patients with AF thromboembolism. Coagulation parameters(D-D,FIB, TF, MPV, sP-S) and inflammatory indexes(CRP, NLR) can provide an objective basis for the syndrome differentiation of AF patients with high risk blood stasis syndromes.