红细胞分布宽度与老年非瓣膜性心房颤动患者左心耳血栓状态的相关性

Relationship between red blood cell distribution width and left atrial appendage thrombogenic milieu in old patients with non-valvular atrial fibrillation

目的探讨红细胞分布宽度(RDW)与老年非瓣膜性心房颤动(NVAF)患者左心耳血栓状态(LAATM)的相关性。方法回顾性分析2010年1月至2016年12月在北京朝阳医院接受经食管超声心动图检查的782例年龄>60岁的NVAF患者的资料,根据超声心动图检查结果将患者分为有LAATM组(65例)和无LAATM组(717例)。比较两组患者的RDW水平,采用多因素logistic回归分析RDW是否为NVAF患者发生LAATM的独立相关因素,通过受试者工作持证(ROC)曲线及曲线下面积评估RDW对于判断LAATM存在与否的价值。结果两组间年龄、心力衰竭病史、心房颤动病程及类型、N末端B型利钠肽原(NT-proBNP)水平、RDW水平、左心室收缩末径内径、左心室舒张末径内径、左心室射血分数(LVEF)、左心房内径、CHADS2评分及CHA2DS2-VASc评分比较,差异均有统计学意义(P均<0.05);LAATM组患者的RDW水平高于无LAATM组患者[13.4%(12.6%,14.1%)比12.1%(11.2%,13.0%),P<0.001]。多因素logistic回归分析显示RDW水平与LAATM独立相关(OR=4.07,95%CI 2.09~7.91,P<0.001)。ROC曲线下面积为0.81(95%CI 0.74~0.88,P<0.001);RDW=13.1%时,患者可能存在LAATM(敏感度为73.1%,特异度为80.5%)。结论在老年NVAF患者中,RDW水平与LAATM独立相关,RDW水平对于判断LAATM的存在具有一定参考价值。

Objective To estimate the correlation between red cell distribution width(RDW)level and left atrial appendage thrombogenic milieu(LAATM)in elderly patients with non-valvular atrial fibrillation(NVAF).Methods This was a retrospective case-control study.A total of 782 NVAF patients(age>60 years old)who finished transesophageal echocardiography(TEE)from January 2010 to December 2016 at Chaoyang Hospital was retrospectively screened,and diveded into LAATM group(n=65)and non LAATM group(n=717).RDW level was compared between the two groups.Potential association between RDW and LAATM was analyzed using multivariate logistic regression analysis.The accuracy of RDW for detecting LAATM was evaluated through receiver operating curve(ROC)analysis.Results There were significant differences in age,history of heart failure,course of atrial fibrillation(AF),type of AF,NT-proBNP level,RDW level,left ventricular end systolic diameter,left ventricular end diastolic diameter,left ventricular ejection fraction(LVEF),left atrial diameter,CHADS2 score and CHA2DS2-VASc score between the two groups(P<0.05).RDW level in LAATM group was significant higher than non LAATM group(13.4%(12.6%,14.1%)vs.12.1%(11.2%,13.0%),P<0.001).Multivariate logistic regression showed that RDW level associated with LAATM(OR=4.07,95%CI 2.09-7.91,P<0.001).In ROC analysis,area under the curve was 0.81(95%CI 0.74-0.88,P<0.001).When RDW level was 13.1%,LAATM could be diagnosed(sensitivity was 73.1%and specificity was 80.5%).Conclusions RDW value is associated with the presence of LAATM in elderly NVAF patients.The RDW level has a certain reference value for predicting LAATM.