作者：朱琳，杨文静，尤立蕊

单位：

1.100010北京市普仁医院综合科　2.100012北京市，中国医科大学航空总医院老年科　3.100191北京市，北京大学第三医院普通内科

Units：

1.Department of General, Beijing Puren Hospital, Beijing 100010, China2.Department of Geriatrics, Aviation General Hospital of China Medical University, Beijing 100012, China3.Department of General Medicine, Peking University Third Hospital, Beijing 100191, China

关键词：

非瓣膜性心房颤动；血栓形成；尿酸；同型半胱氨酸；超敏C反应蛋白

Keywords：

Non-valvular atrial fibrillation; Thrombosis; Uric acid; Homocysteine; Hypersensitive C-reactive protein

CLC：

R 541.75

DOI：

10.12114/j.issn.1008-5971.2023.00.199

Funds：

摘要：

目的　探讨血清尿酸（UA）、同型半胱氨酸（Hcy）及hs-CRP与非瓣膜性心房颤动（NVAF）患者发生血栓形成的关系。方法　采用整群抽样法选取2020年1月至2022年1月北京市普仁医院和中国医科大学航空总医院收治的186例NVAF患者作为房颤组，另选取同期在北京市普仁医院和中国医科大学航空总医院进行体检的53例健康者作为对照组。根据房颤组患者是否发生血栓形成将其分为血栓亚组（n=51）和无血栓亚组（n=135）。比较对照组和房颤组实验室检查指标，血栓亚组和无血栓亚组临床资料和实验室检查指标。NVAF患者发生血栓形成的影响因素分析采用多因素Logistic回归分析，绘制ROC曲线以评估血清UA、Hcy、hs-CRP对NVAF患者发生血栓形成的预测价值。结果　房颤组血清UA、Hcy、hs-CRP高于对照组（P＜0.05）。血栓亚组年龄和左心房内径大于无血栓亚组，有高血压、糖尿病、高脂血症者占比和持续性心房颤动者占比及血清UA、Hcy、hs-CRP高于无血栓亚组，心房颤动病程长于无血栓亚组（P＜0.05）。多因素Logistic回归分析结果显示，年龄、糖尿病、高脂血症、心房颤动病程、左心房内径及血清UA、Hcy、hs-CRP是NVAF患者发生血栓形成的独立影响因素（P＜0.05）。ROC曲线分析结果显示，血清UA、Hcy、hs-CRP预测NVAF患者发生血栓形成的AUC分别为0.964〔95%CI（0.926，0.986）〕、0.934〔95%CI（0.888，0.965）〕、0.976〔95%CI（0.943，0.993）〕。结论　血清UA、Hcy、hs-CRP升高是NVAF患者发生血栓形成的危险因素，且三者均对NVAF患者发生血栓形成具有较高的预测价值。

Abstract：

Objective To investigate the relationship between serum uric acid (UA) , homocysteine (Hcy) ,hypersensitive C-reactive protein (hs-CRP) and thrombosis in patients with nonvalvular atrial fibrillation (NVAF) . MethodsA total of 186 patients with NVAF admitted to Beijing Puren Hospital and Aviation General Hospital of China MedicalUniversity from January 2020 to January 2022 were selected as the atrial fibrillation group by cluster sampling method, and53 healthy subjects who underwent physical examination in Beijing Puren Hospital and Aviation General Hospital of ChinaMedical University during the same period were selected as the control group. According to whether thrombosis occurred inpatients with atrial fibrillation, they were divided into thrombosis subgroup (n=51) and non-thrombosis subgroup (n=135) . Thelaboratory examination indexes were compared between the control group and the atrial fibrillation group, the clinical data andlaboratory examination indexes were compared between the thrombus subgroup and the non-thrombus subgroup. MultivariateLogistic regression analysis was used to analyze the influencing factors of thrombosis in NVAF patients. ROC curve was drawn toevaluate the predictive value of serum UA, Hcy and hs-CRP for thrombosis in NVAF patients. Results The serum UA, Hcy andhs-CRP in the atrial fibrillation group were higher than those in the control group (P < 0.05) . The age and left atrial diameterof the thrombus subgroup were larger than those of the non-thrombus subgroup, the proportion of patients with hypertension,diabetes, hyperlipidemia, persistent atrial fibrillation and serum UA, Hcy and hs-CRP were higher than those of the non-thrombussubgroup, course of atrial fibrillation was longer than that of the non-thrombus subgroup (P < 0.05) . Multivariate Logisticregression analysis results showed that age, diabetes, hyperlipidemia, course of atrial fibrillation, left atrial diameter, serum UA, Hcy and hs-CRP were independent influencing factors of thrombosis in patients with NVAF (P < 0.05) . The results of ROC curveanalysis showed that the AUC of serum UA, Hcy and hs-CRP in predicting thrombosis in NVAF patients was 0.964 [95%CI (0.926,0.986) ] , 0.934 [95%CI (0.888, 0.965) ] and 0.976 [95%CI (0.943, 0.993) ] , respectively. Conclusion Increased serum UA,Hcy and hs-CRP are risk factors of thrombosis in patients with NVAF, and all of them have high predictive value for thrombosis inpatients with NVAF.

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