摘要
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.
作者
赵艳春
宝金才
高翔
王婧
陈美凤
田海萍
ZHAO Yanchun;BAO Jincai;GAO Xiang;WANG Jing;CHEN Meifeng;TIAN Haiping(Department of Cardiology,Affiliated Hospital of Inner Mongolia Medical University,Hohhot,010059,China)
出处
《临床心血管病杂志》
CAS
北大核心
2020年第9期839-843,共5页
Journal of Clinical Cardiology
基金
内蒙古自治区卫生计生委科研项目(No:201702094)
内蒙古自治区自然科学基金项目(No:2014MS0876)。
关键词
心房颤动
左心耳流速
左心房血栓
左心结构及功能
生物学标记物
atrial fibrillation
left atrial appendage velocity
left atrial thrombus
left ventricular structure and function
biological markers