脑钠肽、D-二聚体与心房颤动血栓栓塞并发症的关系

目的:研究心房颤动(房颤)患者脑钠肽(BNP)、D-二聚体水平与血栓形成及血栓栓塞并发症的关系。方法:选取住院及门诊经食管超声心动图(TEE)检查发现左心房和(或)左心耳有血栓,及有明确外周动脉血栓栓塞(脑栓塞)的持续性非瓣膜病性房颤患者共22例为血栓组,经TEE检查未发现血栓且无外周动脉血栓栓塞并发症的持续性非瓣膜病性房颤患者20例为房颤组,另选取无房颤的器质性心脏病患者20例为无房颤组。用ELISA法、化学发光免疫法测定各组D-二聚体与BNP水平,对其结果进行对照分析。结果:BNP与D-二聚体水平在3组间差异有统计学有意义(P<0.05),且BNP水平与D-二聚体水平呈正相关(r=0.388,P<0.05)。结论:房颤患者BNP与D-二聚体水平与血栓形成及血栓栓塞并发症有密切关系。     

心房颤动血栓栓塞评估的新视点:器械检查应用进展

血栓栓塞风险评估公式CHADS2和CHA2DS2-VASc评分,被广泛应用于心房颤动(简称房颤)抗凝治疗前的血栓栓塞风险评估。但血栓栓塞风险评估公式存在不足。经食管超声心动图(TEE)、经胸超声心动图(TTE)、CT、MRI等器械检查已被用于诊断和预测房颤患者卒中风险,并指导抗凝治疗。TEE检查中的危险因素包括:左房异常、复杂的主动脉斑块。TTE检查中的危险因素包括:左室射血分数、左房大小、二尖瓣环速度、左房应变和应变率、左室质量指数。CT、MRI可用于辨识左心耳血栓、主动脉斑块等。     

左房自发性显影的相关因素及临床预测价值的研究

目的:探讨经食管超声检查的心房颤动(房颤)患者左房或左心耳自发性显影形成的相关因素,为临床进行风险评估、指导治疗提供依据。方法:选取该院2011-2014年未进行正规华法林抗凝的113例房颤患者,均行经食管超声心动图检查,将符合标准的92例患者根据是否存有左房自发性显影分为LASEC阳性组和LASEC阴性组,回顾性对比分析两组的临床特征及超声心动图参数,对结果进行多因素分析及诊断价值评估。结果:两组间在房颤类型(持续性)、高血压、左心房内径,左室舒张功能中有显著差异(P0.05),其中持续性房颤、左心房内径40mm、高血压病有极显著差异(P0.01)。CHA2DS2-VASC评分、血浆D-二聚体对LASEC的房颤患者有预测价值。结论:持续性房颤患者LASEC的发生率较高,多合并血栓形成(44%)。LASEC形成的影响因素包括:持续性房颤、左心房内径40mm、高血压、左室舒张功能差;CHA2DS2-VASC评分、D-二聚体对LASEC的形成有临床预测价值。     

炎症与非瓣膜性心房颤动血栓形成的关系

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188.00 μg/L:92.00 μg/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.     

老年非瓣膜性房颤病人血浆BNP水平及其对左房附壁血栓的预测价值研究

目的分析老年非瓣膜性房颤(NVAF)病人血浆B型脑利钠肽(BNP)水平与左房附壁血栓形成的相关性及其预测价值。方法选取在沈阳医学院附属第二医院心内科和老年病科住院的老年非瓣膜性房颤病人204例,男144例,女60例,年龄65～83(72.76±11.13)岁。根据经食管超声心动图(TEE)检测有无左心房附壁血栓分为血栓阳性组与血栓阴性组。比较两组病人血浆BNP、C反应蛋白(CRP)、D-二聚体、左房内径(LAD)、左室舒张末期内径(LVEDd)、左室射血分数(LVEF)等。通过多因素Logistics回归分析老年非瓣膜性房颤病人左房附壁血栓形成的危险因子,并绘制ROC曲线研究各指标对左房血栓形成的预测价值。结果两组病人中,充血性心力衰竭病人比例、CHA2DS2-VASc评分、血浆BNP、D-二聚体水平和LAD左房血栓阳性组均显著大于血栓阴性组(P0.05),LVEF左房血栓阳性组小于血栓阴性组(P0.05)。多因素Logistics逐步回归分析显示,血浆BNP(OR=1.16,95%CI 1.05～4.24,P0.05)和CHA2DS2-VASc评分(OR=2.19,95%CI 1.55～6.45,P0.01)是左房附壁血栓形成的危险因素。ROC曲线显示,血浆BNP ROC曲线下面积为0.801(95%CI 0.731～0.871,P0.01),最佳临界值为307.5pg/mL。结论血浆BNP水平是老年非瓣膜性房颤病人左房附壁血栓形成的风险因素,并且BNP可以作为老年非瓣膜性房颤病人发生左房附壁血栓预测指标。     

不同血栓栓塞风险心房颤动患者微栓子及D-二聚体水平观察

目的 观察不同血栓栓塞风险心房颤动(房颤)患者微栓子及D-二聚体水平,明确其与房颤栓塞风险的关系。方法 观察2020年2月至2021年11月我院门诊及病区首诊的持续性房颤患者206例,常规检测血浆D-二聚体水平并经颅多普勒监测大脑中动脉微栓子,使用CHA2DS2-VASc评分系统评估患者栓塞风险,按≥2分高危组和<2分低中危组分组,根据指南建议预防性抗凝治疗,其中48例患者应用达比加群,1月后复查D-二聚体水平并再次监测微栓子。结果 68例低中危组房颤患者微栓子阳性5例,138例高危组房颤患者微栓子阳性28例,高危组微栓子阳性率显著高于低中危组,两组差异有统计学意义(χ²=5.67,P<0.05);48例房颤患者抗凝治疗前微栓子阳性18例,抗凝治疗后微栓子阳性5例,微栓子阳性率显著降低(χ²=9.66,P<0.05);低中危组D-二聚体水平(286±67)μg/L,高危组D-二聚体水平为(426±79)μg/L,两组差异有统计学意义(P<0.05);48例患者抗凝治疗前D-二聚体水平为(412±58)μg/L,抗凝治疗...     

非瓣膜性心房颤动血栓形成的相关因素分析

目的通过观察非瓣膜性心房颤动患者血浆C反应蛋白、D-二聚体的浓度及左心房直径、射血分数的水平,研究C反应蛋白与非瓣膜性心房颤动患者左心房内血栓形成的关系。方法按照经食管超声心动图（TEE）检查结果将非瓣膜性心房颤动患者98名分为：左心房血栓形成组（血栓组）22例、无左心房血栓形成组（非血栓组）76例。检测血浆中C反应蛋白、D-二聚体的浓度及经胸超声心动图检测左心房直径、射血分数。结果血栓组在C反应蛋白浓度、D-二聚体浓度、左心房直径、射血分数、缩短分数方面与非血栓组差异有统计学意义,分别为C反应蛋白浓度（中位数1.60mg/L比0.80 mg/L,P=0.003）、D-二聚体浓度（中位数170.50μg/L比92.00μg/L,P=0.004）、左心房直径（55.20±12.94 mm比46.77±12.31 mm,P=0.002）、射血分数（57.46%±9.10%比62.81%±8.67%,P=0.006）、缩短分数（29.82%±5.26%比35.24%±5.41%,P〈0.001）。Logistic回归,发现C反应蛋白、左心房直径与非瓣膜性心房颤动合并血栓形成独立相关（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合并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合并血栓形成的高危因素,炎症反应可能参与了心房内血栓的形成。     

非瓣膜病性心房颤动合并脑梗死188例临床分析

目的：比较非瓣膜病性心房颤动中持续性心房颤动与阵发性心房颤动并发脑梗死的危险因素及发病机制的差异。方法回顾性分析资料完整的非瓣膜病性心房颤动合并脑梗死患者的临床资料,将其分为持续性心房颤动组和阵发性心房颤动组,分析比较两组患者的年龄、高血压史、糖尿病史、颈动脉硬化、低密度脂蛋白胆固醇（LDL-C）、D-二聚体和纤维蛋白原（FIB）水平;根据头颅影像学病灶分布的特点,分析两组间发病机制及恶性大脑中动脉梗死发生率的差异。结果两组患者在年龄、高血压史、糖尿病史、LDL-C、D-二聚体、FIB水平比较差异无统计学意义（ P＞0.05）。两组患者栓塞型、分水岭型、栓塞＋分水岭型3种发病机制比较差异无统计学意义（ P＞0.05）,但穿支动脉型在两组间差异有统计学意义（ P＜0.05）,恶性大脑中动脉梗死的发生率比较差异无统计学意义（ P＞0.05）。结论阵发性心房颤动中非心源性因素导致的脑梗死可能比持续性心房颤动更多见,两者有导致恶性大脑中动脉梗死同样的风险。     

非瓣膜性心房颤动病人CHA_2DS_2-VASc评分与血NT-proBNP、D-二聚体、尿酸、肌酐的相关性分析

目的探讨非瓣膜性心房颤动病人血N末端B型钠尿肽前体(NT-proBNP)、D-二聚体、尿酸、肾功能与CHA_2DS_2-VASc的关系,分析血栓高危病人及高风险因素。方法选择上海长征医院2015年1月—2018年10月确诊为非瓣膜性心房颤动病人的临床资料,所有病人均进行CHA_2DS_2-VASc评分,同时记录血NT-proBNP、D-二聚体、尿酸、肌酐[计算估算肾小球滤过率(eGFR)]结果。根据CHA_2DS_2-VASc评分将心房颤动病人发生血栓栓塞风险分为低中危组(60例)和高危组(316例),比较低中危组与高危组NT-proBNP、D-二聚体、尿酸、eGFR差异,并分析差异有统计学意义的研究指标与CHA_2DS_2-VASc评分的相关性。结果 CHA_2DS_2-VASc评分高危组NT-proBNP、D-二聚体水平高于低中危组(P0.05),eGFR低于低中危组(P0.05)。相关性分析结果显示:血NT-proBNP、D-二聚体水平均与CHA_2DS_2-VASc评分呈正相关(r=0.431,P0.001;r=0.460,P0.001);eGFR与CHA_2DS_2-VASc评分呈负相关(r=-0.235,P0.001)。结论 NT-proBNP、D-二聚体、eGFR均与CHA_2DS_2-VASc评分相关,其中D-二聚体相关性最大,可为临床非瓣膜性心房颤动血栓栓塞风险的评估提供依据。     

D-二聚体阴性急性肺血栓栓塞症患者临床分析

目的探讨急性肺栓塞(PE)患者D-二聚体检测阴性的影响因素。方法回顾性分析2012年1月至2015年12月明确诊断为PE的住院患者的病例特点,比较10例D-二聚体阴性与103例D-二聚体阳性PE患者的性别、年龄、发病到就诊时间、高危因素、临床表现、D-二聚体值、经螺旋CT肺动脉造影(CTPA)检查栓子栓塞部位的差异。结果两组性别、年龄、高危因素、临床表现方面无统计学差异(P>0.05);两组发病到就诊时间比较虽无统计学差异(P>0.05),但阴性组略长于阳性组。两组CTPA所示,阴性组段以下肺动脉栓塞的比例高于阳性组;而左右肺动脉及段以上肺动脉栓塞的比例低于阳性组(P<0.05)。结论急性PE患者D-二聚体检测阴性可能与发病到就诊时间较长、血栓阻塞部位较远或血栓较小有关。     

Atrial fibrillation and hyperthyroidism: relation between transoesophageal markers of a thrombogenic milieu and clinical risk factors for thromboembolism

Hyperthyroidism is a questionable risk factor for thromboembolism among patients with atrial fibrillation. Objective To correlate clinical risk factors for thromboembolism from a group of patients with atrial fibrillation related to hyperthyroidism with transoesophageal echocardiography (TOE) markers of a thrombogenic milieu. Design Clinical risk factors for thromboembolism, thyroid hormonal status, time since diagnosis of hyperthyroidism and TOE markers of a thrombogenic milieu were assessed in consecutive patients with atrial fibrillation related to hyperthyroidism. The following TOE parameters were assessed to define the presence of thrombogenic milieu: dense spontaneous echo contrast, thrombi or left atrial appendage blood flow velocities <0·20 m/s. Clinical risk factors for thromboembolism were based on CHADS₂ (Cardiac failure, Hypertension, Age, Diabetes and Stroke) classification. Patients This study included 31 consecutive patients aged between 18 and 65 years with atrial fibrillation related to hyperthyroidism scheduled for TOE. Results Thrombogenic milieu was present in 14 of 31 (45·2%) patients. The thyroid status could not predict the presence of a thrombogenic milieu. Despite low CHADS₂ score of 0/1, 6 of 13 (46·1%) patients had a thrombogenic milieu, whereas 10 of 18 (55·6%) patients with score ≥2 had none. The probability of having a thrombogenic milieu did not correlate with the number of clinical risk factors. Conclusion Among patients younger than 65 years of age with atrial fibrillation related to hyperthyroidism, there is no association between clinical risk factors with TOE markers of a thrombogenic milieu. TOE adds useful information that may affect antithrombotic therapy guided by clinical risk classification.     

Predictive value of coagulative molecular markers for thromboembolism in patients with nonvalvular atrial fibrillation: prospective five-year follow-up study

OBJECTIVES: Nonvalvular atrial fibrillation is a known risk factor for thromboembolism. This study investigated the use of coagulation markers to predict thromboembolism in nonvalvular atrial fibrillation patients. METHODS: One hundred thirty nonvalvular atrial fibrillation patients (104 males, 26 females, mean age 63.7 +/- 10.7 years) treated at the Sendai Cardiovascular Center from April 1996 to August 1997 were enrolled in this study. Coagulation markers such as prothrombin fragment 1 + 2, thrombin-antithrombin III complex and D-dimer were measured, and the patients were followed up prospectively to October 2001. RESULTS: One hundred and twenty-six patents (100 males, 26 females, chase rate 96.9%) were included in this investigation based on the medical chart and telephone interview. During five-year follow-up, 16 patients had thromboembolism accidents (3.25%/year) and two were suspected to die of thromboembolism. Three patients died of malignant disease, four of heart disease, and five of other diseases. Eight (25.8%) of the 31 patients with high levels of thrombin-antithrombin III complex and 6 (33.3%) of 18 patients with high levels of D-dimer suffered thromboembolism accidents. High thrombin-antithrombin III complex and D-dimer were statistically positive predictive markers for thromboembolism in patients with nonvalvular atrial fibrillation (p < 0.05). CONCLUSIONS: Coagulation markers such as thrombin-antithrombin III complex and D-dimer can predict thromboembolism accidents in nonvalvular atrial fibrillation patients.     

Transesophageal echocardiography risk factors for stroke in nonvalvular atrial fibrillation

Atrial fibrillation is a common arrhythmia, particularly in the older age groups. It confers an increased risk of thromboembolism to these patients, and multiple clinical risk factors have been identified to be useful in predicting the risks of thromboembolic events. Recent studies have evaluated the role of transesophageal echocardiography (TEE) in the evaluation of patients with atrial fibrillation. The purpose of this review is to evaluate the significance of transesophageal echocardiographic findings in the prediction of thromboembolic events, particularly stroke, in patients with nonvalvular atrial fibrillation, with an emphasis on recently reported prospective studies. Aortic plaque and left atrial appendage abnormalities are identified as independent predictors of thromboembolic events. Although they are associated with clinical events, they also have independent incremental prognostic values. Other transesophageal echocardiographic findings, such as patent foramen ovale and atrial septal aneurysm, have not been found to be predictors of thromboembolic events in this patient group. Thus, TEE is a useful tool in stratifying patients with nonvalvular atrial fibrillation into different risk groups in terms of thromboembolic events, and it will likely play an important role in future studies to assess new treatment strategies in high-risk patients with atrial fibrillation.     

非瓣膜病心房颤动患者电转复前后左心耳功能的经食管超声心动图研究

目的阐明左心耳功能对非瓣膜病心房颤动（ＮＶＡＦ）患者电转复成功率的预测价值,且对电转复后左心耳收缩功能恢复过程进行观察。方法应用经食管超声心动图对６０例ＮＶＡＦ患者电转复前及转复后２４小时、３天和１周左心耳血流频谱模式、峰值血流速度（ＬＡＡＰＥＶ）及左房自发显影的检测。结果（１）电转复前左心耳ＬＡＡＰＥＶ≥２０ｃｍ／ｓ者,转复成功率为７５％;反之,ＬＡＡＰＥＶ＜２０ｃｍ／ｓ,成功率为３０％;（２）电转复后左心耳血流频谱变成规则收缩与舒张的频谱模式,ＬＡＡＰＥＶ为２３±１０ｃｍ／ｓ,低于转复前３０±１２ｃｍ／ｓ（Ｐ＜０００１）;转复后左房新出现自发显影者８例,自发显影密度增加者１１例。结论ＮＶＡＦ患者电转复前左心耳收缩功能与窦性心律的维持高度相关;转复后左心耳“顿抑”,出现了血栓易于形成的条件,故对此类患者电转复后应给予足够的抗凝治疗,预防左房与左心耳血栓形成。     

Right atrial spontaneous echo contrast indicates a high incidence of perfusion defects in pulmonary scintigraphy in patients with atrial fibrillation

This study investigated the relationship between right atrial SEC (RA-SEC) and silent pulmonary embolism (PE) in patients with nonvalvular atrial fibrillation (NVAF). Spontaneous echo contrast (SEC) within the cardiac chambers is associated with an increased risk of thromboembolism. However, most studies have examined the relationship between left atrial SEC and systemic thromboembolic disease. Transesophageal echocardiography (TEE) was performed in 210 patients with NVAF to assess a risk of thromboembolism. Right atrial SEC was detected in 37 patients, and 35 of these patients with RA-SEC and 29 patients without RA-SEC were enrolled in this study. However, patients with a history of symptomatic PE or deep vein thrombosis were excluded. Spontaneous echo contrast was diagnosed by TEE as the presence of smokelike echoes that swirled in a circular pattern. PE was diagnosed by pulmonary scintigraphy. Thrombotic and thrombolytic parameters, including serum concentrations of plasmin-α-plasmin inhibitor complex (PIC), thrombin-antithrombin complex (TAT), D-dimer, and fibrinogen were measured in all patients. Left ventricular dimension, cardiac function, and hematologic parameters were similar in the two groups. Nevertheless, the incidence of perfusion defects in pulmonary scintigraphy was significantly higher in the group with RA-SEC (40%) than in the group without RA-SEC (7%; chi-square, P = 0.006). The increased incidence of perfusion defects in pulmonary scintigraphy in patients with RA-SEC indicates that right atrial SEC may be a predictable factor at a high risk of PE.     

血小板激活及内皮损伤血液标志物对心房颤动血栓栓塞危险性的评价

目的:研究心房颤动(Af)患者是否存在血小板激活和内皮损伤,探讨其对评价Af血栓栓塞危险性的价值。方法:Af患者共89例,按是否接受了经食管超声心动图(TEE)检查分为两个亚组:①TEE检查亚组:35例,发现左心房和(或)左心耳有血栓者10例,有明确外周动脉血栓栓塞并发症者8例,无血栓者17例;②未检查亚组:54例。另选33例非Af者为对照组。用ELISA法测定两组的血浆可溶性P选择素(sP选择素)、血管性血友病因子(vWF)、D二聚体(DD)水平,用全自动生化分析仪测定平均血小板体积(MPV),对其结果进行对照分析。结果:Af患者血浆sP选择素、vWF、MPV、DD水平显著升高(P<0.05),其中血浆sP选择素、DD、MPV水平在血栓和无血栓者中差异有统计学意义(P<0.05)。且sP选择素与DD水平呈正相关(r=0.311,P<0.05)。结论:Af患者存在有血小板激活及内皮损伤,与其血栓形成及栓塞并发症有一定关系。     

Prevalence of left atrial chamber and appendage thrombi in patients with atrial flutter and its clinical significance

OBJECTIVES: The study was done to assess the prevalence of left atrial (LA) chamber and appendage thrombi in patients with atrial flutter (AFl) scheduled for electrophysiologic study (EPS), to evaluate the prevalence of thromboembolic complications after transesophageal echocardiographic (TEE)-guided restoration of sinus rhythm and to evaluate clinical risk factors for a thrombogenic milieu. BACKGROUND: Recent studies showed controversial results on the prevalence of atrial thrombi and the risk of thromboembolism after restoring sinus rhythm in patients with AFl. METHODS: Between 1995 and 1999, patients with AFl who were scheduled for EPS were included in the study. After transesophageal assessment of the left atrial appendage and exclusion of thrombi, an effective anticoagulation was initiated and patients underwent EPS within 24 h. RESULTS: We performed 202 EPSs (radiofrequency catheter ablation, n = 122; overdrive stimulation, n = 64; electrical cardioversion, n = 16) in 139 consecutive patients with AFl. Fifteen patients with a thrombogenic milieu were identified. All of them had paroxysmal atrial fibrillation (AF). Transesophageal echocardiography revealed LA thrombi in two cases (1%). After EPS no thromboembolic complications were observed. Diabetes mellitus, arterial hypertension and a decreased left ventricular ejection fraction were found to be independent risk factors associated with a thrombogenic milieu. CONCLUSIONS: The findings of a low prevalence of LA appendage thrombi (1%) in patients with AFl and a close correlation between a history of previous embolism and paroxysmal AF support the current guidelines that patients with pure AFl do not require anticoagulation therapy, whereas patients with AFl and paroxysmal AF should receive anticoagulation therapy. In addition, the presence of clinical risk factors should alert the physician to an increased likelihood for a thrombogenic milieu.     

Transesophageal Echocardiographic Correlates of Clinical Risk of Thromboembolism in Nonvalvular Atrial Fibrillation

Objectives. This study explored the mechanisms linking clinical and precordial echocardiographic predictors to thromboembolism in atrial fibrillation (AF) by assessing transesophageal echocardiographic (TEE) correlations.

Background. Clinical predictors of thromboembolism in patients with nonvalvular AF have been identified, but their mechanistic links remain unclear. TEE provides imaging of the left atrium, its appendage and the proximal thoracic aorta, potentially clarifying stroke mechanisms in patients with AF.

Methods. Cross-sectional analysis of TEE features correlated with low, moderate and high thromboembolic risk during aspirin therapy among 786 participants undergoing TEE on entry into the Stroke Prevention in Atrial Fibrillation III trial.

Results. TEE features independently associated with increased thromboembolic risk were appendage thrombi (relative risk [RR] 2.5, p = 0.04), dense spontaneous echo contrast (RR 3.7, p < 0.001), left atrial appendage peak flow velocities ≤20 cm/s (RR 1.7, p = 0.008) and complex aortic plaque (RR 2.1, p < 0.001). Patients with AF with a history of hypertension (conferring moderate risk) more frequently had atrial appendage thrombi (RR 2.6, p < 0.001) and reduced flow velocity (RR 1.8, p = 0.003) than low risk patients. Among low risk patients, those with intermittent AF had similar TEE features to those with constant AF.

Conclusions. TEE findings indicative of atrial stasis or thrombosis and of aortic atheroma were independently associated with high thromboembolic risk in patients with AF. The increased stroke risk associated with a history of hypertension in AF appears to be mediated primarily through left atrial stasis and thrombi. The presence of complex aortic plaque distinguished patients with AF at high risk from those at moderate risk of thromboembolism.     

不同类型非瓣膜病性心房颤动并发缺血性脑卒中临床风险比较

目的研究非瓣膜病性心房颤动（房颤）患者中持续性房颤与阵发性房颤患者发生急性缺血性脑卒中的临床风险比较。方法将343例脑卒中患者分为重症（NIHSS评分≥22分）,轻症（NIHSS评分≤8分）,再将重症患者分为持续性房颤组、阵发性房颤组与非房颤组。轻症患者同样分组,进行临床资料分析。结果重症患者中房颤发生总例数明显增多,较非房颤差异有统计学意义,其中,持续性房颤组与阵发性房颤组比较差异无统计学意义。轻症患者中,非房颤例数明显增多,较房颤组差异有统计学意义,持续性房颤组与阵发性房颤组比较差异有统计学意义。在脑卒中危险因素中,D-二聚体及纤维蛋白原房颤患者较血栓形成脑卒中差异有统计学意义。结论房颤易造成大面积脑梗死,且病情危重,阵发性房颤与持续性房颤同样具有高风险,应得到及时有效的预防措施。