低CHA_(2)DS_(2)-VASc-评分的非瓣膜性心房颤动患者的心房血栓形成的独立危险因素

Independent risk factors of atrial thrombosis in patients with nonvalvular atrial fibrillation and low CHA_(2)DS_(2)-VASc scores

目的探讨入院时低CHA_(2)DS_(2)-VASc评分(男性≤1分,女性≤2分)非瓣膜性心房颤动(NVAF)患者心房血栓形成的危险因素。方法采用回顾性研究方法收集2009年6月~2019年2月在上海交通大学附属胸科医院行经食管超声心动图检查的NVAF患者临床资料(10382例)。纳入48例伴有血栓的NVAF患者作为实验组,240例无血栓NVAF患者作为对照组。对两组的基线特征、临床生化指标和超声心动图进行单因素分析及多因素Logistic回归分析,对指标进行Pearson相关分析。结果两组研究对象基线资料差异无统计学意义(P>0.05)。与对照组相比,伴有心房血栓患者的左心房内径增大(P<0.001),肥厚型心肌病比例更多(P<0.001),C反应蛋白(P<0.05)和尿酸(P<0.001)及红细胞分布宽度标准差(P<0.001)水平明显增高,差异均有统计学意义。其中左心房内径(P<0.001)、肥厚型心肌病(P<0.05)和C反应蛋白(P<0.05)是影响低评分患者心房血栓形成的独立影响因素。结论左心房内径增大、肥厚性心肌病和C反应蛋白升高是低CHA_(2)DS_(2)-VASc评分的NVAF患者心房血栓形成的独立危险因素。临床中对合并上述危险因素的低评分NVAF患者应予积极抗凝,预防卒中发生。

Objective To explore the risk factors of atrial thrombosis in patients with nonvalvular atrial fibrillation(NVAF)with low CHA_(2)DS_(2)-VASc scores at admission(≤1 for male and≤2 for female patients).Methods We retrospectively analyzed the clinical data of 10382 patients with NVAF undergoing transesophageal echocardiography in our hospital from 2009 to 2019,and enrolled 48 NVAF patients with thrombosis as the observation group and another 240 NVAF patients without thrombosis as the control group.The baseline characteristics,biochemical indicators,and echocardiographic findings of the patients were analyzed using univariate analysis,multivariate logistic regression analysis and Pearson correlation analysis.Results The baseline data did not differ significantly between the two groups(P>0.05).Compared with those in the control group,the patients with atrial thrombosis had an increased left atrial diameter(LAD;P<0.001),a greater likelihood of hypertrophic cardiomyopathy(HCM;P<0.001),significantly higher levels of C-reactive protein(CRP;P<0.05)and uric acid(P<0.001),and greater standard deviation of red blood cell distribution width(RDW-SD;P<0.001).LAD(P<0.001),HCM(P<0.05)and CRP(P<0.05)were identified as the independent factors affecting the occurrence of atrial thrombosis in patients with low CHA_(2)DS_(2)-VASc scores.Conclusions LAD enlargement,HCM,and an elevated CRP level are independent risk factors for atrial thrombosis in NVAF patients with low CHA_(2)DS_(2)-VASc scores.Active anticoagulation therapy should be administered for these patients once these risk factors are detected to prevent the occurrence of stroke.