血浆脑钠肽和同型半胱氨酸对非瓣膜性心房颤动患者左心房血栓形成的预测价值

Predictive value of plasma brain natriuretic peptide and homocysteine in left atrial thrombosis in patients with nonvalvular atrial fibrillation

目的探讨血浆脑钠肽和同型半胱氨酸(Hcy)对非瓣膜性心房颤动(NVAF)患者左心房血栓形成的预测价值。方法回顾性分析2017年5月至2018年7月承德医学院附属医院收治的312例疑似左心房血栓形成的NVAF患者临床资料,根据经食管超声心动图检查结果分为左心房血栓形成组(观察组,70例)和非左心房血栓形成组(对照组,242例)。比较2组患者的基础资料、卒中风险评估量表评分、实验室指标水平和超声心动图检查结果。分析NVAF患者左心房血栓形成的影响因素及血浆脑钠肽和Hcy对NVAF患者左心房血栓形成的预测价值。结果观察组左心室射血分数低于对照组,短暂性脑缺血发作/脑卒中史、持续性/永久性心房颤动比例和CHADS2评分、CHA2DS2-VASc评分高于对照组,血清白细胞介素1β(IL-1β)、IL-18、C反应蛋白水平和白细胞计数、中性粒细胞与淋巴细胞比值,左心房内径、左心房自发显影比例均高于对照组,血浆脑钠肽和Hcy水平高于对照组[(66±25)ng/L比(36±23)ng/L,(29±13)μmol/L比(19±8)μmol/L](均P<0.05)。短暂性脑缺血发作/脑卒中病史、持续性/永久性心房颤动、CHADS2评分、CHA2DS2-VASc评分、IL-1β、IL-18、C反应蛋白、左心房内径、左心房自发显影、脑钠肽、Hcy均为NVAF患者左心房血栓形成的独立危险因素(均P<0.05)。血浆脑钠肽和Hcy二者联合预测NVAF患者左心房血栓形成的曲线下面积大于血浆脑钠肽和Hcy单独检测(0.863比0.835、0.812)(均P<0.05)。结论血浆脑钠肽与Hcy水平均为NVAF患者并发左心房血栓形成的独立危险因素,二者联合检测对预测NVAF患者左心房血栓形成具有一定的临床价值。

Objective To investigate the predictive value of plasma brain natriuretic peptide(BNP)and homocysteine(Hcy)in left atrial thrombosis in patients with nonvalvular atrial fibrillation(NVAF).Methods The clinical data of 312 patients with NVAF suspected left atrial thrombosis admitted to Affiliated Hospital of Chengde Medical College from May 2017 to July 2018 were retrospectively analyzed.According to the results of transesophageal echocardiography,they were divided into left atrial thrombosis group(observation group,70 cases)and non left atrial thrombosis group(control group,242 cases).The basic data,stroke risk assessment scale score,laboratory indexes levels and results of echocardiographic examination were compared between the two groups.The influencing factors of left atrial thrombosis in patients with NVAF and the predictive value of plasma BNP and Hcy in left atrial thrombosis in patients with NVAF were analyzed.Results The left ventricular ejection fraction of the observation group was lower than that of the control group,rates of the transient ischemic attack/cerebral apoplexy history,persistent/permanent atrial fibrillation,and scores of CHADS2 and CHA2 DS2-VASc of the observation group were higher than those of the control group;the levels of serum interleukin-1β(IL-1β),IL-18,C-reactive protein,white blood cell count,neutrophil to lymphocyte ratio,left atrial diameter and left atrial spontaneous imaging ratio of the observation group were higher than those of the control group;levels of plasma BNP and Hcy of the observation group were higher than those of the control group[(66±25)ng/L vs(36±23)ng/L,(29±13)μmol/L vs(19±8)μmol/L](all P<0.05).Transient ischemic attack/cerebral apoplexy history,persistent/permanent atrial fibrillation,CHADS2 score,CHA2 DS2-VASc score,IL-1β,IL-18,C-reactive protein,left atrial diameter,left atrial spontaneous imaging,BNP and Hcy were independent risk factors for left atrial thrombosis in NVAF patients(all P<0.05).The area under the curve of plasma BNP combined with Hcy in predicting left atrial thrombosis in NVAF patients was larger than that of plasma BNP and Hcy alone(0.863 vs 0.835,0.812)(both P<0.05).Conclusions Both of the plasma levels of BNP and Hcy are independent risk factors for left atrial thrombosis in NVAF patients.The combined detection of plasma BNP and Hcy has certain clinical value in predicting left atrial thrombosis in NVAF patients.