尿酸和红细胞分布宽度与非瓣膜性心房颤动患者左心房血栓形成的关系及其预测价值研究

Relations of UA and RDW with Left Atrial Thrombosis in Patients with Non-valvular Atrial Fibrillation and Their Predictive Value

背景非瓣膜性心房颤动(NVAF)是引起血栓栓塞并发症的主要原因,左心耳是NVAF患者血栓形成的主要部位,NVAF患者左心房血栓形成的影响因素及针对性防治措施是当前研究热点之一。目的分析尿酸、红细胞分布宽度(RDW)与NVAF患者左心房血栓形成的关系及其预测价值。方法选取2013年5月—2018年1月重庆市南川区人民医院收治的疑似左心房血栓形成的NVAF患者320例,根据左心房血栓形成情况分为左心房血栓形成组50例和非左心房血栓形成组270例。比较两组患者一般资料〔包括年龄,性别,体质指数(BMI),吸烟史,饮酒史,高血压病史,糖尿病病史,冠心病病史,充血性心力衰竭、缺血性脑卒中、持续性心房颤动发生情况及心房颤动病程〕、实验室检查指标〔包括RDW、白细胞计数(WBC)、红细胞计数(RBC)、肌酐(Cr)、尿酸、天冬氨酸氨基转移酶(AST)、丙氨酸氨基转移酶(ALT)〕;尿酸、RDW与NVAF患者左心房血栓形成的相关性分析采用Spearman秩相关分析,NVAF患者左心房血栓形成的影响因素分析采用多因素Logistic回归分析;绘制ROC曲线以评价尿酸、RDW及二者联合检测对NVAF患者左心房血栓形成的预测价值。结果 (1)两组患者年龄、性别、BMI、吸烟史、饮酒史、高血压病史、糖尿病病史及冠心病病史、WBC、RBC、Cr、AST、ALT比较,差异无统计学意义(P>0.05);左心房血栓形成组患者充血性心力衰竭、缺血性脑卒中、持续性心房颤动发生率及尿酸高于非左心房血栓形成组,心房颤动病程长于非左心房血栓形成组,RDW小于非左心房血栓形成组(P<0.05)。(2)Spearman秩相关分析结果显示,尿酸(rs=0.536)、RDW(rs=0.468)与NVAF患者左心室血栓形成呈正相关(P<0.05)。(3)多因素Logistic回归分析结果显示,尿酸〔OR=2.044,95%CI(1.459,2.864)〕、RDW〔OR=1.917,95%CI(1.325,2.780)〕是NVAF患者左心房血栓形成的独立危险因素(P<0.05)。(4)绘制ROC曲线发现,尿酸预测NVAF患者左心房血栓形成的曲线下面积为0.80〔95%CI(0.69,0.87)〕,灵敏度、特异度分别为83.3%、71.4%;RDW预测NVAF患者左心房血栓形成的曲线下面积为0.81〔95%CI(0.71,0.89)〕,灵敏度、特异度分别为76.5%、81.3%;尿酸联合RDW预测NVAF患者左心房血栓形成的曲线下面积为0.84〔95%CI(0.75,0.92)〕,灵敏度、特异度分别为88.9%、85.7%。结论尿酸、RDW与NVAF患者左心房血栓形成呈正相关,是左心房血栓形成的独立危险因素,且二者联合检测对NVAF患者左心房血栓形成具有一定预测价值。

Background Non-valvular atrial fibrillation(NVAF)is the main cause of thromboembolic complications,left atrial appendage is the major site of thrombosis in patients with NVAF,moreover influencing factors of left atrial thrombosis and targeted controlling measures are current research hotspots in patients with NVAF. Objective To analyze the relations of UA and RDW with left atrial thrombosis in patients with non-valvular atrial fibrillation and their predictive value. Methods From May 2013 to January 2018,320 NVAF patients suspected as left atrial thrombosis were selected in the People's Hospital of Nanchuan District,Chongqing,and they were divided into A group(complicated with left atrial thrombosis,n=50)and B group(did not complicated with left atrial thrombosis,n=270) according to the incidence of left atrial thrombosis. General information(including age,gender,BMI,history of smoking,drinking,diabetes and coronary heart disease,incidence of congestive heart failure,ischemic stroke and persistent atrial fibrillation,and course of atrial fibrillation)and laboratory examination results(including RDW,WBC,RBC,Cr,UA,AST and ALT)were compared between the two groups;Spearman rank correlation analysis was used to analyze the correlations of UA,RDW with left atrial thrombosis in patients with NVAF,multivariate Logistic regression analysis was used to analyze the influencing factors of left atrial thrombosis in patients with NVAF,and ROC curve was drawn to analyze the predictive value of UA,RDW and UA combined with RDW on left atrial thrombosis in patients with NVAF. Results (1)No statistically significant difference of age,gender,BMI,history of smoking,drinking,hypertension,diabetes or coronary heart disease,WBC,RBC,Cr,AST or ALT was found between the two groups(P>0.05);incidence of congestive heart failure,ischemic stroke and persistent atrial fibrillation,and UA in A group were statistically significantly higher than those in B group,course of atrial fibrillation in A group was statistically significantly longer than that in B group,RDW in A group was statistically significantly wider than that in B group(P<0.05).(2)Spearman rank correlation analysis result showed that,UA(rs=0.536)and RDW(rs=0.468) was positively correlated with left atrial thrombosis in patients with NVAF,respectively(P<0.05).(3)Multivariate Logistic regression analysis results showed that,UA〔OR=2.044,95%CI( 1.459,2.864)〕and RDW〔OR=1.917,95%CI( 1.325,2.780)〕 were independent risk factors of left atrial thrombosis in patients with NVAF(P<0.05).(4)ROC curve showed that,AUC of UA was 0.80〔95%CI(0.69,0.87)〕in predicting left atrial thrombosis in patients with NVAF,the sensitivity was 83.3%, the specificity was 71.4%;AUC of RDW was 0.81〔95%CI(0.71,0.89)〕in predicting left atrial thrombosis in patients with NVAF,the sensitivity was 76.5%,the specificity was 81.3%;AUC of UA combined with RDW was 0.84〔95%CI(0.75,0.92)〕 in predicting left atrial thrombosis in patients with NVAF,the sensitivity was 88.9%,the specificity was 85.7%. Conclusion UA and RDW is positively correlated with left atrial thrombosis in patients with NVAF,respectively,both UA and RDW are independent risk factors of left atrial thrombosis in patients with NVAF,moreover UA combined with RDW has certain predictive value on left atrial thrombosis in patients with NVAF.