摘要:
目的:分析心房颤动患者左心房及左心耳(LA/LAA)血栓形成的相关影响因素.方法:对心房颤动患者369例,分为血栓组34例和非血栓组335例.详细记录患者既往病史、实验室化验结果、经胸心脏彩超结果,根据患者一般资料,比较两组资料的差别分析探讨LA/LAA血栓形成的危险因素.结果:入选的369例患者中男性214例、女性155例,年龄24~87岁,平均(61.22±9.24)岁,阵发性心房颤动282例(76.4%),持续性/永久性心房颤动87例(23.6%),经超声心动图检查确诊LA/LAA血栓34例(9.2%),非血栓组335例(90.8%).两组患者临床基本特征比较:①血栓组吸烟史、持续性/永久性心房颤动、左心房内径(LAD)、左心室舒张末内径(LVEDD)、D-二聚体明显高于对照组(P<0.05),LVEF值、左心耳开口直径明显低于对照组,差异有统计学意义(P<0.01).②两组患者年龄、性别、体质指数(BMI)、饮酒史、高血压病、糖尿病、冠心病、心房颤动病程、阿司匹林服药史以及患者血小板计数、纤维蛋白原水平、血尿素氮、血肌酐、TG、TC、LDL水平差异均无统计学意义(P>0.05).结论:本文结果显示,LAD、LVEDD、LVEF、D-二聚体、持续性/永久性心房颤动、左心耳开口大小(LAA-W)是LA/LAA血栓形成的独立危险因素,尤其是LAA-W在血栓形成机理认识及左心耳夹闭手术中具有潜在的指导价值.%Objective:The purpose of this paper is to to investigate risk factors of left atrial or left atrial appendage thrombus in atrial fibrillation patients.Methods:We conducted a retrospective cohort study of 335 consecutive non-valvular AF,then divided into LA/LAA thrombus group (n =34) and non LA/LAA thrombus group(n =335).Every patient's medical history,general conditions,laboratory test results,transthoracic echocardiography (TTE) results were recorded in detail.compare the difference between the two groups of data,analysis to explore the dangerous factors of LA/LAA thrombosis.Results:369patients were enrolled,male 214cases,female 155 cases,with age of 24 ~ 87 (61.22 ± 9.24) years,paroxysmal AF282 cases (76.4%),persistent / permanent AF 87 cases (23.6%),the LA/LAA thrombus confirmed by 3D transesophageal echocardiography were 34 cases (9.2%) in thrombotic group,335cases (90.8%) in non-thrombotic group patients,1.Compare two grouos of pationts with clinical basic characteristics:(1) Thrombus groups,smoking history,persistent/permanent AF,left arterial diameter (LAD),D-dimmer hypertension,level were significantly higher than that of control group (P < 0.05).(2)diabetes mellitus,coronary heart disease,AF duration,aspirin medication history,and the platelet count,fibrinogen level,serum creatinine,triglyceride,total cholesterol,low-density lipoprotein cholesterol levels there were no statistically significant difference (P > 0.05).Conclusion:In this paper,the results showed that,LAD,LVEDD,LVEF,D-dimmer stroke/TIA history,persistent/permanent atrial fibrillation,left atrial appendage width,LAA-W is LA/LAA independent risk factors for thrombosis,Especially the LAA-W has the potential value in left atrial appendage clamp guiding closed surgery and formation mechanism of the thrombosis.