同型半胱氨酸对非瓣膜性心房颤动患者合并左心房血栓的预测价值

摘要

Objective To investigate the predictive value of homocysteine in patients with nonvalvular atrial fibrillation complicated with left atrial thrombus.Methods Totally 318 nonvalvular atrial fibrillation patients with(18 cases,thrombus group) or without(300 cases,control group) left atrium/auricle thrombus from January to June 2015 in Beijing Anzhen Hospital,Capital Medical University were enrolled.Fasting venous blood was sampled to test homocysteine through enzymatic cycling assay.CHA2DS2-VASc scores were recorded in all patients.The independent risk factors of left atrial thrombus in patients with nonvalvular atrial fibrillation were analyzed.Results The plasma homocysteine level in thrombus group was significantly higher than that in coutrol group[(18 ± 10) μmol/L vs (14 ± 5) μmol/L] (P =0.003).The incidence of left atrial thrombus increased with the CHA2DS2-VASc score[CHA2DS2-VASc 0-1:4.7％ (9/190),2-3:5.2％ (6/114),≥4:21.4％ (3/14)].Multivariate logistic regression analysis showed that plasma homocysteine level was an independent risk factor of left atrial thrombus (Odds ratio:0.934,95％ confidence interval:0.878-0.993,P =0.030).Conclusion Homocysteine level is an independent predictive factor of left atrial thrombus in patients with nonvalvular atrial fibrillation.%目的 探讨同型半胱氨酸(Hcy)对非瓣膜性心房颤动患者合并左心房血栓的预测价值.方法 连续入选2015年1-6月于首都医科大学附属北京安贞医院心房颤动中心住院的非瓣膜性心房颤动患者共318例,其中左心房(或左心耳)血栓形成的患者18例(血栓组),余300例患者无左心房(或左心耳)血栓(对照组).采用循环酶法测定患者血浆Hcy水平.依据CHA2DS2-VASc评分系统,计算每例患者的CHA2DS2-VASc评分.采用多因素Logistic回归分析患者发生左心房血栓的独立危险因素.结果 血栓组的血浆Hcy浓度明显高于对照组[(18±10) μmol/L比(14±5)μmol/L] (P =0.003).左心房血栓发生率随评分的增加而增高[CHA2DS2-VASc评分0～1分患者为4.7％(9/190),2～3分患者为5.2％(6/114),4分及以上患者为21.4％ (3/14)].多因素Logistic回归分析显示,血浆Hcy是左心房血栓形成的独立危险因素(比值比:0.934,95％置信区间:0.878～0.993,P=0.030).结论 血浆Hcy水平升高是预测非瓣膜性心房颤动患者发生左心房血栓形成的独立危险因素.