非瓣膜性心房颤动与脑梗死的相关因素分析

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摘要目的：探讨非瓣膜性心房颤动患者血小板平均体积（MPV）、纤维蛋白原（FI）、左房内径（LAD）与缺血性脑梗死之间的关系。方法：选取165位平均年龄（75.8±7.6）岁的慢性心房颤动患者，根据CT和/或MRI检查确诊为脑梗死，分为心房颤动合并脑梗死（n=80）和单纯心房颤动（n=85），分别评估两组患者CHA2DS2-vasc积分、MPV、FI、LAD、血压、血脂和肾功能之间的差异。结果：心房颤动合并脑梗死和单纯心房颤动患者在CHA2DS2-vasc积分（P＜0.001）、MPV（P＜0.001）、FI（P=0.002）、血清脂蛋白（a）（P=0.017）、LAD（P＜0.001）、空腹血浆葡萄糖（P=0.034）之间存在明显的统计学差异，logistic回归分析显示CHA2DS2-vas、MPV、FI、LAD是心房颤动相关脑梗死的独立危险因素。结论：除CHA2DS2-vasc评分系统外，联合测定MPV、FI和LAD预测非瓣膜性心房颤动发生脑梗死具有重要的临床价值。

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	郑建雷1
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关键词 ：心房颤动, 脑梗死, 血小板平均体积, 纤维蛋白原, 左房内径

Abstract：Objective: To explore the relationship among the mean platelet volume, fibrinogen and left atrial size and cerebral infarction in patients with nonvalvular atrial fibrillation (AF). Methods: One hundred and sixty-five patients with AF were divided into AF with and without cerebral infarction diagnosed with computed tomography (CT) and/or magnetic resonance imaging (MRI). CHA2DS2-vasc score, mean platelet volume, plasma fibrinogen, left atrial size, blood pressure, serum lipid level and renal function were detected in the enrolled population. Results: Compared with the patients without cerebral infarction, the AF patients with cerebral infarction showed higher level of CHA2DS2-vasc score (P<0.001), plasma fibrinogen (P=0.002), mean platelet volume (P<0.001), fasting plasma glucose (P=0.034), lipoprotein (a) (P=0.017) and larger left atrial size (P<0.001). After adjustment of multiple traditional cardiovascular risk factors, logistic regression analysis showed that mean platelet volume, plasma fibrinogen, left atrial size and CHA2DS2-vasc score were independent risk factors for AF-related cerebral infarction. Conclusion: Except CHA2DS2-vasc score, the combined index of mean platelet volume, plasma fibrinogen and left atrial size may also play an important role in predicting the occurrence of cerebral infarction in patients with AF.

收稿日期: 2013-07-14

作者简介: 郑建雷（1977-），男，浙江乐清人，主治医师，博士

链接本文:

https://xb.wmu.edu.cn/CN/ 或 https://xb.wmu.edu.cn/CN/Y2014/V44/I1/44

[1] Camm AJ, Lip GY, De Caterina R, et al. 2012 focused up- date of the ESC Guidelines for the management of atrial fibrillation: an update of the 2010 ESC Guidelines for the management of atrial fibrillation-developed with the spe- cial contribution of the European Heart Rhythm Associa- tion[J]. Europace, 2012, 14(10): 1385-1413.
[2] Bouzas-Mosquera A, Broull FJ, varez-Garc N, et al. Left atrial size and risk for all-cause mortality and ischemic stroke[J]. CMAJ, 2011, 183(10): E657-664.
[3] Pisters R, Lane DA, Marin F, et al. Stroke and thromboem- bolism in atrial fibrillation[J]. Circ J, 2012, 76(10): 2289- 2304.
[4] Bath P, Algert C, Chapman N, et al. Association of mean platelet volume with risk of stroke among 3134 individuals with history of cerebrovascular disease[J]. Stroke, 2004, 35 (3): 622-626.
[5] Lang RM, Bierig M, Devereux RB, et al. Recommendations for chamber quantification: a report from the American Society of Echocardiography抯 Guidelines and Standards Committee and the Chamber Quantification Writing Group, developed in conjunction with the European Association of Echocardiography, a branch of the European Society of Cardiology[J]. J Am Soc Echocardiogr, 2005, 18(12): 1440- 1463.
[6] Magnani JW, Rienstra M, Lin H, et al. Atrial fibrillation: Current knowledge and future directions in epidemiology and genomics[J]. Circulation, 2011, 124(18): 1982-1993.
[7] Abhayaratna WP, Seward JB, Appleton CP, et al. Left atrial size: physiologic determinants and clinical applications[J]. J Am Coll Cardiol, 2006, 47(12): 2357-2363.
[8] Van der Loo B, Martin JF. A role for changes in platelet production in the cause of acute coronary syndromes[J]. Arterioscler Thromb Vasc Biol, 1999, 19(3): 672-679.
[9] Khode V, Sindhur J, Kanbur D, et al. Mean platelet volume and other platelet volume indices in patients with stable coronary artery disease and acute myocardial infarction: A case control study[J]. J Cardiovasc Dis Res, 2012, 3(4): 272- 275.
[10] Turfan M, Erdogan E, Ertas G, et al. Usefulness of mean platelet volume for predicting stroke risk in atrial fibrilla- tion patients[J]. Blood Coagul Fibrinolysis, 2013, 24(1): 55-58.
[11] Loukas M, Dabrowski M, Wagner T, et al. Fibrinogen and smooth muscle cell detection in atherosclerotic plaques from stable and unstable angina-an immunohistochemical study [J]. Med Sei Monit, 2002, 8(4): BR144-148.
[12] Gouni-Berthold I, Berthold HK. Lipoprotein(a): current per- spectives[J]. Curr Vasc Pharmacol, 2011, 9(6): 682-692.
[13] Emerging Risk Factors Collaboration, Erqou S, Kaptoge S, et al. Lipoprotein(a) concentration and the risk of coro- nary heart disease, stroke, and nonvascular mortality[J]. JAMA, 2009, 302(4): 412-423.
[14] Wityk RJ, Kittner SJ, Jenner JL, et al. Lipoprotein(a) and the risk of ischemic stroke in young women[J]. Atheros- clerosis, 2000, 150(2): 389-396.
[15] 陈昆明, 赵尖萍. 急性脑梗塞患者致炎细胞因子和早期神经功能恶化的关系[J]. 温州医学院学报, 2004, 34(4): 250-252.