摘要
目的探讨低密度脂蛋白(LDL)联合左心房内径(LAD)与非瓣膜性心房颤动(NVAF)患者中左心房血栓形成的相关性。方法回顾性分析2021年1月—2022年12月新乡医学院附属开封市中心医院收治的566例心房颤动的住院患者,根据排除标准最终纳入212例符合标准的行经食道超声或肺静脉CT血管造影(CTV)的NVAF患者。最终入组患者依据经食道超声心动图或肺静脉CTV检查结果提示左心房是否存在血栓分为非血栓组(n=178)与血栓组(n=34)。比较两组之间临床资料,分析房颤患者中左心房血栓形成的危险因素,并探讨LDL联合LAD与NVAF患者中左心房血栓形成的相关性。采用多因素Logistic回归分析探讨影响血栓形成的独立危险因素。采用ROC曲线分析LAD和LDL对左心房血栓形成的预测结果。结果血栓组中LDL水平、LAD、非阵发性心房颤动患者比例、心力衰竭患者比例、CHA 2DS 2-VASc评分、纤维蛋白原、D-二聚体、NT-proBNP高于非血栓组;左室射血分数(LVEF)低于非血栓组。左心房血栓形成的单因素Logistic回归分析显示,LDL升高、LAD扩大、心力衰竭患者比例、非阵发性心房颤动、高CHA 2DS 2-VASc积分、低LVEF、D-二聚体是NVAF患者左房血栓形成的危险因素。左心房血栓形成的多因素Logistic回归分析显示,LAD扩大、LDL升高、非阵发性心房颤动是NVAF患者左心房血栓形成的独立危险因素。LAD预测NVAF患者左心房血栓形成的ROC曲线下面积为0.754(95%CI:0.679~0.830,P<0.001);LAD联合LDL预测NVAF患者左心房血栓形成的ROC曲线下面积为0.821(95%CI:0.755~0.886,P<0.001)。两ROC曲线下面积相比差异有统计学意义(Z=2.344,P=0.019)。结论LDL、LAD与NVAF患者左心房血栓的形成相关,两者联合预测价值更佳。
Objective To investigate the correlation of LDL combined with LAD in left atrial thrombosis in patients with NVAF.Methods A total of 566 inpatients with atrial fibrillation from our hospital were collected.According to the exclusion criteria,212 NVAF patients with transesophageal ultrasound or pulmonary venous CTV meeting the criteria were finally included.Finally enrolled patients were divided into two groups according to the results of transesophageal echocardiography or pulmonary venous CTV examination indicating whether there was thrombus in the left atrium:non-thrombotic group(n=178)and thrombotic group(n=34).The clinical data collected between the two groups were compared to analyze the risk factors of left atrial thrombosis in patients with atrial fibrillation,and explore the predictive value of LAD combined with LDL in left atrial thrombosis in patients with NVAF.Multivariate Logistic regression analysis was used to investigate the independent risk factors of thrombosis.ROC curve was used to analyze the prediction results of left atrial diameter and low density lipoprotein on left atrial thrombosis.Results Compared with the non-thrombotic group,the level of LDL,LAD,proportion of patients with non-paroxysmal atrial fibrillation,proportion of patients with heart failure,CHA 2DS 2-VASc score,fibrinogen,D-dimer and NT-proBNP in the thrombotic group were higher than those in the non-thrombotic group.The Left ventricular ejection fraction(LVEF)was lower than that in the non-thrombotic group.Univariate Logistic regression analysis of left atrial thrombosis in patients with elevated LDL,enlarged LAD,heart failure,non-paroxysmal atrial fibrillation,high CHA 2DS 2-VASc score,low LVEF and D-dimer were risk factors for left atrial thrombosis in patients with NVAF.Multivariate Logistic regression analysis of left atrial thrombosis showed that LAD enlargement,LDL increase and non-paroxysmal atrial fibrillation were independent risk factors for left atrial thrombosis in patients with NVAF.The area under ROC curve predicted by LAD for left atrial thrombosis in NVAF patients was 0.754(95%CI:0.679~0.830,P<0.001).The area under ROC curve of LAD combined with LDL for predicting left atrial thrombosis in NVAF patients was 0.821(95%CI:0.755~0.886,P<0.001).The difference in area under ROC curve between the two was statistically significant(Z=2.344,P=0.019).Conclusion LDL combined with LAD is associated with left atrial thrombosis in patients with NVAF.
作者
董志强
刘洁云
秦雷
DONG Zhiqiang;LIU Jieyun;QIN Lei(Department of Cardiology,Kaifeng Central Hospital,Xinxiang Medical College,Kaifeng 475000,Henan,China;Department of Cardiology,Zhengzhou Seventh People's Hospital,Zhengzhou 450000,China)
出处
《西部医学》
2025年第3期387-392,共6页
Medical Journal of West China
