左心房功能结合血小板参数变化对非瓣膜性心房颤动血栓栓塞风险的评价研究

Evaluation on risk of thromboembolism by left atrial function and platelet parameters in patients with non-valvular atrial fibrillation

目的通过检测非瓣膜性心房颤动患者左心房功能和血小板参数变化,以期获得有价值的评价患者血栓栓塞风险的临床客观指标。方法将118例心房颤动患者按照心房颤动指南分为4组:阵发性心房颤动、持续性心房颤动、长程持续性心房颤动、永久性心房颤动组;均进行常规心脏超声检查,观察左心房前后径(LAD)、左心室射血分数(LVEF)等指标;并利用二维斑点追踪显像(2D—STI)观察左心房功能变化[收缩期左心房心肌应变率(mSRs)、舒张早期左心房心肌应变率(mSRe)、舒张晚期左心房应变率(mSRa)]。同时检测血小板平均容积(MPV)、血小板相关组织因子(TF)及P-选择素。结果与阵发性心房颤动组比较,长程持续性心房颤动、永久性心房颤动患者LAD、MPV、TF、P-选择素均明显升高(均P<0.01),mSRs、mSRe、mSRa及LVEF值均明显降低(均P<0.01),持续性心房颤动组变化不明显(均P>0.05);与其他类型的心房颤动组相比,永久性心房颤动组CHA_2DS_2-VASc评分升高(P<0.05),血栓栓塞事件发生率亦较高;CHA_2DS_2-VASc评分与血栓栓塞事件有相关性(P<0.05);CHA_2DS_2-VASc评分为血栓栓塞事件的独立危险因素(OR=1.522);mSRs、mRSe、TF、MPV与CHA_2DS_2-VASc评分有相关性(P<0.05或0.01)。结论左心房功能变化(mSRs、mRSe)和血小板参数(MPV、TF)可以作为评估非瓣膜性心房颤动血栓栓塞风险的客观指标。

Objective To evaluate the risk of thromboembolism by left atrial function and platelet parameters in patients with non-valvular atrial fibrillation （AF）. Methods One hundred and eighteen patients with atrial fibrillation were classified in four groups： paroxysmal AF, persistent AF, longstanding persistent AF, permanent AF. Patients underwent conventional cardiac ultrasonography and two-dimensional speckle tracking imaging （2D-STI） examinations; the left atrium diameter （LAD）, left ventricular ejection fraction （LVEF） and other left atrial function indicators （mSRs; mSRe; mSRa） were observed. At the same time, the platelet parameters （MPV, TF, sP-selectin） were measured. Results Compared with paroxysmal AF, the values of LAD,MPV, TF and sP-selectin were significantly were increased in longstanding persistent AF and permanent AF （P〈0.01）, the values of mSRs, mSRe, mSRa and EF were decreased significantly （P〈0.01）; there were no significantly changes of above indicators in persistent AF （P 〉0.05）. Compared with other types of AF, the CHA2DS2-VASc scores and the incidence of thromboembolic events in permanent AF were increased significantly （P 〈0.05）. CHA2DS2-VASc score was significant correlated with thromboembolic events （P〈0.05）, and CHA2DS2-VASc score was the independent risk factor of the thromboembolic events （OR=1.522）; and the CHA2DS2-VASc score was significant correlated with mSRs, TF, mRSe and MPV （P〈0.05 or 0.01）. Con- clusion The risk of thromboembolism is increased significantly in patients with permanent AF. The left atrial function parameters mSRs, mRSe and platelet parameters MPV, TF may be used as objective indicators to evaluate the risk of thromboembolism in patients with non valvular atrial AF.