老年慢性心房颤动患者左心房内血栓形成的危险因素与预测

Predictors and risk factors of occurrence of left atrial thrombosis in aged patients with chronic atrial fibrillation

目的 研究老年慢性非瓣膜病心房颤动患者中左心房内血栓形成的危险因素与预测 ,并探讨其可能的原因。方法 6 4例老年慢性心房颤动患者 ,通过单因素及多元逐步logistic回归分析 ,首次将轻度二尖瓣反流作为一项待选变量 ,结合超声影像学和其他临床指标 ,对左心房内血栓形成的危险因素进行分析。结果 与左心房内血栓相关的因素有 :轻度二尖瓣反流、心房颤动持续时间、血小板表面P 选择素表达、血浆 β 血小板球蛋白 (P <0 .0 5 )。轻度二尖瓣反流与心房颤动持续时间是左心房内血栓形成的独立危险因素。结论 轻度二尖瓣反流增加而非降低心房颤动患者左心房内血栓形成 ,其原因可能与轻度二尖瓣反流激活血小板有关。持续的心房颤动可能通过心房肌的结构重构导致心肌收缩力进一步下降 。

Objective To determine the predictors and risk factor of thrombosis in left atrium in aged patients with chronic atrial fibrillation.Methods Eleven clinical and echocardiographic variables in 64 aged patients with chronic atrial fibrillation were analyzed by univariate regression and multivariate logistic regression to investigate the relationship between the occurrence of left atrial thrombosis and these factors.Results Univariate analysis revealed that mild mitral regurgitation,duration of atrial fibrillation,P-selectin expression on platelets and plasma β-thromboglobulin level were risk factors of occurrence of left atrial thrombosis is(P<0.05).However, stepwise multivariate logistic regression analysis identified that only mild mitral regurgitation and duration of atrial fibrillation were the significant and independent predictors of left atrial thrombosis.Conclusion The presence of mild mitral regurgitation in patients with atrial fibrillation was associated with increased prevalence of thrombosis in left atrium, which may be attributed to the activation of platelets.