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目的 :观察房颤患者微栓子和D-二聚体水平与血栓栓塞危险分层的关系。方法 :300例持续性房颤患者,监测微栓子及检测D-二聚体水平,同时参考房颤栓塞临床危险分层给每例评分,依据微栓子是否阳性及D-二聚体水平是否高于正常单独及联合分组,比较各组临床评分。结果:微栓子监测阳性78例,阴性222例,两组非瓣膜病性房颤患者存在的危险因素评分(CHADS2)分别为(3.8±1.1)分和(2.6±1.0)分(P<0.05);血浆D-二聚体阳性107例,正常193例,两组CHADS2评分分别为(3.4±1.2)分和(2.8±1.3)分(P<0.05)。微栓子阳性同时D-二聚体阳性(A组)48例,微栓子阳性同时D-二聚体正常(B组)30例,微栓子阴性同时D-二聚体阳性(C组)59例,微栓子阴性同时D-二聚体正常(D组)163例,各组CHADS2评分分别为A组(3.6±1.3)分、B组(3.3±1.2)分、C组(3.2±1.3)分、D组(2.6±1.2)分,4组间评分结果有显著性差异(F=5.20,P=0.002),A组评分高于其他3组,与D组差异有统计学意义(P<0.05);微栓子监测与D-二聚体水平存在关联性(χ2=30.74,P<0.05,r=0.32)。结论 :房颤患者微栓子阳性以及D-二聚体阳性与较高的CHADS2评分一致;微栓子监测与D-二聚体检查联合可在CHADS2评分基础上协助评估房颤患者栓塞风险。
Objective: To investigate the relationship between the level of micro-emboli and D-dimer in patients with atrial fibrillation and the risk stratification of thromboembolism. Methods: Three hundred patients with persistent AF were monitored for microemboli and D-dimer levels. At the same time, each patient was scored according to the clinical risk stratification of atrial fibrillation. According to whether microemboli were positive and D-dimer level Whether higher than the normal single and combined group, comparing the clinical scores of each group. Results: The positive rate of CHADS2 in the two groups of non-valvular AF patients was (3.8 ± 1.1) and (2.6 ± 1.0) points respectively (P <0.05) ). The plasma D-dimer was positive in 107 cases and normal in 193 cases. The CHADS2 scores of the two groups were (3.4 ± 1.2) and (2.8 ± 1.3) points respectively (P <0.05). Forty-eight patients with positive micro-emboli and positive D-dimer (group A), 30 patients with micro-embolus positive and normal D-dimer (group B), 30 patients with positive micro-emboli and positive D-dimer (group C) ) (N = 59). There were 163 patients with normal micro-emboli and normal D-dimer (group D). The CHADS2 scores in each group were 3.6 ± 1.3 in group A, 3.3 ± 1.2 in group B and 3.2 ± 1.3) in group D, and 2.6 ± 1.2 in group D, there was a significant difference between the four groups (F = 5.20, P = 0.002). The score of group A was higher than that of the other three groups (P <0.05). There was a correlation between micro-embolus monitoring and D-dimer level (χ2 = 30.74, P <0.05, r = 0.32). Conclusions: The positive of micro-emboli and the positive of D-dimer in patients with atrial fibrillation are consistent with the higher CHADS2 score. The combination of microemboli monitoring and D-dimer test can assist in assessing the embolic risk of atrial fibrillation based on the CHADS2 score.