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目的研究心房颤动(房颤)患者高凝相关指标及影响因素,探讨其临床意义。方法根据房颤患者是否有心力衰竭分为两组:房颤1组为无心力衰竭者(30例),房颤2组为有心力衰竭者(30例)。具器质性心脏病且心功能正常的窦性心律患者(40例)为窦性心律组,另选33例正常健康者为正常对照组。在慢性房颤患者、心脏病无房颤患者和健康正常人中,用酶联免疫法测定血浆D二聚体、用全自动血凝分析仪测定血浆纤维蛋白原(fibrinogen,Fg)。结果房颤1组患者D二聚体为474.5μg/L(220.0~843.9μg/L),房颤2组患者血浆D二聚体为657.9μg/L(365.8~1 448.6μg/L),明显高于窦性心律组271.6μg/L(186.6~426.2μg/L)和正常对照组179.5μg/L(131.4~235.1μg/L),(P<0.05)。房颤1组患者血浆Fg(3.74±0.76)g/L和房颤2组患者血浆Fg(4.25±0.95)g/L明显高于窦性心律组(3.26±0.80)g/L和正常对照组(2.97±0.72)g/L,(P<0.05)。与房颤1组比,房颤2组患者D二聚体、Fg显著升高(P<0.05)。与左房内径<40 mm的房颤患者比,左房内径≥40 mm的房颤患者D二聚体、Fg升高(P<0.05)。结论房颤患者存在着高凝状态,并且心力衰竭和左房扩大增加房颤的高凝状态,这些异常可能与房颤患者血栓形成和(或)栓塞事件相关。
Objective To study the hypercoagulable index and its influencing factors in patients with atrial fibrillation (AF) and to explore its clinical significance. Methods Atrial fibrillation patients with heart failure were divided into two groups: one group of patients with atrial fibrillation without heart failure (30 cases), two cases of atrial fibrillation with heart failure (30 cases). Patients with organic heart disease and normal heart rhythm (40 cases) were sinus rhythm group, while the other 33 normal controls were normal control group. In patients with chronic atrial fibrillation, patients with atrial fibrillation without heart disease, and healthy controls, plasma D dimer was measured by enzyme - linked immunosorbent assay and plasma fibrinogen (Fg) was measured by an automatic hemagglutination analyzer. Results D-dimer was 474.5μg / L (220.0 ~ 843.9μg / L) in patients with atrial fibrillation and plasma D dimer was 657.9μg / L (365.8 ~ 1448.6μg / L) in two groups. 271.6 μg / L (186.6 ~ 426.2 μg / L) in sinus rhythm group and 179.5 μg / L (131.4 ~ 235.1 μg / L) in normal control group (P <0.05). Plasma Fg (3.74 ± 0.76) g / L in AF group and Fg (4.25 ± 0.95) g / L in AF group were significantly higher than those in sinus rhythm group (3.26 ± 0.80) g / L and normal control group (2.97 ± 0.72) g / L, (P <0.05). Compared with AF 1 group, D-dimer and Fg in AF group were significantly increased (P <0.05). Compared with patients with atrial fibrillation with atrial diameter less than 40 mm in the left atrium, the D dimer and Fg in patients with atrial fibrillation with atrial diameter ≥40 mm were significantly higher (P <0.05). Conclusions Atrial fibrillation patients have hypercoagulable state, and heart failure and left atrial enlargement increase the hypercoagulability of atrial fibrillation. These abnormalities may be related to thrombosis and / or embolic events in AF patients.