老年非瓣膜心脏病心房颤动患者血小板功能及血管性血友病因子的改变

目的探讨老年非瓣膜心脏病心房颤动(房颤)患者血小板活化、内皮细胞功能改变及临床意义. 方法采用全血法流式细胞仪分别测定老年非瓣膜心脏病房颤或无房颤患者及健康老年人血小板膜上活化糖蛋白IIb/IIIa复合物(glycoprotein IIb/IIIa complex, GPIIb/IIIa)和糖蛋白Ib(glycoprotein Ib, GPIb)水平.用全自动细胞分析仪及酶联免疫吸附法分别测定平均血小板体积(MPV)和血浆血管性血友病因子(vWF). 结果老年非瓣膜心脏病房颤患者血小板表面活化GPIIb/IIIa荧光阳性率为9.23%(0.66%～73.89%),显著高于无房颤患者的2.61%(0.58%～17.33%)及健康老年组1.71%(0.45%～6.11%),(均为P<0.01).而老年非瓣膜心脏病房颤患者的GPIb荧光阳性率为(93.66±3.66)%,明显低于无房颤组的(96.65±2.10)%及健康老年组(97.88±1.89)%(均为P<0.01).此外,房颤患者的MPV水平也显著高于无房颤患者及健康老年人(P<0.05). 结论老年非瓣膜心脏病房颤患者存在血小板活性增高及内皮细胞功能受损,这些异常改变可能与老年房颤患者心房内血栓形成及血栓或栓塞并发症有关.     

抗栓治疗对非瓣膜病心房颤动患者血小板活化状态的影响

心房颤动（房颤）长期治疗的重点之一是预防脑卒中。华法林和阿司匹林抗栓治疗分别使脑卒中发病率降低约60％和20％。血小板活化在血栓形成过程中起关键作用，认识血小板活化的血清标志物，包括血小板α颗粒膜糖蛋白-140（GMP-140）、血栓素B2（TXB2）以及TXB2／6-酮-前列腺F1α（6-k-PGF1α）比值等，在抗栓治疗中的变化，有助于房颤患者的血栓栓塞危险分层和判断抗栓治疗的强度。     

老年非瓣膜性心房颤动抗凝治疗现状分析

目的分析影响老年非瓣膜性心房颤动患者抗凝治疗的因素,为提高老年心房颤动患者抗凝治疗寻求解决方法。方法对2009-10-01—2010-04-30入住北京协和医院,年龄≥65岁的老年非瓣膜性心房颤动患者进行门诊及电话随访,观察分析全因死亡、抗凝比例、未选择抗凝的原因、抗凝终止的原因、不抗凝(抗凝终止)后的抗栓方法等指标。结果共70例连续入院的患者纳入研究,平均随访9.1个月(6.0~13.5个月)。有效随访63例,其中包括年龄<75岁组33例和年龄≥75岁组30例。失访7例(10%)。随访期间共8例(12.7%)死亡,包括年龄<75岁组1例(3%)和年龄≥75岁组7例(23.3%)。有效随访病例中,进行抗凝治疗的仅16例(25.4%),这16例中INR达标13例。8例死亡患者均未进行抗凝治疗,其中6例称大夫未交待抗凝,另2例有明确抗凝禁忌证。结论老年心房颤动患者抗凝比例低,有效抗凝率低。抗凝过程中中断的比例高。解决老年心房颤动患者抗凝过程的具体困难是有效治疗的关键。     

非心瓣膜疾病性心房颤动与血栓栓塞

心房颤动（房颤）是临床上常见的心律失常，其发病率随年龄的增长而逐渐增高。房颤的并发症血栓栓塞，尤其是栓塞所致脑卒中的发病率也随之增加。非心瓣膜疾病性房颤的存在可使脑卒中发病率增加5～6倍。房颤的并发症血栓栓塞，尤其是脑栓塞是房颤致死、致残的最主要原因之一。国际上多个临床试验已经证实抗栓治疗可明显减少非心瓣膜疾病性房颤脑卒中的发生率和致残率，因此，对非瓣膜病患脑卒中的预防越来越受到心血管医师的重视。     

非瓣膜病性心房颤动的抗栓治疗

心房颤动（房颤）是最常见的持续性心律失常，80岁以上患者发病率接近10％。房颤的主要危害之一为脑卒中，目前研究认为15％的缺血性脑卒中与房颤有关，非瓣膜病房颤患者发生脑卒中的危险性是没有房颤者的5—7倍。基于此，房颤抗栓治疗已成为房颤规范化治疗的重要组成部分，抗栓治疗的新药物和新技术不断涌现，治疗手段也更趋于个体化。[第一段]     

非瓣膜性心房颤动与血栓栓塞

心房颤动是最常见的心律失常 ,并且是缺血性脑卒中最重要的危险因素之一 ,本文对非瓣膜性心房颤动与血栓栓塞的流行病学 ;非瓣膜性心房颤动发生血栓栓塞的血液学改变、危险因素以及预防作一综述。     

陕西关中地区县级医院非瓣膜性心房颤动患者的抗凝治疗现况及影响因素

目的 了解陕西关中地区县级医院非瓣膜性心房颤动(房颤)患者的抗凝治疗现况及影响因素。方法 通过查询住院电子病历和门诊存档病历,采用临床资料分析、电话随访+面对面随访、问卷调查的方式,筛选出2019年1～12月于陕西关中地区8家县级医院心内科就诊的门诊和住院房颤患者,分析中高危栓塞风险患者的抗凝治疗现况、华法林和非维生素K拮抗剂口服抗凝药(NOACs)长期抗凝治疗依从性及影响因素。问卷调查心内科医生房颤患者的栓塞风险评估、抗凝药物选择、栓塞风险及抗凝获益宣教情况。结果 共纳入房颤患者4 577例,平均年龄(67.9±10.1)岁,其中男性2 793例,女性1 784例,门诊患者1 968例,住院患者2 609例。采用CHA2DS2-VASc评分,门诊抗凝治疗率为14.9%,住院抗凝治疗率为44.9%。华法林抗凝治疗1年依从性良好、一般、较差的患者比例分别为24.0%、26.7%、49.3%;NOACs抗凝治疗1年依从性良好、一般、较差的患者比例分别为32.7%、25.2%、42.1%。影响患者抗凝治疗依从性的主要因素:频繁监测凝血及国际标准化比值(INR)难以保持目标水平、过于担忧出血风...     

预防非瓣膜性心房颤动患者缺血性脑卒中的抗栓疗法比较

非瓣膜性心房颤动(Af)作为缺血性脑卒中的独立危险因素可使栓塞的发生率显著增加,减少非瓣膜性Af患者缺血性脑卒中发生的重要措施就是抗栓治疗.本研究回顾性分析210例非瓣膜性Af患者的抗栓治疗状况,比较抗凝与抗血小板治疗对缺血性脑卒中的预防作用,为临床抗栓疗法的选择进一步提供依据.     

非瓣膜性心房颤动患者的综合治疗

心房颤动(AF)是临床上最常见的心律失常类型,既往AF管理侧重于AF相关栓塞预防以及心室率和节律的控制。近年来,AF综合管理的理念逐渐普及。AF综合管理强调在做好AF相关栓塞预防及症状控制的基础上,同时关注患者生活质量的改善以及合并症的管理,以进一步改善患者的预后。本文就非瓣膜性心房颤动患者的抗凝治疗、症状管理及危险因素的控制作一综述。     

左心耳结构复杂性与非瓣膜性心房颤动患者左心耳血栓形成的关系

目的:探讨左心耳结构复杂性与非瓣膜性心房颤动(NVAF)患者左心耳血栓形成的关系。方法:连续入选拟行射频消融术治疗的NVAF患者295例,记录病史资料和化验指标,进行CHA2DS2-VASc评分。行经食道超声心动图和计算机断层扫描血管造影(CTA)检查了解左心耳有、无血栓形成,以此将患者分为血栓组(n=42)和无血栓组(n=253)。应用CT影像后处理系统对左心房CTA影像进行三维重建,获取每例患者的左心耳形态,将左心耳形态分为单纯型和复杂型两类。分析左心耳血栓形成与各项潜在危险因素的关系。结果:血栓组非阵发性心房颤动(76.2%vs 18.2%)、复杂型左心耳比例(66.7%vs 45.1%)显著高于无血栓组(P均<0.01)。此外,血栓组患者的年龄、心房颤动病程、左心房前后径、B型利钠肽、血尿酸、CHA2DS2-VASc评分均大于无血栓组(P均<0.05)。相对于无血栓组,血栓组患者的高血压、糖尿病、冠心病、慢性心力衰竭、脑卒中/短暂性脑缺血发作/血栓栓塞以及血管疾病的患病率更高(P均<0.05)。多因素Logistic回归分析显示,复杂型左心耳(OR=4.129,95%CI:1.413~12.069)、心房颤动病程(OR=1.021,95%CI:1.006~1.036)、非阵发性心房颤动(OR=13.910,95%CI:4.563~42.406)与CHA2DS2-VASc评分(OR=2.580,95%CI:1.115~5.966)均是左心耳血栓形成的独立危险因素(P均<0.05)。结论:复杂型左心耳为NVAF患者左心耳血栓形成的独立危险因素。     

他汀类药物在心房颤动治疗中的作用

他汀类药物可以减少心房颤动的发生率.现对其治疗心房颤动的作用及可能的作用机制作一综述.     

Left Ventricular Hypertrophy Determines the Severity of Diastolic Dysfunction in Patients with Nonvalvular Atrial Fibrillation and Preserved Left Ventricular Systolic Function

Regression of left ventricular (LV) hypertrophy (LVH) is known to be related to a lower incidence of stroke in hypertensive patients with nonvalvular atrial fibrillation (NV-AF). However, its mechanism remains controversial. Recently, diastolic dysfunction (DD) was reported to be correlated with ischemic stroke in NV-AF. We hypothesized that hypertension (HTN) and resultant LVH might be associated with the severity of DD in NV-AF. Two hundred and ninety-four patients (204 males, age 66 ± 12 y) with NV-AF with preserved LV systolic function were included. Clinical and echocardiographic data were compared between patients with enlarged left atrial (LA) volume (n == 237) and patients with normal LA. Age (60 ± 12 vs. 67 ± 11 years), sex (male; 81 vs. 62%%), duration of NV-AF (4.1 ± 7.8 vs. 45.7 ± 49.0 months), brain natriuretic peptide (108.3 ± 129.3 vs. 236.1 ± 197.0 pg//mL), right ventricular systolic pressure (24.5 ± 5.5 vs. 33.1 ± 11.1 mmHg), mitral inflow velocity (E [77.4 ± 22.2 vs. 88.3 ± 22.0 cm//s]), LV mass index (LVMI [87.6 ± 22.2 vs. 105.1 ± 23.2 g//m²]), peak systolic mitral annular velocity (S' [7.2 ± 2.0 vs. 5.8 ± 1.8 cm//s]), and mitral inflow velocity to diastolic mitral annular velocity (E//E' [9.8 ± 3.4 vs. 12.1 ± 4.4]) were significantly different between the two groups, respectively (P < 0.05). In multivariate analysis, LVMI was independently correlated with increased LA volume (OR: 1.037 [95%% CI: 1.011–1.063], P < 0.05), whereas HTN was not. LA enlargement, which reflects the severity and chronicity of DD, is independently associated with LVH in patients with NV-AF. Therefore, regression of LVH with anti-hypertensive treatment may lead to improvement of diastolic function and favorable clinical outcomes in hypertensive patients with NV-AF.     

他汀类药物抗心房颤动作用

他汀类药物可以减少心房颤动的发生率,其确切作用机制不明,可能与改变心肌离子通道与载体; 抗炎作用;延缓心肌组织、电重构; 改善自主神经功能等有关.     

非瓣膜性持续心房颤动患者抗血栓治疗临床调查

对我院从1997年1月至2002年12月住院的535例非瓣膜性持续心房颤动(简称房颤)患者病历资料进行逐项调查,分析房颤病因、抗血栓治疗及并发血栓栓塞性疾病情况。结果:病因以高血压最常见(38.5%),其次为冠心病(34.6%)。使用华法令52例(9.7%),维持INR在2.0~3.0范围,无1例出现血栓栓塞性疾病及严重出血。使用阿斯匹林331例(61.9%),用量为平均75mg/d出现血栓栓塞性疾病76例(占23%)。未使用任何抗血栓治疗者152例(28.4%),出现血栓栓塞性疾病36例(23.7%)。结论:华法令能明显减少房颤相关血栓栓塞性疾病的发生,小剂量阿斯匹林则无此作用。     

Combined Antiplatelet Therapy in Atrial Fibrillation:

Atrial fibrillation (AF), the most commonly encountered cardiac rhythm disorder, affects approximately 1% of the general population and is associated with serious complications, most notably ischemic stroke. AF-associated stroke occurs at an annual rate of 4.5%. Anticoagulation therapy with warfarin has been demonstrated in randomized controlled trials to reduce the risk for AF-related stroke by two thirds, but warfarin therapy is markedly underused in clinical practice because of its narrow therapeutic window and its implications on quality of life. This article reviews the present knowledge and potential future research avenues for the role of antiplatelet therapy in AF as an alternative to anticoagulation with warfarin for prevention of AF-associated stroke. Antiplatelet therapy recently has been shown to be protective against thrombotic events related to blood stasis. There is ample evidence from experimental and clinical studies that a combination of different antiplatelet agents may increase antithrombotic efficacy compared to monotherapy. Accordingly, a series of randomized controlled trials (ACTIVE [Atrial fibrillation Clopidogrel Trial with Irbesartan for prevention of Vascular Events]) has been designed to vigorously examine the role of combined antithrombotic therapy for prevention of vascular events, including stroke in high-risk AF patients. The ACTIVE program began patient enrollment in spring 2003. (J Cardiovasc Electrophysiol, Vol. 14, pp. S60-S63, September 2003, Suppl.)     

Reduced Peak Atrial Systolic Mitral Annular Velocity Predicts the Development of Nonvalvular Atrial Fibrillation

We investigated whether the echocardiographic parameters of the left atrium (LA) can predict the development of nonvalvular atrial fibrillation (AF). Among 14,062 patients ( > 20 years old) who underwent an echocardiographic examination were evaluated, 2,606 patients who underwent follow-up ECG with an interval of > 6 months were investigated. Newly developed AF was noted in 42 (1.6%) patients with follow-up duration of 31.8 ± 8.9 months. Cox regression analysis revealed that a higher left atrial volume index (hazard ratio [HR ]= 1.06; 95% confidence interval [CI] 1.03–1.09, P < 0.001), relative wall thickness (RWT) of ≥ 0.407 (HR = 2.74, 95% CI 1.39–5.41, P = 0.004), a reduced peak atrial systolic mitral annular velocity (HR = 0.845, 95% CI 0.72–0.99, P = 0.037), and an advanced age (HR = 1.04, 95% CI 1.01–1.07, P = 0.009) were independently related to the development of nonvalvular AF. Therefore, reduced A ' , which is parameter of LA contractile function, might be an important predictor for the development of nonvalvular AF.