作者：赵曌，王文强，赵春慧，宋凌慧，李付强

单位：

1.075000河北省张家口市第一医院心内二科 2.075000河北省张家口市第一医院检验科 3.075000河北省张家口市第一医院心内一科 通信作者：李付强，E-mail：tl6105210@163.com

Units：

1.Department of Cardiology 2, Zhangjiakou First Hospital, Zhangjiakou 075000, China 2.Laboratory Department, Zhangjiakou First Hospital, Zhangjiakou 075000, China 3.Department of Cardiology 1, Zhangjiakou First Hospital, Zhangjiakou 075000, China Corresponding author: LI Fuqiang, E-mail: tl6105210@163.com

关键词：

心房颤动; 非瓣膜性心房颤动; 左心耳血栓; 血小板形态参数; 左心耳血流动力学参数;

Keywords：

Atrial fibrillation; Non-valvular atrial fibrillation; Left atrial appendage thrombus; Platelet morphologyparameters; Left atrial appendage hemodynamic parameters

CLC：

DOI：

10.12114/j.issn.1008-5971.2022.00.047

Funds：

2021年度河北省医学科学研究课题计划项目（20211605）

摘要：

背景随着人口老龄化进程日益加速,老年非瓣膜性心房颤动(NVAF)患病率呈逐年上升趋势,血栓栓塞是其主要并发症,而左心耳是NVAF患者血栓形成的主要部位。因此,探索左心耳血栓形成的发生机制对早期预测血栓栓塞事件发生风险、改善患者预后具有重要意义。目的 分析血小板形态参数、左心耳血流动力学参数与老年NVAF患者左心耳血栓形成的关系。方法 回顾性选取2016年6月至2021年7月张家口市第一医院收治的287例老年NVAF患者为研究对象,根据左心耳血栓形成发生情况将患者分为血栓组22例和对照组265例。比较两组患者的临床资料。采用多因素Logistic回归分析探讨老年NVAF患者发生左心耳血栓形成的影响因素;采用Pearson相关分析探讨老年NVAF伴左心耳血栓形成患者血小板形态参数与左心耳血流动力学参数的相关性。结果 血栓组患者年龄、左心室舒张末期容积(LVEDV)、血小板分布宽度(PDW)、平均血小板体积(MPV)大于对照组,病程长于对照组,慢性心力衰竭、脑卒中、其他血栓性疾病发生率、非阵发性心房颤动者占比、CHA2DS2-VASc评分、血小板计数(PLT)、大血小板比率(PLCR)、尿酸(UA)高于对照组,左心室射血分数(LVEF)、左心房射血分数(LAEF)低于对照组,左心耳血流峰值排空速度(LAA-EV)、左心耳血流平均排空速度(LAA-AEV)、左心耳血流峰值充盈速度(LAA-FV)、左心耳血流平均充盈速度(LAA-AFV)慢于对照组(P<0.05)。多因素Logistic回归分析结果显示,年龄、病程、慢性心力衰竭、脑卒中、其他血栓性疾病、心房颤动类型、LAA-EV、LAA-AEV、LAA-FV、LAAAFV、UA、PLT、PDW、MPV、PLCR是老年NVAF患者发生左心耳血栓形成的影响因素(P<0.05)。Pearson相关分析结果显示,老年NVAF伴左心耳血栓形成患者PDW、MPV、PLCR与LAA-EV、LAA-AEV、LAA-FV、LAA-AFV分别呈负相关(P<0.05)。结论 血小板形态参数(PDW、MPV、PLCR)、左心耳血流动力学参数(LAA-EV、LAAAEV、LAA-FV、LAA-AFV)是老年NVAF患者发生左心耳血栓形成的影响因素。

Abstract：

【Abstract】 Backgroud With the accelerating process of population aging, the prevalence of elderly nonvalvular atrialfibrillation (NVAF) is increasing year by year, thromboembolism is a main complication of the disease, and left atrial appendage isthe main site of thrombosis in NVAF patients. Therefore, exploring the mechanism of left atrial appendage thrombosis is of greatsignificance for early predicting the risk of thromboembolism and improving the prognosis of patients. Objective To evaluatethe relationship between platelet morphology parameters, left atrial appendage hemodynamic parameters and left atrial appendagethrombosis in elderly NVAF patients. Methods Two hundred and eighty-seven elderly patients with NVAF hospitalized inZhangjiakou First Hospital from June 2016 to July 2021 were enrolled in this study, and the patients were divided into thrombosisgroup (22 cases) and control group (265 cases) according to the occurrence of left atrial appendage thrombosis. Clinical data werecompared between the two groups. Multivariate Logistic regression analysis was used to explore the influencing factors of left atrialappendage thrombosis in elderly patients with NVAF; Pearson correlation analysis was used to explore the correlation betweenplatelet morphological parameters and left atrial appendage hemodynamic parameters in elderly NVAF patients complicatedwith left atrial appendage thrombosis. Results Age, left ventricular end diastolic volume (LVEDV) , platelet distribution width(PDW) and mean platelet volume (MPV) in the thrombosis group were larger than those in the control group, the course of diseasewas longer than that in the control group, incidence of chronic heart failure, stroke, the other thrombotic diseases, the proportionof non-paroxysmal atrial fibrillation, CHA2DS2-VASc score, platelet count (PLT) , platelet large cell ratio (PLCR) and uric acid(UA) were higher than those in the control group, left ventricular ejection fraction (LVEF) , left atrial ejection fraction (LAEF) werelower than those in the control group, left atrial appendage emptying peak flow velocity (LAA-EV) , left atrial appendage averageemptying flow velocity (LAA-AEV) , left atrial appendage filling peak flow velocity (LAA-FV) , left atrial appendage averagefilling flow velocity (LAA-AFV) were slower than those in the control group (P < 0.05) . Multivariate Logistic regression analysisshowed that age, course of disease , chronic heart failure, stroke, other thrombotic diseases, type of atrial fibrillation, LAA-EV,LAA-AEV , LAA-FV, LAA-AFV, UA, PLT, PDW, MPV, PLCR were influencing factors of left atrial appendage thrombosis inelderly patients with NVAF (P < 0.05) . Pearson correlation analysis results showed that PDW, MPV and PLCR were negativelycorrelated with LAA-EV, LAA-AEV, LAA-FV, LAA-AFV in elderly NVAF patients complicated with left atrial appendagethrombosis, respectively (P < 0.05) . Conclusion Platelet morphology parameters (PDW, MPV, PLCR) and left atrial appendagehemodynamic parameters (LAA-EV, LAA-AEV, LAA-FV, LAA-AFV) are the influencing factors of left atrial appendage thrombosisin elderly patients with NVAF.

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