HDL-C与非瓣膜性房颤左心房血栓形成的关系

发布时间：2018-03-04 22:32

本文选题：心房颤动　切入点：高密度脂蛋白胆固醇　出处：《郑州大学》2017年硕士论文　论文类型：学位论文

【摘要】：背景心房颤动(atrial fibrillation,AF)是临床工作中最常见的心脏节律异常。随着人口老龄化的进展,房颤发病率呈逐年增长趋势。持续快递、且紊乱的心脏搏动常常导致血流动力学障碍和不良的生活质量。心房颤动与许多心血管疾病密切相关,房颤患者伴发的冠心病、高血压、心脏瓣膜病、心功能不全等疾病常导致心房结构重构和电重构,并与心房颤动互为因果,参与或加剧房颤的发生及发展进程。房颤时心房血栓脱落诱发的脑卒中等血栓栓塞事件具有较高的致残率和致死率。房颤人群中约65.2%为非瓣膜病心房颤动患者。国内研究证实非抗凝情况下,非瓣膜性房颤患者心源性脑卒中的发生率为5.3%,是正常人群发生脑栓塞风险的5.6倍。超过90%的非瓣膜性房颤患者血栓来自于左心房尤其是左心耳,与其特殊的解剖及功能紧密相关。经食道超声心动图(transesophageal echocardiography,TEE)常被作为房颤患者射频消融术前或电复律前的常规检查,目前是排除心房血栓的金标准。众所周知,血脂异常是动脉粥样硬化和冠心病的重要原因。低密度脂蛋白胆固醇(low-density lipoprotein cholesterol,LDL-C)水平增高和高密度脂蛋白胆固醇(high-density lipoprotein cholesterol,HDL-C)水平降低与冠心病风险增加直接相关。血脂异常作为心房颤动的危险因素,在其发生发展进程中的作用尚不明确。近年来,血脂与心房颤动的关系引起诸多学者的关注,成为一个新的研究热点。来自美国的动脉粥样硬化多种族研究(the Multi-Ethnic Study of atherosclerosis,mesa)和弗明汉心脏病研究(theframinghamheartstudy,fhs)的数据表明,高甘油三酯和低水平的hdl-c与心房颤动风险增加相关。在一项来自日本的队列研究中,watanabe等也提出hdl-c能降低心房颤动的发生风险。hdl-c除了是动脉粥样硬化的有效保护因子,同时具有抗动、静脉血栓的作用,其在脑卒中、肺栓塞、特发性静脉血栓等栓塞事件中的保护作用相继报道。而目前关于hdl-c水平与非瓣膜性房颤患者左心房血栓形成关系的报道尚少,仍需进一步研究。目的分析非瓣膜性房颤患者左心房血栓形成的危险因素,探讨hdl-c与非瓣膜性房颤左心房血栓形成的关系,及危险因素对心房血栓的预测价值。研究方法回顾性分析2014年1月至2016年4月在郑州大学第一附属医院心血管内科拟行房颤射频消融术的非瓣膜性房颤患者共计473例,经食道超声心动图检查确诊左心房是否有血栓形成分为两组:血栓组(n=60例)、非血栓组(n=413例)。比较两组患者一般资料、cha2ds2-vasc积分、实验室检查(包括hdl-c)、心脏彩超指标的差异,对差异有统计学意义的指标进行单因素及多因素的logistic回归分析,并绘制roc曲线分析危险因素对左心房血栓形成的预测价值。结果(1)血栓组与非血栓组一般资料比较血栓组年龄、脑卒中比例、cha2ds2-vasc积分、非阵发性房颤比例、rdw水平、左心房内径高于非血栓组,hdl-c水平低于非血栓组。(2)左心房血栓形成的单因素logistic回归分析结果表明高龄、脑卒中、高cha2ds2-vasc积分、高rdw水平、lad增大、非阵发性房颤是非瓣膜性房颤患者左心房血栓形成的危险因素,而hdl-c是左心房血栓形成的保护因素。(3)左心房血栓形成的多因素Logistic回归分析结果表明高CHA_2DS_2-VASc积分、非阵发性房颤是非瓣膜性房颤患者左心房血栓形成的独立危险因素,而HDL-C是左心房血栓形成独立保护因素。(4)CHA_2DS_2-VASc积分及HDL-C水平联合CHA_2DS_2-VASc积分、房颤类型的ROC曲线CHA_2DS_2-VASc积分预测非瓣膜性房颤患者左心房血栓的ROC曲线下面积为0.717(95%CI:0.671-0.759,p0.001),HDL-C水平联合CHA_2DS_2-VASc积分、房颤类型的ROC曲线下面积为0.791(95%CI:0.749-0.829,p0.001)。且两者曲线下面积相比差异有统计学意义(p=0.012)。结论低HDL-C水平是非瓣膜性房颤左心房血栓形成的危险因素,HDL-C水平联合CHA_2DS_2-VASc积分、房颤类型预测非瓣膜性房颤患者左心房血栓形成价值优于CHA_2DS_2-VASc积分。
[Abstract]:Background atrial fibrillation (atrial fibrillation AF) is the most common heart rhythm abnormality in clinical work. With the progress of population aging, the incidence of atrial fibrillation increases year by year. Continue to express, and heart disorder often leads to disorder of hemodynamics and poor quality of life. Atrial fibrillation is associated with many cardiovascular diseases hair, coronary heart disease, atrial fibrillation in patients with hypertension, valvular heart disease, heart failure and other diseases often lead to atrial structural remodeling and electrical remodeling in atrial fibrillation, and reciprocal causation and the occurrence and development process, participate in or exacerbate atrial fibrillation. Atrial thrombosis induced by stroke and thromboembolic events with high disability rate and death rate. About 65.2% population of patients with atrial fibrillation for patients with non valvular atrial fibrillation. The study confirmed that non anticoagulant cases occurred in non valvular atrial fibrillation in patients with cardiac stroke. The rate is 5.3%, is 5.6 times the risk of occurrence of cerebral embolism in normal population. Thrombosis in patients with non valvular atrial fibrillation more than 90% from the left atrium especially the left heart ear, and is closely related to the special anatomy and function. Transesophageal echocardiography (transesophageal, echocardiography, TEE) are often regarded as real fibrillation RF ablation or electrical cardioversion before the routine examination, is currently the gold standard of exclusion of atrial thrombi. As everyone knows, dyslipidemia is an important cause of atherosclerosis and coronary heart disease. Low density lipoprotein cholesterol (low-density lipoprotein, cholesterol, LDL-C) and increased the level of high density lipoprotein cholesterol (high-density lipoprotein cholesterol, HDL-C) levels decreased is directly related with the risk of coronary heart disease increased. Dyslipidemia as a risk factor for atrial fibrillation, in the role of the development process is not clear. In recent years, with the blood lipid The relationship between atrial fibrillation aroused the concern of many scholars, has become a new research hotspot. The multi ethnic study of atherosclerosis from America (the Multi-Ethnic Study of atherosclerosis, MESA) and the Framingham Heart Study (theframinghamheartstudy, FHS) data show that the increased risk of high triglycerides and low levels of HDL-C and atrial fibrillation. In a Japanese cohort study, Watanabe of HDL-C can reduce the risk of atrial fibrillation in.Hdl-c is an effective protective factor of atherosclerosis, and resist, venous thrombosis, the stroke, pulmonary embolism, protective effect of idiopathic venous thrombosis and embolism events has been reported. At present, on the level of HDL-C and non valvular atrial fibrillation in patients with left atrial thrombosis are less reported, still need further study. The analysis of non valvular purpose The risk factors of left atrial thrombus formation in patients with atrial fibrillation, left atrial thrombus and explore the relationship between HDL-C and non valvular atrial fibrillation formation, value and risk factors to predict atrial thrombosis. Methods a retrospective analysis from January 2014 to April 2016 in the First Affiliated Hospital of Zhengzhou University of cardiovascular medicine to atrial fibrillation radiofrequency ablation in patients with non valvular atrial fibrillation a total of 473 Cases, transesophageal echocardiography of left atrial thrombosis diagnosed map check whether there are divided into two groups: thrombus group (n=60 cases), non thrombosis group (n=413 cases). Cha2ds2-vasc were compared between the two groups of patients with general information, integration, laboratory examination (including HDL-C), differences in echocardiographic parameters, single regression analysis factor and multi factor Logistic had significant difference on the index, and predictive value of ROC curve analysis of risk factors of left atrial thrombosis. Results (1) thrombosis group and non thrombus group General information of the thrombus group age, stroke scale, cha2ds2-vasc score, the proportion of non paroxysmal atrial fibrillation, RDW level, left atrial diameter is higher than that of the non thrombus group, the HDL-C level is lower than the non thrombosis group. (2) logistic single factors of left atrial thrombosis in the regression analysis results showed that the high age, stroke, high cha2ds2-vasc score, high the level of RDW, lad increased, non paroxysmal atrial fibrillation are risk factors of non valvular atrial fibrillation in patients with left atrial thrombosis, while HDL-C is a protective factor for left atrial thrombosis. (3) Logistic multi factors of left atrial thrombosis in the regression analysis results showed that the high CHA_2DS_2-VASc score, non paroxysmal atrial fibrillation were independent risk factors for non valvular atrial fibrillation in patients with left atrial thrombosis, and HDL-C were the independent protective factors of left atrial thrombus formation. (4) CHA_2DS_2-VASc integral and HDL-C level combined with CHA_2DS_2-VASc integral, ROC curve of CH type of atrial fibrillation The A_2DS_2-VASc score in predicting ROC curve in patients with non valvular atrial fibrillation of left atrial thrombus was 0.717 (95%CI:0.671-0.759, p0.001), combined with CHA_2DS_2-VASc HDL-C integral, ROC curve type of atrial fibrillation under 0.791 (95%CI:0.749-0.829, p0.001) and the area under the curve. Both had significant difference (p=0.012). Conclusion: low HDL-C level is a risk factor for non valvular atrial fibrillation left atrial thrombosis, combined with CHA_2DS_2-VASc HDL-C integral level, type of atrial fibrillation predicts non valvular atrial fibrillation in patients with left atrial thrombosis value than the CHA_2DS_2-VASc integral.

【学位授予单位】：郑州大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R541.75

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