Relationship between fibrinogen and left atrial appendage thrombogenic milieu in patients with non-valvular atrial fibrillation
-
摘要: 目的:探讨纤维蛋白原(Fib)与非瓣膜性心房颤动(NVAF)患者左心耳血栓状态(LAATM)之间的相关性。方法:连续入选2016年1月—2020年1月于河北医科大学第二医院心内科符合标准的NVAF患者696例,根据术前经食管超声心动图结果将患者分为LAATM组(88例)和无LAATM组(608例)。采用单因素及多因素logistic回归分析Fib是否与NVAF患者LAATM具有相关性,并利用受试者工作特征(ROC)曲线评估Fib对于判断是否存在LAATM的效能。结果:与无LAATM组相比,LAATM组的年龄、舒张压、心率、心房颤动类型、心房颤动病史>1年、饮酒、高血压、心力衰竭、脑卒中、CHA2DS2-VASc、D-二聚体、Fib、脑钠肽(BNP)、中性粒细胞/淋巴细胞比值(NLR)、左心耳排空速度、e’、左房直径、左室收缩末期容积、左室射血分数经单因素分析,其差异有统计学意义(P<0.05)。且LAATM组患者的Fib水平高于无LAATM组(P<0.001)。多因素回归分析显示Fib仍是NVAF患者LAATM的独立危险因素(OR=2.23,95%CI1.297~3.833,P=0.004)。ROC曲线下面积为0.63(95%CI0.56~0.70,P<0.001);当Fib=2.825 g/L时,患者可能存在LAATM(敏感度为77.27%,特异度为44.74%)。结论:在NVAF患者中,Fib是存在LAATM的独立危险因素,在评估LAATM是否存在时,Fib具有一定参考价值。Abstract: Objective: To investigate the relationship between fibrinogen(Fib) and left atrial appendage thrombogenic milieu(LAATM) in patients with non-valvular atrial fibrillation(NVAF).Methods: We retrospectively selected a total of 696 patients with NVAF who met the criteria in the Department of Cardiology of the Second Hospital of Hebei Medical University from January 2016 to January 2020. According to the results of transesophageal echocardiography before operation, the patients were divided into LAATM group(n=88) and non-LAATM group(n=608). Univariate and multivariate logistic regression were used to analyze whether Fib was correlated with LAATM in patients with NVAF, and the efficacy of Fib in judging the existence of LAATM was evaluated by the receiver's work certificate curve(ROC).Results: Compared with non-LAATM group, age, diastolic blood pressure, heart rate, type of atrial fibrillation, history of atrial fibrillation>1 year, drinking, hypertension, heart failure, stroke, CHA2DS2-VASc, D-dimer, Fib, BNP, NLR, left atrial appendage emptying velocity, e', left atrial diameter, left ventricular end-systolic volume and left ventricular ejection fraction in LAATM group were statistically significant by univariate analysis. And the level of Fib in LAATM group was higher than that in non-LAATM group(P<0.001). Multivariate regression analysis showed that Fib was still an independent risk factor for LAATM in patients with NVAF(OR=2.23, 95%CI1.297-3.833, P=0.004). The area under the ROC curve was 0.63(95%CI0.56-0.70, P<0.001); when Fib=2.825 g/L, the patient may suffered LAATM(sensitivity: 77.27%, specificity: 44.74%).Conclusion: In patients with NVAF, Fib is an independent risk factor for the existence of LAATM. Fib has a certain reference value in evaluating the existence of LAATM.
-
Key words:
- atrial fibrillation /
- fibrinogen /
- left atrial appendage /
- thrombogenic milieu
-
-
[1] 黄从新,张澍,黄德嘉,等.心房颤动:目前的认识和治疗建议(2018)[J].中华心律失常学杂志,2018,22(4):279-346.
[2] Conen D.Epidemiology of atrial fibrillation[J].Eur Heart J,2018,39(16):1323-1324.
[3] January CT,Wann LS,Calkins H,et al.2019AHA/ACC/HRS Focused Update of the 2014AHA/ACC/HRS Guideline for the Management of Patients With Atrial Fibrillation:A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines and the Heart Rhythm Society[J].J Am Coll Cardiol,2019,74(1):104-132.
[4] Tu HT,Campbell BC,Christensen S,et al.Pathophysiological determinants of worse stroke outcome in atrial fibrillation[J].Cerebrovasc Dis,2010,30(4):389-395.
[5] Arboix A,AlióJ.Cardioembolic stroke:clinical features,specific cardiac disorders and prognosis[J].Curr Cardiol Rev,2010,6(3):150-161.
[6] Malik R,Alyeshmerni DM,Wang Z,et al.Prevalence and predictors of left atrial thrombus in patients with atrial fibrillation:is transesophageal echocardiography necessary before cardioversion?[J].Cardiovasc Revasc Med,2015,16(1):12-14.
[7] Fu Y,Li K,Gao Y,et al.A novel risk score for predicting left atrial and left atrial appendage thrombogenic milieu in patients with non-valvular atrial fibrillation[J].Thromb Res,2020,192:161-166.
[8] Li W,Yu F,Zhu W,et al.Detection of left atrial appendage thrombi by third-generation dual-source dualenergy CT:Iodine concentration versus conventional enhancement measurements[J].Int J Cardiol,2019,292:265-270.
[9] Novo G,Mansueto P,La Franca ML,et al.Risk factors,atrial fibrillation and thromboembolic events[J].Int Angiol,2008,27(5):433-438.
[10] Aynaci O,Tekata爧A,Aynaci G,et al.Effects of CHADS2score,echocardiographic and haematologic parameters on stroke severity and prognosis in patients with stroke due to nonvalvular atrial fibrillation[J].Ideggyogy Sz,2019,72(7-8):241-256.
[11] 王敏红.无症状脑梗死患者治疗前后TEG与常规凝血功能的相关性分析[J].临床血液学杂志,2018,31(2):120-123.
[12] Issac TT,Dokainish H,Lakkis NM.Role of inflammation in initiation and perpetuation of atrial fibrillation:a systematic review of the published data[J].JAm Coll Cardiol,2007,50(21):2021-2028.
[13] Letsas KP,Weber R,Bürkle G,et al.Pre-ablative predictors of atrial fibrillation recurrence following pulmonary vein isolation:the potential role of inflammation[J].Europace,2009,11(2):158-163.
[14] Breitenstein A,Glanzmann M,Falk V,et al.Increased prothrombotic profile in the left atrial appendage of atrial fibrillation patients[J].Int J Cardiol,2015,185:250-255.
[15] 刘振良,武丽萍.心房颤动患者的左心耳结构与左心耳血栓形成的关系[J].中国心脏起搏与心电生理杂志,2017,31(5):397-400.
[16] Nakazono A,Oginosawa Y,Takeuchi M,et al.Left atrial appendage thrombus in a patient with sinus rhythm and left atrial appendage dysfunction[J].JEchocardiogr,2015,13(4):157-158.
[17] Kreidieh B,Valderrábano M.Malignant left atrial appendage morphology and embolization risk in atrial fibrillation[J].Heart Rhythm Case Rep,2015,1(6):406-410.
[18] 徐海英,叶雪存.房颤患者左心耳血栓形成与结构功能的关系[J].中国医学影像技术,2010,26(11):2079-2082.
[19] 郭冠军,方爱娟,杨益宁,等.左心房内径联合心脏节律预测非瓣膜性心房颤动患者左心耳血栓形成的价值[J].临床心血管病杂志,2020,36(7):613-616.
[20] Oshita T,Mine T,Kishima H,et al.Predictors of movable type left atrial appendage thrombi in patients with atrial fibrillation[J].Heart Vessels,2020,35(9):1227-1233.
[21] Uziębło-6)Zyczkowska B,Krzesiński P,Jurek A,et al.Left ventricular ejection fraction is associated with the risk of thrombus in the left atrial appendage in patients with atrial fibrillation[J].Cardiovasc Ther,2020,2020:3501749.
[22] 赵艳春,宝金才,高翔,等.超声心动图结合生物标记物在非瓣膜性心房颤动患者左心房血栓诊断中的意义[J].临床心血管病杂志,2020,36(9):839-843.
[23] Yao Y,Shang MS,Gao LJ,et al.Elevated homocysteine increases the risk of left atrial/left atrial appendage thrombus in non-valvular atrial fibrillation with low CHA2DS2-VASc score[J].Europace,2018,20(7):1093-1098.
[24] Tang Z,Zeng L,Lin Y,et al.Circulating galectin-3is associated with left atrial appendage remodelling and thrombus formation in patients with atrial fibrillation[J].Heart Lung Circ,2019,28(6):923-931.
[25] Watson T,Shantsila E,Lip GY.Mechanisms of thrombogenesis in atrial fibrillation:Virchow's triad revisited[J].Lancet,2009,373(9658):155-166.
[26] 黎安玲,段勇威,廖凡路,等.急性脑梗死患者血栓弹力图和常规凝血试验及脂代谢指标的相关性研究[J].临床血液学杂志(输血与检验版),2020,33(6):871-873.
[27] 王岚峰,杨丽华,周立君,等.慢性非瓣膜性心房颤动血栓形成与脂蛋白(a)和纤维蛋白原浓度的研究[J].中华心血管病杂志,2002,30(7):417-418.
[28] Sakamoto S,Mizushige K,Takagi Y,et al.Effect of batroxobin on spontaneous echo contrast and hemorheology in left atrial appendage in atrial fibrillation assessed by transesophageal echocardiograpy[J].Am J Cardiol,1999,84(7):816-819.
[29] Mondillo S,Sabatini L,Agricola E,et al.Correlation between left atrial size,prothrombotic state and markers of endothelial dysfunction in patients with lone chronic nonrheumatic atrial fibrillation[J].Int JCardiol,2000,75(2-3):227-232.
[30] Papagianni A,Kokolina E,Kalovoulos M,et al.Carotid atherosclerosis is associated with inflammation,malnutrition and intercellular adhesion molecule-1in patients on continuous ambulatory peritoneal dialysis[J].Nephrol Dial Transplant,2004,19(5):1258-1263.
-
计量
- 文章访问数: 740
- PDF下载数: 285
- 施引文献: 0
下载: