非瓣膜性心房颤动患者心外膜脂肪组织体积与血栓栓塞事件相关性分析

发布时间：2018-07-21 17:48

【摘要】：目的：探讨心外膜脂肪组织(EAT)体积与非瓣膜性心房颤动(简称房颤)患者血栓栓塞间的关系方法：入选155例2012年-2015年于本院住院治疗的非瓣膜性房颤患者。使用螺旋CT扫描技术半手动测定所有患者的总心外膜脂肪体积及左心房周心外膜脂肪体积,同时记录左心房内径、基线资料、伴发疾病情况及抗凝药物使用情况。根据既往有无房颤相关的缺血性脑卒中、短暂性脑缺血发作(TIA)及体循环栓塞病史将研究对象分为栓塞组和非栓塞组,比较两组各指标间的差异,探讨房颤患者心外膜脂肪组织与栓塞事件间的关系。155例患者中95例未接受抗凝治疗患者纳入房颤组,另选取50例年龄、BMI及房颤病程相匹配者作为正常对照组,收集红细胞比积、血小板平均体积、D-二聚体和纤维蛋白原(FIB)等凝血状态指标,测定总心外膜脂肪体积及左心房周心外膜脂肪体积,比较两组凝血状态指标间的差异,并分析房颤患者中凝血指标与心外膜脂肪体积的相关性。结果：(1)合并高血压、糖尿病、血管疾病、冠心病的房颤患者较未合并者具有明显升高EAT及EAT-LA体积,单因素相关性分析显示EAT及LA-EAT体积与年龄CHA2DS2-VASc评分正相关(2)心外膜脂肪组织与栓塞事件：155例中,22例发生缺血性脑卒中或短暂性脑缺血发作(TIA)、体血环栓塞的房颤患者被纳入了栓塞事件组(平均年龄62.50±10.42岁,女性7例),余133例作为对照组(平均年龄54.45±10.81岁,女性38例)。研究发现与非栓塞事件组患者相比,栓塞事件组患者拥有更大的左心房内径、更高平均年龄及CHA2DS2-VASc评分，而在性别、体质量指数(BMI)、高血压、糖尿病、冠心病等伴发疾病及血脂水平等方面两组患者间未见明显差异。血栓栓塞事件组患者的EAT及LA-EAT体积较对照组明显增加(123.49±31.25 cm3 vs.100.55±35.36 cm3, P=0.005; 34.22±6.84 cm3 vs.27.10±9.55 cm3, P0.001).多因素相关性分析提示在矫正了CHA2DS2-VASc评分等混杂因素的情况下,EAT (OR=1.10,P=0.039)及LA-EAT (OR=1.10,P=0.024)均为房颤患者血栓栓塞之间的独立危险因素。(3)房颤组心外膜脂肪体积较正常对照组明显增高,同时相较正常对照组,房颤组具有更高的D-二聚体[0.26(0.21-0.41)vs 0.22(0.17-0.29),P0.001]和纤维蛋白原[2.85(2.46-3.83)vs2.69(2.42-3.36),P0.001]。相关性分析提示心外膜脂肪组织体积与D-二聚体和纤维蛋白原水平独立相关。结论：(1)积聚的心外膜脂肪组织与房颤血栓栓塞危险因素间关系密切,合并有高血压、糖尿病、冠心病、血管疾病及高龄等房颤血栓栓塞危险因素的房颤患者具有更大的心外膜脂肪体积。(2)心外膜脂肪组织体积是房颤患者血栓栓塞的独立危险因素,积聚的心外膜脂肪组织可能促进了房颤患者血栓栓塞的发生。(3)非瓣膜性房颤患者较正常人群具有明显的血栓前状态,心外膜脂肪体积与房颤患者血栓前状态间存在相关性。
[Abstract]:Objective: to investigate the relationship between the volume of epicardial adipose tissue (EAT) and thromboembolism in patients with non-valvular atrial fibrillation (AF). The total epicardial fat volume and epicardial fat volume of left atrium were measured by semi-manual spiral CT scanning. The diameter of left atrium, baseline data, associated diseases and anticoagulant use were recorded. According to the history of transient ischemic attack (TIA) and systemic circulation embolism, the subjects were divided into embolization group and non-embolization group, and the differences between the two groups were compared. To explore the relationship between epicardial adipose tissue and embolism events in patients with atrial fibrillation. 95 of 155 patients without anticoagulant therapy were included in the atrial fibrillation group. 50 patients with age-matched BMI and course of atrial fibrillation were selected as the normal control group to collect hematocrit. The mean platelet volume and coagulation state indexes such as D-dimer and fibrinogen (FIB), total epicardial fat volume and left atrial pericardial epicardial fat volume were measured, and the difference of coagulation state between the two groups was compared. The correlation between coagulation parameters and epicardial fat volume in patients with atrial fibrillation was analyzed. Results: (1) Atrial fibrillation patients with hypertension, diabetes, vascular disease and coronary heart disease had significantly higher volume of eat and EAT-LA than those without. Univariate correlation analysis showed that the volumes of eat and LA-EAT were positively correlated with age CHA2DS2-VASc scores (2) epicardial adipose tissue and embolism events occurred in 22 out of 155 patients with ischemic stroke or transient ischemic attack (TIA) and atrial fibrillation with systemic blood ring embolism. Patients were enrolled in the embolization event group (mean age 62.50 卤10.42 years). The remaining 133 cases were used as control group (mean age 54.45 卤10.81 years, female 38 cases). The study found that patients in the event group had greater left atrial diameter, higher average age and CHA2DS2-VASc score than those in the non-embolism event group, while gender, body mass index (BMI), hypertension, diabetes. There was no significant difference in coronary heart disease and blood lipid level between the two groups. The volume of eat and LA-EAT in the thromboembolism group was significantly higher than that in the control group (123.49 卤31.25 cm3 vs.100.55 卤35.36 cm 3, P < 0.005; 34.22 卤6.84 cm3 vs.27.10 卤9.55 cm 3, P 0.001). Multivariate correlation analysis showed that EAT (OR1. 10 P0. 039) and LA-EAT (OR1. 10 P0. 024) were independent risk factors between thromboembolism in patients with atrial fibrillation. (3) epicardial fat volume in AF group was significantly higher than that in normal control group. At the same time, atrial fibrillation group had higher D-dimer [0.26 (0.21-0.41) vs 0.22 (0.17-0.29) P0.001] and fibrinogen [2.85 (2.46-3.83) vs2.69 (2.42-3.36) P0.001]. Correlation analysis showed that the volume of epicardial adipose tissue was independent of D-dimer and fibrinogen levels. Conclusion: (1) the accumulation of epicardial adipose tissue is closely related to the risk factors of thromboembolism in atrial fibrillation. Vascular disease and elderly patients with atrial fibrillation with thromboembolism risk factors have greater epicardial fat volume. (2) epicardial adipose tissue volume is an independent risk factor for thromboembolism in patients with atrial fibrillation. The accumulation of epicardial adipose tissue may promote the occurrence of thromboembolism in patients with atrial fibrillation. (3) Non-valvular atrial fibrillation patients have significant prethrombotic state, and there is a correlation between epicardial fat volume and prethrombotic state in patients with atrial fibrillation.
【学位授予单位】：中国人民解放军医学院
【学位级别】：硕士
【学位授予年份】：2016
【分类号】：R541.75

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