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中华临床医师杂志(电子版)

中华临床医师杂志(电子版) ›› 2021, Vol. 15 ›› Issue (08) : 605 -609. doi: 10.3877/cma.j.issn.1674-0785.2021.08.009

临床研究

非瓣膜性心房颤动患者左心耳结构复杂性与其血栓形成的相关性研究
张敏1,†(), 解美玲1, 刘微2, 吕明礼1, 尹惜民1, 喻群群1, 陈光平1, 李拉拉1, 胡安雷1, 赵东英1, 曾莲1, 周娜1, 邵敏艳1, 赵寿礼1   
  1. 1. 553000　贵州六盘水，首钢水钢总医院心内科
    2. 550000　贵阳，贵州省人民医院心内科
  • 收稿日期:2021-05-07 出版日期:2021-08-15
  • 通信作者: 张敏
  • 基金资助:
    2018年度六盘水市社会公关项目(52020-2018-0-4-03)

Association between thrombus formation and structural complexity of the left atrial appendage in patients with nonvalvular atrial fibrillation

Min Zhang1,†(), Meiling Xie1, Wei Liu2, Mingli Lv1, Ximin Yin1, Qunqun Yu1, Guangping Chen1, Lala Li1, Anlei Hu1, Dongying Zhao1, Lian Zeng1, Na Zhou1, Minyan Shao1, Shouli Zhao1   

  1. 1. Department of Cardiology, Shougang Shuigang General Hospital, Liupanshui 553000, China
    2. Department of Cardiology, Guizhou Provincial People's Hospital, Guiyang 550002, China
  • Received:2021-05-07 Published:2021-08-15
  • Corresponding author: Min Zhang
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引用本文：

张敏, 解美玲, 刘微, 吕明礼, 尹惜民, 喻群群, 陈光平, 李拉拉, 胡安雷, 赵东英, 曾莲, 周娜, 邵敏艳, 赵寿礼. 非瓣膜性心房颤动患者左心耳结构复杂性与其血栓形成的相关性研究[J]. 中华临床医师杂志(电子版), 2021, 15(08): 605-609.

Min Zhang, Meiling Xie, Wei Liu, Mingli Lv, Ximin Yin, Qunqun Yu, Guangping Chen, Lala Li, Anlei Hu, Dongying Zhao, Lian Zeng, Na Zhou, Minyan Shao, Shouli Zhao. Association between thrombus formation and structural complexity of the left atrial appendage in patients with nonvalvular atrial fibrillation[J]. Chinese Journal of Clinicians(Electronic Edition), 2021, 15(08): 605-609.

目的

评估非瓣膜性心房颤动（NVAF）患者左心耳结构复杂性与左心耳血栓形成的关系。

方法

纳入2018年10至2021年3月于首钢水钢总医院住院的NVAF患者，收集患者人口统计学资料、既往病史、心脏彩超等，进行CHA2DS2-VASc评分，行计算机断层扫描血管造影（CTA）评估患者有无左心耳血栓形成，并根据左心房CTA影像进行三维重建，将左心耳形态分为单纯型和复杂型两类，并以此进行分组。采用多因素Logistic回归分析探讨左心耳结构复杂性与左心耳血栓形成的关系。

结果

本研究入选218例NVAF患者，其中单纯型左心耳104例，复杂型左心耳组114例。单纯型左心耳组CHA2DS2-VASc评分［（2.4±1.7）分］、脑卒中/短暂性脑缺血发作（TIA）发生率（12.5%）、左心房血栓形成比例（5.8%）、高血压患病率（44.2%）均显著低于复杂型左心耳组［（2.9±1.5）分、27.2%、16.7%、59.6%］，差异均有统计学意义（P均＜0.05）。多因素Logistic回归分析显示，复杂型左心耳患者左心耳血栓形成风险是简单型左心耳患者的3.506倍（OR=3.506，95% CI：1.125~10.928）；此外，充血性心力衰竭（OR=12.552，95% CI：3.225~48.852）、左心房前后径（OR=1.082，95% CI：1.003~1.169）、NYHA心功能分级（OR=2.103，95% CI：1.222~3.622）、CHA2DS2-VASc评分（OR=1.871，95% CI：1.261~2.778）均是左心耳血栓形成的独立危险因素（P均＜0.05）。

结论

复杂型左心耳显著增加NVAF患者左心耳血栓形成风险。

关键词: 非瓣膜性房颤, 左心耳解剖, 左心耳血栓
Objective

To evaluate the relationship between left atrial appendage (LAA) thrombus formation and structural complexity in patients with nonvalvular atrial fibrillation (NVAF).

Methods

Patients with NVAF hospitalized between October 2018 and March 2021 at Shougang Shuigang General Hospital were enrolled in this study. Demographic data, medical history, and echocardiography parameters were collected, and CHA2DS2-VASc scores were calculated. Left atrium computed tomography angiography was preformed to detect LAA thrombosis. LAA morphology was evaluated by computer-assisted LAA three-dimensional reconstruction. The patients were divided into a simple type group and a complex type group according to the results of LAA morphologies. Multivariate Logistic regression analysis was performed to investigate the relationship between the structural complexity of the LAA and thrombosis.

Results

A total of 218 patients with NVAF were included in the study, of whom 104 had a simple type LAA, and 114 had a complex type. CHA2DS2-VASc scores [(2.4±1.70) vs (2.9±1.5), P＜0.01], the rate of stoke/transient ischemic attack (12.5% vs 27.2%, P＜0.01), the incidence of hypertension (44.2% vs 59.6%, P＜0.05), and LAA thrombosis rate (5.8% vs 16.7%, P＜0.05) were all significantly lower in the simple type group than those in the complex type group. Multivariate logistic regression analysis showed that the risk of LAA thrombosis was 3.506-fold higher in patients with complex type LAA than in those with simple type LAA [odds ratio (OR)=3.506, 95% confidence interval (CI): 1.125-10.928]. Besides, congestive heart failure (OR=12.552, 95% CI: 3.225-48.852), anteroposterior diameter of the left atrium (OR=1.082, 95% CI: 1.003-1.169), NYHA heart function grade (OR=2.103, 95% CI: 1.222-3.622), and CHA2DS2-VASc score (OR=1.871, 95% CI: 1.261-2.778) were independent risk factors for LAA thrombosis (P＜0.05).

Conclusion

Complex LAA significantly increases the risk of LAA thrombosis in NVAF patients.

Key words: Nonvalvular atrial fibrillation, Left atrial appendage morphology, Left atrial appendage thrombosis
表1 2组非瓣膜性心房颤动患者一般资料比较
项目 单纯型左心耳组（104例） 复杂型左心耳组（114例） 统计值 P值
年龄（岁，
x¯
±s）		 65.2±10.3 67.8±10.9 t=-1.800 0.073
AF病程（月，
x¯
±s）		 23.7±32.9 31.5±64.7 t=-1.133 0.259
LAD（mm，
x¯
±s）		 39.7±8.8 38.6±6.4 t=1.087 0.279
LVEDD（mm，
x¯
±s）		 47.6±8.6 45.9±8.9 t=1.385 0.168
LVEF（%，
x¯
±s）		 56.0±8.7 56.7±9.6 t=-0.514 0.606
CHA2DS2-VASc评分（分，
x¯
±s）		 2.4±1.7 2.9±1.5 t=-2.660 0.008
男性［例（%）］ 44（42.3） 52（45.6） χ2=0.241 0.623
持续性AF［例（%）］ 60（57.7） 79（61.4） χ2=0.311 0.577
充血性心力衰竭［例（%）］ 44（42.3） 50（43.9） χ2=0.053 0.817
高血压［例（%）］ 46（44.2） 68（59.6） χ2=5.182 0.023
糖尿病［例（%）］ 10（9.6） 20（17.5） χ2=2.881 0.090
脑卒中/TIA/TE［例（%）］ 13（12.5） 31（27.2） χ2=7.288 0.007
LAA血栓［例（%）］ 6（5.8） 19（16.7） χ2=6.361 0.012
NYHA心功能分级［例（%）］ χ2=0.468 0.926

Ⅰ级

 54（51.9） 62（54.4）

Ⅱ级

 24（23.1） 22（19.3）

Ⅲ级

 12（11.5） 14（12.3）

Ⅳ级

 14（13.5） 16（14.0）
表2 左心耳血栓形成相关影响因素的多因素Logistic回归分析
变量 B SE Wald P值 OR值 95% CI
下限 上限
女性 1.488 0.582 6.531 0.011 4.430 1.415 13.872
充血性心力衰竭 2.530 0.693 13.315 0.000 12.552 3.225 48.852
复杂型左心耳 1.255 0.580 4.680 0.031 3.506 1.125 10.928
LAD 0.079 0.039 4.111 0.043 1.082 1.003 1.169
NYHA心功能分级 0.744 0.277 7.191 0.007 2.103 1.222 3.622
CHA2DS2-VASc评分 0.627 0.202 9.664 0.002 1.871 1.261 2.778
常量 -11.820 2.423 23.793 0.000 0.000
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