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目的探讨D-二聚体(DD)结合CHA_2DS_2-VASc评分对非瓣膜性心房颤动(NVAF)患者左心房血栓(LAT)的诊断价值。方法对2013年1月至2014年6月江西省人民医院临床怀疑LAT的NVAF患者205例进行回顾性分析,包括一般情况及病史、CHA_2DS_2-VASc评分、血生化检查及经食管超声心动图(TEE)检查。根据TEE检查结果分为左心房血栓形成组(LAT组)和无血栓形成组(非LAT组)。应用单因素分析及多因素Logistic回归分析确立LAT形成的独立危险因素,进而改良CHA_2DS_2-VASc评分方案。绘制受试者工作曲线(ROC),比较改良前后两种不同的评分方案对NVAF患者LAT的诊断价值。结果 DD阳性、CHA_2DS_2-VASc>2分是LAT形成的独立危险因素;依据Logistic回归分析结果,将DD阳性记为1分,加入CHA_2DS_2-VASc评分中,组成CHA_2DS_2-VAScDD评分方案。ROC曲线显示,CHA_2DS_2-VASc评分的曲线下面积(AUC)为0.663,最佳诊断点为2分,灵敏度为0.744,特异度为0.707;CHA_2DS_2-VASc-DD评分的AUC为0.811,最佳诊断点为3分,灵敏度为0.768,特异度为0.745。结论 DD结合CHA_2DS_2-VASc评分对NVAF患者LAT形成有更高的诊断价值。
Objective To investigate the diagnostic value of D-dimer (DD) combined with CHA_2DS_2-VASc in the diagnosis of left atrial thrombus (LAT) in patients with nonvalvular atrial fibrillation (NVAF). Methods A total of 205 NVAF patients with suspected LAT in Jiangxi Provincial People’s Hospital from January 2013 to June 2014 were retrospectively analyzed, including general and history, CHA_2DS_2-VASc score, blood biochemical examination and transesophageal echocardiography (TEE )an examination. According to TEE examination results were divided into left atrial thrombosis group (LAT group) and non-thrombosis group (non-LAT group). Univariate analysis and multivariate Logistic regression analysis were used to establish independent risk factors for LAT formation and to improve the CHA_2DS_2-VASc score scheme. The receiver operating characteristic curve (ROC) was drawn to compare the diagnostic value of two different scoring schemes before and after the improvement of LAT in patients with NVAF. Results DD was positive and CHA_2DS_2-VASc> 2 was an independent risk factor for LAT. According to Logistic regression analysis, the positive score of DD was recorded as 1, and the score of CHA_2DS_2-VASc was added to the score of CHA_2DS_2-VAScDD. The ROC curve showed that the area under the curve (AUC) of CHA_2DS_2-VASc score was 0.663, the best diagnosis point was 2, the sensitivity was 0.744 and the specificity was 0.707. The AUC of CHA_2DS_2-VASc-DD score was 0.811. The best diagnostic point A score of 3, a sensitivity of 0.768 and a specificity of 0.745. Conclusion DD combined with CHA_2DS_2-VASc score has a higher diagnostic value for the formation of LAT in patients with NVAF.