非风湿性房颤左心房血栓形成患者左心耳功能、血脂蛋白(a)和D-二聚体检测

Detection of left atrial appendage function, lipoprotein(a) and D-Dimer in patients with left atrium thrombus of nonrheumatic atrial fibrillation

目的 :检测非风湿性房颤 (NRAF)左心房血栓形成患者左心耳 (LAA)功能和血脂蛋白 (a) (Lp(a) )、D -二聚体 (D -D)水平。方法 :NRAF左心房血栓形成患者 1 1例 (血栓组 ) ,非风湿性房颤无血栓形成患者 75例 (无血栓组 ) ,经食管超声心动图 (TEE)检测①LAA射血分数 (LAA -EF)、②LAA最大排空速度 (LAA -PEV)、③LAA自发超声对比现象 (LASEC)等指标 ,同时检测血清Lp(a)、D -D含量。结果 :①血栓组LAA -PEV、LAA -EF明显较无血栓组低 (P =0 .0 0 9,0 .0 1 )。②血栓组LASEC(≥ 2级 )出现率 (1 0 0 % )明显较无血栓组 (2 1 .3% )高 (P =0 .0 0 1 )。③高Lp(a)、D -D水平组血栓发现率 (2 1 .1 % ,2 2 .5 % )明显较低Lp(a)、D -D水平组血栓发现率 (6 .3% ,4 .3% )高 (P =0 .0 4 3,0 .0 2 1 )。结论 :高水平的Lp(a)、低LAA -PEV及LAA -EF是NRAF患者左心房血栓形成的危险因子 ,高D

Aim: To detect the left atrial appendage(LAA) function, lipoprotein(a) and D-Dimer in patients with left atrium(LA) thrombus of nonrheumatic atrial fibrillation(NRAF). Methods:Eleven patients with LA thrombus (thrombus group) and 75 patients without LA thrombus (non-thrombus group) of NRAF were performed transesophageal echocardiography to detect LAA ejection fraction(LAA-EF), LAA maximal peak emptying velocity(LAA-PEV), severity of left atrial spontaneous echo contrast (LASEC), etc. Serum concentration of Lp(a) and D-Dimer were measured.Results: LAA-PEV and LAA-EF were lower in the thrombus group than those of non-thrombus group.All of 11 patients with LA thrombus presented LASEC≥2-degree; 16 (21.3%) of 75 patients without LA thrombus presented LASEC( P =0.001).LA thrombus incidence(21.1%, 22.5%) was higher in patients with high Lp(a) and D-D level than those(6.3%, 4.3%) in patients with low Lp(a) and D-D level ( P =0.043, 0.021). Conclusion:High level of Lp(a), low LAA-PEV and LAA-EF are risk factors for left atrial thrombosis in patiens with NRAF.LASEC and high level of D-Dimer are important indicators of thrombosis.