超声心动图结合生物标记物在非瓣膜性心房颤动患者左心房血栓诊断中的意义

Echocardiography combined with biomarkers in the diagnosis of left atrial thrombosis in patients with nonvalvular atrial fibrillation

目的:通过联合检测左心耳流速、左房前后径及血清生物学标记物,探讨其对非瓣膜性房颤(NVAF)患者左心房血栓的诊断意义。方法:入选2017年12月-2019年12月内蒙古医科大学附属医院收治的NVAF患者,通过食管超声心动图结果将患者分为无血栓组和血栓组,并测量左心耳流速,经胸超声心动图测量患者的左房前后径及左室射血分数。计算CHA2DS2-VASc评分,检测D-二聚体、同型半胱氨酸及脑钠肽前体。结果:①两组患者一般情况(年龄、性别、高血压、糖尿病)及CHA2DS2-VASc评分无统计学差异(P>0.05)。②血栓组患者左心耳流速减慢、左房前后径增大、LVEF减低(P<0.05)。单因素Logistic回归分析显示,左心耳流速、左房前后径、左室射血分数在左心房血栓诊断中具有重要意义。③血栓组患者血清D-二聚体、脑钠肽前体、同型半胱氨酸高于无血栓组。④多因素logistic回归分析显示,左心耳流速(OR=0.83,95%CI:0.78~10.87,P<0.001)、左房前后径(OR=1.09,95%CI:1.00~1.18,P=0.044)是左心房血栓诊断的重要指标。当左心耳流速截点值为25.5 cm/s时,诊断左心房血栓形成的灵敏度和特异度分别为98%、45%,ROC曲线下面积为0.939。左心耳流速联合左房前后径诊断左心房血栓形成ROC曲线下面积为0.945。在二者基础上联合D-二聚体及脑钠肽前体诊断左心房血栓形成ROC曲线下面积为0.948。结论:左心耳流速减慢在NVAF患者左心房血栓诊断中具有重要作用。左心耳流速联合左心房前后径及血清D-二聚体、脑钠肽前体,提高了对NVAF患者左心房血栓的诊断能力,其敏感性及有效性增加。

Objective:To explore the diagnostic significance of left atrial appendage velocity(LAAV),Left atrial diameter(LAD) and serum biomarkers in patients with non-valvular atrial fibrillation(NVAF).Method:Patients with NVAF admitted to the Affiliated Hospital of Inner Mongolia Medical University from December 2017 to December 2019 were divided into non-thrombotic group and thrombotic group by transesophageal echocardiography(TEE).The LAAV was measured,and the LAD and LVEF were measured by transthoracic echocardiography(TTE).We calculated CHA2 DS2-VASc score,and measured D-dimer and pro-brain natriuretic peptide.Result:① There was no significant difference in general condition(age,sex,hypertension,diabetes) and CHA2 DS2-VASc score between the two groups(P>0.05). ② LAAV decreased,LAD increased and LVEF decreased in thrombus group(P<0.05).Univariate logistic regression analysis showed that LAAV,LAD and LVEFhad played the important roles in the diagnosis of LAT. ③ Serum D-dimer,pro-brain natriuretic peptide and homocysteine in patients with thrombosis were higher than those in patients without thrombosis. ④ Multivariate logistic regression analysis showed that LAAV(OR=0.83,95%CI:0.78-10.87,P<0.001) and LAD(OR=1.09,95%CI:1.00-1.18,P=0.044) were important indicators in the diagnosis of LAT.When LAAV was 25.5 cm/s,the sensitivity and specificity of diagnosing LAT were 98% and 45%,and the area under ROC curve was 0.939.The area under ROC curve of LAAV combined LAD diagnosis LAT was 0.945.On the basis of both,combined with D-dimer and pro-brain natriuretic peptide,the area under ROC curve for diagnosing LAT was 0.948.Conclusion: The slow velocity of left atrial appendage plays an important role in the diagnosis of left atrial thrombus in patients with NVAF. The LAAV combined withLAD,serum D-dimer and pro-brain natriuretic peptide precursor,can improve the diagnostic ability,sensitivity and effectiveness of LAT in NVAF patients.