血清FIB、Lp-PLA2、Hcy水平对非瓣膜性心房颤动合并缺血性脑卒中的预测价值及与左心房大小的关系

Predictive Value of Levels of Serum FIB,Lp-PLA2,Hcy in Patients with Nonvalvular Atrial Fibrillation and Ischemic Stroke,and Its Relationship with the Size of Left Atrium

目的探讨血清纤维蛋白原(FIB)、脂蛋白磷脂酶A2(Lp-PLA2)、同型半胱氨酸(Hcy)水平对非瓣膜性心房颤动合并缺血性脑卒中(NVAFIS)的预测价值及与左心房大小的关系。方法选取攀钢集团总医院密地院区2017年3月—2020年3月NVAFIS病人68例为NVAFIS组,同期非瓣膜性心房颤动(NVAF)病人68例为NVAF组。检测两组入院当天、入院第5天、入院第7天血清FIB、Lp-PLA2、Hcy水平,探讨各时间点血清FIB、Lp-PLA2、Hcy水平与NVAFIS发病的关系,探讨血清FIB、Lp-PLA2、Hcy对NVAF病人发生缺血性脑卒中(IS)的预测价值;测定入院当天两组左心房内径指数(LADi)、左心房内径(LAD),统计不同LADi、LAD水平NVAFIS病人入院当天血清FIB、Lp-PLA2、Hcy水平,分析血清FIB、Lp-PLA2、Hcy与NVAFIS病人左心房大小的相关性。结果NVAFIS组入院当天、入院第5天、入院第7天血清FIB、Lp-PLA2、Hcy水平高于NVAF组(P<0.05);经Logistic回归分析得出,入院当天、入院第5天、入院第7天血清FIB、Lp-PLA2、Hcy水平均为NVAFIS发病的影响因素(P<0.05);绘制受试者工作特征(ROC)曲线得出,入院第7天血清各指标联合预测NVAF病人发生IS的曲线下面积高于单一指标预测,联合预测时敏感度为75.00%,特异度为88.24%;NVAFIS组入院当天LADi、LAD水平高于NVAF组(P<0.05),且LADi、LAD高水平病人入院当天血清FIB、Lp-PLA2、Hcy水平高于LADi、LAD低水平病人(P<0.05);Pearson相关性分析显示,NVAFIS病人血清FIB、Lp-PLA2、Hcy水平与LADi、LAD水平呈正相关(P<0.05)。结论NVAFIS病人血清FIB、Lp-PLA2、Hcy水平增高,且其表达与左心房大小有关,可用于预测NVAF病人发生IS的风险。

Objective To investigate the predictive value of levels of serum fibrinogen(FIB),lipoprotein phospholipase A2(Lp-PLA2),and homocysteine(Hcy)in patients with nonvalvular atrial fibrillation and ischemic stroke(NVAFIS)and its relationship with the size of left atrium.Methods A total of 68 NVAFIS patients were selected as NVAFIS group,and 68 patients with nonvalvular atrial fibrillation(NVAF)during the same period were selected as the NVAF group.The levels of serum FIB,Lp-PLA2,and Hcy were compared and analyzed between two groups at the first day,the 5th day,and the 7th day of admission.The relationship between the levels of serum FIB,Lp-PLA2,Hcy,and the incidence of NVIFIS at each time points were explored,and their predictive value for the occurrence of ischemic stroke in NVAF patients were explored.Left atrial inner diameter index(LADi)and left atrial inner diameter(LAD)were measured in two groups at the day of admission.Serum indexes of NVAFIS patients with different LADi and LAD levels were measured at the day of admission,and the relationship between serum indexes and left atrial size of NVAFIS patients was observed.Results The levels of serum FIB,Lp-PLA2,and Hcy in the NVAFIS group were higher than those of the NVAF group at the first day,the 5th and 7th day of admission(P<0.05).Logistic regression analysis showed that levels of serum FIB,Lp-PLA2,and Hcy were risk factors for NVAFIS at the first day,the 5th day,and the 7th day of admission(P<0.05).All the serum indicators at the 7th day of admission were higher than that of the single indicator,the combined prediction would supply a sensitivity of 75.00%and a specificity of 88.24%.The levels of LADi and LAD at the day of admission in the NVAFIS group were higher than those of the NVAF group,and the levels of serum FIB,Lp-PLA2,and Hcy of patients with high levels of LADi and LAD on the first day of admission were higher than those with low levels of LADi and LAD(P<0.05).Pearson correlation analysis showed that the levels of serum FIB,Lp-PLA2,and Hcy were positively correlated with the levels of LADi and LAD in patients with NVAFIS(P<0.05).Conclusion The levels of serum FIB,Lp-PLA2,and Hcy of NVAFIS patients are increased,and their expression are related to the size of the left atrium,which can be used to predict the risk of ischemic stroke in NVAF patients.