作者：杨尹，杨金江，李晓霞，张国美，杨丽，成家茂，陈海燕

单位：

1.大理大学第一附属医院超声科大理大学临床医学院超声教研室2.大理大学第一附属医院血管外科3.大理大学基础医学院解剖学教研室

Units：

Department of Ultrasound, the First Affiliated Hospital of Dali University/Department of Ultrasound, School of Clinical Medicine, Dali University;Department of Vascular Surgery, the First Affiliated Hospital of Dali University;Department of Anatomy, School of Basic Medical Sciences, Dali University;

关键词：

心房颤动; 非瓣膜性心房颤动; 左心房; 左心耳; 血栓形成; 危险因素; Meta分析;

Keywords：

Atrial fibrillation;Non-valvular atrial fibrillation;Left atrium;Left auricle;Thrombosis;Risk factors;Meta-analysis;

CLC：

DOI：

10.12114/j.issn.1008-5971.2022.00.334

Funds：

云南省教育厅科学研究基金项目（2022Y855）；

摘要：

目的 通过Meta分析探讨非瓣膜性心房颤动（NVAF）患者左心房（LA）或左心耳（LAA）血栓形成的危险因素。方法 通过计算机系统检索PubMed、Cochrane Library、Web of Science、Embase、中国生物医学文献数据库、中国知网、维普网、万方数据知识服务平台公开发表的关于NVAF患者LA或LAA血栓形成危险因素的文献，检索时限从建库至2022-03-31。由2名研究者完成文献检索、筛选和数据提取，使用纽卡斯尔-渥太华量表（NOS）评估纳入文献的质量。使用RevMan 5.4软件进行Meta分析。结果 最终共纳入15篇文献进行Meta分析，其中中文文献8篇，英文文献7篇；共有7 719例患者；共涉及10个危险因素，分别为年龄、非阵发性心房颤动（AF）、卒中史、充血性心力衰竭史、周围血管病、CHA2DS2-VASc评分、D-二聚体、左心房前后径（LAD）、左心室射血分数（LVEF）、B型利钠肽（BNP）。Meta分析结果显示，年龄增长[OR=1.02,95%CI(1.01,1.04),P=0.000 5]、非阵发性AF[OR=3.24,95%CI(1.85,5.68),P<0.000 1]、卒中史[OR=2.44,95%CI(1.27,4.67),P=0.007]、充血性心力衰竭史[OR=1.45,95%CI(1.02,2.06),P=0.04]、周围血管病[OR=3.14,95%CI(1.38,7.14),P=0.006]、CHA2DS2-VASc评分升高[OR=1.41,95%CI(1.06,1.87),P=0.02]、D-二聚体升高[OR=1.85,95%CI(1.19,2.87),P=0.006]、LAD增大[OR=1.11,95%CI(1.04,1.18),P=0.002]、LVEF降低[OR=0.92,95%CI(0.90,0.94),P<0.000 01]是NVAF患者LA或LAA血栓形成的危险因素，BNP不是NVAF患者LA或LAA血栓形成的影响因素[OR=1.00,95%CI(1.00,1.00),P=0.08]。敏感性分析结果显示，更换效应模型后，各变量的Meta分析结果完全一致或基本一致，表明结果可靠。对报道LAD与NVAF患者LA或LAA血栓形成关系的文献进行发表偏倚分析，结果显示，漏斗图的数据点大致分布在对称轴的两侧，且大部分数据点分布在漏斗图的中上部，提示报道LAD与NVAF患者LA或LAA血栓形成关系文献的发表偏倚较小。结论 年龄增大、非阵发性AF、卒中史、充血性心力衰竭史、周围血管病、CHA2DS2-VASc评分升高、D-二聚体升高、LAD增大、LVEF降低是NVAF患者LA或LAA血栓形成的危险因素。

Abstract：

Objective To explore the risk factors of left atrial（LA） or left atrial appendage（LAA） thrombosis in patients with non-valvular atrial fibrillation（NVAF） by meta-analysis. Methods The literature on the risk factors of thrombosis in LA or LAA of NVAF patients published in PubMed, Cochrane Library, Web of Science, Embase, Chinese Biomedical Database, CNKI, VIP, Wanfang Data was searched through the computer system. The retrieval time limit was from database creation to 2022-03-31. Literature search, screening, and data extraction were performed by two researchers. The quality of the included literature was assessed using the Newcastle-Ottawa Scale（NOS）. Meta-analysis was performed using RevMan 5.4 software. Results Finally, a total of 15 literature were included for meta-analysis, including 8 Chinese literature and 7 English literature, with a total of 7 719 patients. A total of 10 risk factors were involved, which were age, non paroxysmal atrial fibrillation（AF）, history of stroke, history of congestive heart failure, peripheral vascular disease, CHA2DS2-VASc score, D-dimer, left atrial diameter（LAD）, left ventricular ejection fraction（LVEF）, and B-type natriuretic peptide（BNP）. The results of meta-analysis showed that age increase [OR=1.02, 95%CI（1.01, 1.04）, P=0.000 5], non paroxysmal AF [OR=3.24, 95%CI（1.85, 5.68）, P < 0.000 1], stroke history [OR=2.44, 95%CI（1.27, 4.67）, P=0.007], history of congestive heart failure [OR=1.45, 95%CI（1.02, 2.06）, P=0.04], peripheral vascular disease [OR=3.14, 95%CI（1.38, 7.14）, P=0.006], increased CHA2DS2-VASc score [OR=1.41, 95%CI（1.06, 1.87）, P=0.02], increased D-dimer [OR=1.85, 95%CI（1.19, 2.87）, P=0.006], increased LAD [OR=1.11, 95%CI（1.04, 1.18）, P=0.002], and decreased LVEF [OR=0.92, 95%CI（0.90, 0.94）, P < 0.000 01] were risk factors for LA or LAA thrombosis in NVAF patients, BNP was not an influencing factor for LA or LAA thrombosis in NVAF patients [OR=1.00, 95%CI（1.00, 1.00）, P=0.08]. The sensitivity analysis results showed that after the replacement of the effect model, the meta-analysis results of each variable were completely consistent or basically consistent, indicating that the results were reliable. The publication bias analysis of literature reporting the relationship between LAD and LA or LAA thrombosis in NVAF patients showed that the data points of funnel plot were roughly distributed on both sides of the symmetry axis, and most of the data points were distributed in the middle and upper part of the funnel plot, suggesting that the publication bias of literature reporting the relationship between LAD and LA or LAA thrombosis in NVAF patients was small. Conclusion Age increase, non paroxysmal AF, stroke history, congestive heart failure history, peripheral vascular disease, CHA2DS2-VASc score increase, D-dimer increase, LAD increase, LVEF decrease are the risk factors of LA or LAA thrombosis in NVAF patients.

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