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目的:通过观察非瓣膜性心房颤动患者血浆C反应蛋白(CRP)、D-二聚体的浓度及左心房直径、射血分数的水平,研究CRP与其左心房内血栓形成的关系。方法:将经食管超声心动图(TEE)检查的非瓣膜性心房颤动患者(107例)分为:左心房血栓形成组31例(血栓组)、无左心房血栓形成组76例(非血栓组)。检测血浆中CRP、D-二聚体的浓度及经胸超声心动图检测左心房直径、缩短分数、射血分数。结果:血栓组与非血栓组CRP浓度(中位数1.65 mg/L∶0.80 mg/L,P<0.01)、D-二聚体浓度(中位数188.00μg/L∶92.00μg/L,P<0.01)、左心房直径[(54.68±12.44)∶(46.77±12.31)mm,P<0.05]、射血分数[(58.20±9.42)∶(62.81±8.67)%,P<0.05]、缩短分数[(30.46±5.75)∶(35.24±5.41)%,P<0.01]。Logistic回归发现CRP、左心房直径与非瓣膜性心房颤动并发血栓形成独立相关(P<0.05),而D-二聚体、射血分数、缩短分数与非瓣膜性心房颤动并发血栓形成无显著相关。结论:CRP增高、左心房直径扩大是非瓣膜性心房颤动并发血栓形成的高危因素,炎症反应可能参与了心房内血栓形成。
OBJECTIVE: To investigate the relationship between CRP and left atrial thrombosis by observing the levels of plasma C-reactive protein (CRP), D-dimer and left atrium diameter and ejection fraction in patients with nonvalvular atrial fibrillation. Methods: A total of 107 patients with nonvalvular atrial fibrillation underwent transesophageal echocardiography (TEE) were divided into three groups: thromboembolism group (31 cases), thrombus group (left atrial thrombus group), non-thrombus group ). Plasma concentrations of CRP and D-dimer were measured and transthoracic echocardiography was performed to detect left atrial diameter, fractional shortening, and ejection fraction. Results: The CRP concentrations in thrombosis group and non-thrombus group (median 1.65 mg / L: 0.80 mg / L, P <0.01) and D-dimer concentrations (P <0.05). The ejection fraction (58.20 ± 9.42) :( 62.81 ± 8.67)%, P <0.05], shortening fraction [(30.46 ± 5.75): (35.24 ± 5.41)%, P <0.01]. Logistic regression showed that CRP was associated with non-valvular atrial fibrillation and thrombosis independently (P <0.05), while D-dimer, ejection fraction and fractional shortening were not significantly correlated with non-valvular atrial fibrillation complicated by thrombosis . CONCLUSIONS: Increased CRP and enlarged left atrium are risk factors for non-valvular atrial fibrillation complicated with thrombosis. Inflammatory reaction may be involved in atrial thrombosis.