HDL-C与非瓣膜性心房颤动左心房/左心耳血栓形成的关系

摘要

目的：探讨高密度脂蛋白胆固醇（HDL－C）与非瓣膜性心房颤动（AF）左心房（LA）/左心耳（LAA）血栓形成的关系。方法：纳入非瓣膜性AF患者188例，根据HDL－C水平分为低HDL－C组44例（23．4％），正常HDL－C组144例（76．6％）；根据LA/LAA血栓分为血栓组（n＝39例）和非血栓组（n＝139例）。详细记录患者既往病史、实验室检验结果、经胸心脏彩超及经食管心脏超声（TEE）结果，比较两组的一般资料、LA或LAA血栓等。进一步单因素及多因素Logistic回归分析探讨LA／LAA血栓形成的相关危险因素。结果：（1）入选的188例患者中男108例、女80例，年龄（60．88±9．63）（29～78）岁。低HDL－C组男性、糖尿病、LA/LAA血栓比例及体质量指数、甘油三酯（TG）、空腹血糖（FBG）、左心房内径（LAD）大小、CHADS2评分高于正常HDL－C组（P＜0．01或0．05）。（2）Pearson相关分析显示，HDL－C水平与LA/LAA血栓形成负相关（r＝－0．231，P＝0．001）。（3）与非血栓组患者比较，LA／LAA血栓组患者既往脑卒中或一过性脑缺血发作（TIA）史、周围血管病史、持续性或永久性AF、低HDL－C血症比例、CHADS2评分较高，LAD较大，HDL－C水平比非血栓组显著偏低（P＜0．01或0．05）。（4）多因素Logistic回归分析显示，HDL－C （OR＝0．046，95％CI：0．007～0．300，P＝0．001）、持续性或永久性AF （OR＝0．306，95％CI：0．116～0．808，P＝0．017）、脑卒中或TIA（OR＝15．657，95％CI：2．525～97．069，P＝0．003）、周围血管病（OR＝5．817，95％CI：1．123～30．145，P＝0．036）与AF患者LA/LAA血栓形成独立相关。结论：HDL－C水平与LA/LAA血栓形成负相关，低HDL－C血症是LA/LAA血栓形成的高危因素。%O bjective:To investigate the relationship between high-density lipoprotein cholesterol (HDL-C) and left atrial (LA)/left atrial appendage (LAA) thrombus in non-valvular atrial fibrillation(AF)patients. Methods:One hundred and eighty-eight non-valvular AF patients were collected consecutively, and divided into low HDL-C group(n=44, 23.4%) and normal HDL-C group(n=144,76.6%),and also divided into thrombotic group and on-thrombotic group based on transesophagel echocardiography (TEE) result. Medical history, general conditions, laboratory test results, transthoracic echocardiography (TTE) and TEE results of the patients were recorded in detail, and compared between the two groups, including general information and LA or LAA thrombosis. Univariate and multivariate logistic regression analysis were used to explore the risk factors leading to LA or LAA thrombus formation. Results:(1) One hundred and eighty-eight patients were enrolled, 108 male cases and 80 female cases, with an average age of (60.88±9.63)years (29~78). The proportion of men, diabetes mellitus, LA or LAA thrombus, BMI, triglycerides (TG), fasting plasma glucose (FBG), left atrial diameter (LAD), CHADS2 score were significantly higher in low HDL-C group(P<0.01 or 0.05). (2) Pearson correlation analysis showed that, HDL-C levels and LA or LAA thrombus were negatively correlated (r=-0.231, P=0.001). (3) Compared with non-thrombotic group, previous history of stroke or TIA, history of peripheral vascular disease, persistent or permanent AF, and low HDL-C levels were in higher proportion in LA or LAA thrombus group, and higher CHADS2 score, LAD also wers found (P<0.01 or 0.05). (4) Univariate and multivariate logistic regression analysis demonstrated that HDL-C(OR=0.046, 95%CI:0.007~0.300,P=0.001), persistent or permanent AF(OR=0.306, 95%CI:0.116~0.808, P=0.017), previous history of stroke or TIA (OR=15.657, 95%CI:2.525-97.069, P=0.003), history of peripheral vascular disease (OR =5.817, 95% CI:1.123~30.145, P=0.036) were independent risk factors for LA/LAA thrombus. Conclusion:HDL-C levels are negatively correlated with LA or LAA thrombus. Low HDL-C level is a high risk factor for LA or LAA thrombus.