阻塞性睡眠呼吸暂停低通气综合征对非瓣膜性心房颤动患者左心房血栓形成的影响

The effect of obstructive sleep apnea hypopnea syndrome on left atrial appendage thrombus in patients with nonvalvular atrial fibrillation

目的 探讨阻塞性睡眠呼吸暂停低通气综合征（OSAHS）对非瓣膜性心房颤动（房颤）患者左心房血栓形成的影响.方法 回顾性分析2013年3月～2015年3月在郑州大学第-附属医院心血管内科拟行房颤射频消融术的非瓣膜性房颤患者,经食道心脏彩色多普勒超声（心脏彩超）检查确诊左心房是否有血栓形成分为两组,有左心房血栓形成作为试验组,无血栓患者作为对照组.收集患者的-般情况、合并疾病、心脏彩超指标、实验室检查指标等,比较两组患者各个指标的差异,并对差异有统计学意义的指标进行多因素Logistic回归分析.结果 左心房有血栓患者共28例（占29.5%）,与67例对照组相比,试验组患者合并OSAHS（75.0% vs. 46.3%,P=0.011）、非阵发性房颤（持续性和长程持续性房颤）（67.9% vs. 44.8%,P=0.015）和糖尿病（39.3% vs. 11.9%,P=0.003）的比例更高,CHA2DS2-VASc评分[2（1,3） vs. 1（1,2）,P=0.016]、左心房内径[40（38,43）mm vs. 37（34,40）mm,P=0.008]明显升高,差异有统计学意义.多因素Logistic回归分析结果显示OSAHS、糖尿病、CHA2DS2-VASc评分和左心房内径是非瓣膜性房颤患者左心房血栓形成的独立危险因素（OR分别为4.94、3.36、1.77、1.12,P均〈0.05）.结论 非瓣膜性房颤患者左心房血栓形成不仅与糖尿病、左心房内径和CHA2DS2-VASc评分等传统的因素有关,也与OSAHS独立相关.

Objective This study sought to assess the impact of obstructive sleep apnea hypopnea syndrome（OSAHS） on the risk of left atrial appendage （LAA） thrombus in patients with nonvalvular atrial fibrillation（AF）. Method From March 2013 to March 2015, 95 consecutive patients with refractory AF who underwenttransesophageal echocardiography （TEE） before AF ablation were included. The patients were divided intotwo groups according to the presence （n=28） or absence （n=67） of LAA thrombus. Clinical characteristics,echocardiographic measures and biochemical parameters were compared to determine variables predicting LAAthrombus. Multivariate Logistic regression analysis was used to analyze the independent risk factors for LAAthrombus. Results LAA thrombus was observed in 28 （29.5%） patients. Patients with thrombus exhibited higherrate of OSAHS （75.0% vs. 46.3%, P=0.011）, nonparoxysmal AF （67.9% vs. 44.8%, P=0.015） and diabetesmellitus （39.3% vs. 11.9%, P=0.003）, higher CHA2DS2-VASc score [2（1,3） vs. 1（1,2）, P=0.016] andleft atrium diameter [40（38,43） mm vs. 37（34,40） mm, P=0.008] compared with those without thrombus.Multivariate Logistic regression analysis revealed OSAHS （OR4.94, 95%CI：1.49-16.41, P=0.009）,diabetes mellitus （OR：3.36, 95%CI：1.00-11.28, P=0.048）, CHA2DS2-VASc score （OR：1.77, 95%CI：1.11-2.82, P=0.016） and left atrium diameter （OR：1.12, 95%CI：1.02-1.64, P=0.023） to be independentlyassociated with thrombus formation. Conclusions OSAHS was associated with the presence of LAA thrombus innonvalvular AF patients independently of diabetes mellitus, CHA2DS2-VASc score and left atrium diameter.