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2017 年第 10 期 第 12 卷

心内科CHA2DS2-VASc评分对非瓣膜性心房颤动患者左心房血栓发生风险的评估作用及左心房血栓形成的危险因素

The role of CHA2DS2-VASc score in assessing risk of left atrial thrombus in patients with nonvalvular atrial fibrillation and risk factors of left atrial thrombosis

作者:崔晶杜昕汤日波白融吴嘉慧吕强康俊萍宁曼戴天医桑才华蒋晨曦龙德勇李松楠刘小慧董建增马长生

英文作者:Cui Jing Du Xin Tang Ribo Bai Rong Wu Jiahui Lyu Qiang Kang Junping Ning Man Dai Tianyi Sang Caihua Jiang Chenxi Long Deyong Li Songnan Liu Xiaohui Dong Jianzeng Ma Changsheng

单位:100029首都医科大学附属北京安贞医院心内科四十病房(崔晶、白融、吕强、康俊萍、宁曼、戴天医、刘小慧、董建增),心内科二病房(杜昕、汤日波、吴嘉慧、桑才华、蒋晨曦、龙德勇、李松楠、马长生)

英文单位:The 40th Ward Department of Cardiology Beijing Anzhen Hospital Capital Medical University Beijing 100029 China(Cui J Bai R Lyu Q Kang JP Ning M Dai TY Liu XH Dong JZ); the 2nd Ward Department of Cardiology Beijing Anzhen Hospital Capital Medical University Beijing 100029 China(Du X Tang RB Wu JH Sang CH Jiang CX Long DY Li SN Ma CS)

关键词:心房颤动;左心房(耳)血栓;CHA2DS2-VASc评分;危险因素

英文关键词:Atrialfibrillation;Leftatrial(auricle)thrombus;CHA2DS2-VAScscore;Riskfactors

  • 摘要:
  • 【摘要】

    目的  探讨CHA2DS2-VASc评分对非瓣膜性心房颤动(NVAF)患者左心房血栓发生风险的评估作用及左心房血栓形成的危险因素。方法连续入选2016年1月1日至2017年1月1日在首都医科大学附属北京安贞医院心内科住院,因电复律或导管消融治疗进行经食管超声心电图检查发现有左心房血栓形成的NVAF患者,按照病例对照1∶4匹配原则,从研究样本中完全随机抽取无血栓患者作为对照(无血栓组,228例),血栓组56例。比较血栓组与无血栓组患者的临床和超声参数差异,分析CHA2DS2-VASc评分与血栓发生的关系。采用Logistic回归法分析NVAF患者左心房血栓形成的危险因素。结果  血栓组年龄、CHA2DS2-VASc评分、左心房前后径(LAD)、二尖瓣反流、三尖瓣反流程度明显大于无血栓组,持续性心房颤动、心力衰竭、左心室射血分数(LVEF)<50%和CHA2DS2-VASc≥2分的患者比例高于无血栓组,差异均有统计学意义(P<0.05)。患者的CHA2DS2-VASc评分与血栓形成相关(比值比=1.312,95%置信区间:1.093~1.577,P=0.004),但校正心房颤动类型后,Logistic多因素回归分析结果显示2组CHA2DS2-VASc评分差异无统计学意义(比值比=1.077,95%置信区间:0.850~1.363,P=0.540)。Logistic多因素分析校正心房颤动类型、三尖瓣反流后,年龄(65~74岁,比值比=2.323,95%置信区间:1.112~4.852, P=0.025;≥75岁,比值比=4.486,95%置信区间:1.503~11.012,P=0.006)、LAD增大(比值比=1.105,95%置信区间:1.043~1.171,P=0.001)和LVEF<50% (比值比=3.305,95%置信区间:1.045~10.451,P=0.042)是NVAF患者左心耳血栓形成的独立危险因素。结论  单纯依赖CHA2DS2-VASc评分系统评价NVAF患者形成左心房(耳)的血栓风险并不准确。高龄、左心房增大、LVEF减低是NVAF患者发生左心耳血栓的独立危险因素。

  • Objective  To investigate the role of CHA2DS2-VASc score in assessing risk of left atrial thrombus in patients with nonvalvular atrial fibrillation(NVAF); to analyze risk factors of left atrial thrombosis. Methods  A prospective case-control study was conducted on NVAF patients who were detected left atrial thrombus by transesophageal echocardiography from January 1st, 2016 to January 1st, 2017 in Beijing Anzhen Hospital, Capital Medical University; 56 patients were enrolled in thrombus group and 228 patients were enrolled in non-thrombus group. Clinical data, ultrasonic parameters and CHA2DS2-VASc score were recorded. The relation between CHA2DS2-VASc score and left atrial thrombosis was analyzed. Risk factors of left atrial thrombosis were analyzed. Results  Age, CHA2DS2-VASc score, left atrial diameter(LAD), degrees of mitral regurgitation and tricuspid regurgitation, ratios of permanent atrial fibrillation, heart failure, left ventricular ejection fraction(LVEF)<50% and CHA2DS2-VASc score≥2 points in thrombus group were significantly higher than those in non-thrombus group(P<0.05). The CHA2DS2-VASc score of NVAF patients was related to left atrial thrombosis(odds ratio=1.312, 95% confidence interval: 1.093-1.577, P=0.004), but multivariate logistic analysis showed that the relation between CHA2DS2-VASc score and left atrial thrombosis was not significant after adjustment of types of atrial fibrillation(odds ratio=1.077, 95% confidence interval: 0.850-1.363, P=0.540). With adjustments of atrial fibrillation types and tricuspid regurgitation, multivariate logistic analysis showed that age(65-74 years old, odds ratio=2.323, 95% confidence interval: 1.112-4.852, P=0.025; ≥75 years old, odds ratio=4.486, 95% confidence interval: 1.503-11.012, P=0.006), LAD(odds ratio=1.105, 95% confidence interval: 1.043-1.171, P=0.001) and LVEF<50%(odds ratio=3.305, 95% confidence interval: 1.045-10.451, P=0.042) were independent risk factors of left atrial thrombosis. Conclusions  CHA2DS2-VASc scoring system to assessing risk of thrombus formation in left atrium/auricle is not accurate. Advanced age, left atrial enlargement and decreasing LVEF are independent risk factors of left atrial thrombosis in NVAF patients.

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