非瓣膜性心房颤动病人CHA2DS2-VASc评分与血NT-proBNP、D-二聚体、尿酸、肌酐的相关性分析

The Correlation between CHA2DS2-VASc Score and NT-proBNP,D-dimer,Uric Acid,Creatinine in Patients with Nonvalvular Atrial Fibrillation

目的探讨非瓣膜性心房颤动病人血N末端B型钠尿肽前体(NT-proBNP)、D-二聚体、尿酸、肾功能与CHA2DS2-VASc的关系,分析血栓高危病人及高风险因素。方法选择上海长征医院2015年1月—2018年10月确诊为非瓣膜性心房颤动病人的临床资料,所有病人均进行CHA2DS2-VASc评分,同时记录血NT-proBNP、D-二聚体、尿酸、肌酐[计算估算肾小球滤过率(eGFR)]结果。根据CHA2DS2-VASc评分将心房颤动病人发生血栓栓塞风险分为低中危组(60例)和高危组(316例),比较低中危组与高危组NT-proBNP、D-二聚体、尿酸、eGFR差异,并分析差异有统计学意义的研究指标与CHA2DS2-VASc评分的相关性。结果CHA2DS2-VASc评分高危组NT-proBNP、D-二聚体水平高于低中危组(P<0.05),eGFR低于低中危组(P<0.05)。相关性分析结果显示:血NT-proBNP、D-二聚体水平均与CHA2DS2-VASc评分呈正相关(r=0.431,P<0.001;r=0.460,P<0.001);eGFR与CHA2DS2-VASc评分呈负相关(r=-0.235,P<0.001)。结论NT-proBNP、D-二聚体、eGFR均与CHA2DS2-VASc评分相关,其中D-二聚体相关性最大,可为临床非瓣膜性心房颤动血栓栓塞风险的评估提供依据。

Objective To investigate the correlation between CHA2DS2-VASc Score and N-terminal B-type natriuretic peptide precursor(NT-proBNP),D-dimer,uric acid,and creatinine in patients with nonvalvular atrial fibrillation.Methods Three hundred and seventy-six nonvalvular atrial fibrillation patients were selected from January 2015 to October 2018 in Shanghai Changzheng Hospital.Every patient underwent CHA2DS2-VASc score calculation and test results of serum NT-proBNP,D-dimer,uric acid and creatinine[calculate estimation of glomerular filtration rate(eGFR)]were recorded.According to the CHA2DS2-VASc score,the patients with nonvalvular atrial fibrillation were divided into low-intermediate risk group(n=60)and the high-risk group(n=316).NT-proBNP,D-dimer,uric acid,and creatinine between the low-intermediate risk group and the high-risk group were compared,and the correlation between the study indexes and CHA2DS2-VASc score were analyzed.Results The levels of NT-proBNP and D-dimer in the high-risk group were significantly higher than those in the low-intermediate risk group(P<0.05),while eGFR in the high-risk group were significantly lower than that in the low-intermediate risk group(P<0.05).Correlation analysis results showed that NT-proBNP and D-dimer were significantly positively correlated with CHA2DS2-VASc score(r=0.431,P<0.001;r=0.460,P<0.001),while eGFR was significantly negatively correlated with CHA2DS2-VASc score(r=-0.235,P<0.001).Conclusion NT-proBNP,D-dimer,and eGFR were all correlated with CHA2DS2-VASc score,while D-dimer was the most correlated,which could provide the proof for the risk assessment of thromboembolism in clinical nonvalvular atrial fibrillation.