非瓣膜性房颤患者肱动脉FMD、颈动脉IMT及左房容积与CHA2DS2-VASc评分的关系

The Realtionship between Brachial artery FMD, Carotid Artery IMT, Left Atrial Volume and CHA 2DS2-VASc Score in Patients with Non-valvular Atrial FiBrillation

目的:研究非瓣膜性房颤患者肱动脉血管内皮功能(flow-mediate dilation,FMD)、颈动脉内中膜厚度(intima-media thickness,IMT)、左房容积(left atrial volume,LAV)和CHA2DS2-VASc评分的关系。方法:选取2018年1月-2019年6月间在我院门诊及住院的非瓣膜性房颤患者155例作为观察组,所有非瓣膜性房颤患者均通过心电图和或24小时动态心电图明确诊断为持续性心房颤动并使用CHA2DS2-VASc评分表进行评分分组。150例年龄、性别、吸烟史相匹配非房颤者作为对照组。分别比较两组各项指标的差别,旨在更深入研究非瓣膜性房颤患者肱动脉FMD、颈动脉IMT、左房容积和CHA2DS2-VASc评分的关系。结果:观察组与对照组FMD、IMT及LAV差异均有统计学意义(P<0.05);低中危组和高危组患者FMD、IMT及LAV差异均有统计学意义(P<0.05);ROC曲线分析显示,IMT AUC(0.491,P>0.05),诊断价值低;FMD AUC(0.711,P<0.05),诊断截断值8.04%,敏感度80.0%,特异度54.2%;LAV AUC(0.664,P<0.05),诊断截断值35.57ml,敏感度66.0%,特异度73.8%。可见FMD和LAV有较好的诊断价值,而当二者联用AUC(0.758,P<0.05),敏感度67.0%,特异性72.9%,联用诊断准确性更高。结论:肱动脉FMD、颈动脉IMT及左房容积LAV与非瓣膜性房颤缺血性卒中相关,相对颈动脉IMT而言,肱动脉FMD及左房容积LAV是更为敏感和特异的卒中预测因子,二者联合应用有助于提高预测的准确性。

Objective:To investigate the relationship between brachial artery endothelial function(FMD),carotid artery medial media thickness(IMT)and left atrial volume(LAV)and cha2ds2-vasc score in patients with nvaf.Methods:155 cases of patients with nvaf who were admitted to our hospital from January 2018 to June 2019 were selected as the observation group.All patients with nvaf were clearly diagnosed as persistent atrial fibrillation through electrocardiogram(ecg)and 24-hour dynamic electrocardiogram(CGS),and the cha2ds2-vasc rating scale was used for scoring groups.150 patients with age,sex and smoking history were used as control group.The differences between the two groups were compared,and the correlation between the LAV and cha2ds2-vasc scores of brachial artery FMD,carotid artery IMT and left atrial volume in patients with nvaf was further discussed.Results:The differences of FMD,IMT and LAV between the observation group and the control group were statistically significant(P<0.05).The differences of FMD,IMT and LAV between low-middle risk group and high-risk group were statistically significant(P<0.05).ROC curve analysis showed that IMT AUC(0.491,P>0.05)was of low diagnostic value.FMD AUC(0.711,P<0.05),diagnostic cut-off value 8.04%,sensitivity 80.0%,specificity 54.2%;LAV AUC(0.664,P<0.05),diagnostic cut-off value 35.57ml,sensitivity 66. 0%,specificity 73. 8%. It can be seen that FMD and LAV have better diagnostic value,while when the two arecombined with AUC ( 0. 758,P < 0. 05) ,the sensitivity is 67. 0%,the specificity is 72. 9%,and the diagnostic accuracyis higher. Conclusion: FMD,IMT and LAV were correlated with ischemic stroke in patients with nvaf. Compared withIMT,FMD and LAV were more sensitive and specific predictors of stroke,and their combined application could improve theaccuracy of the prediction.