北京市非瓣膜病心房颤动患者血栓栓塞事件的发病风险及影响因素

目的:分析北京市2007至2009年,非瓣膜病心房颤动(NVAF)患者1年内血栓栓塞事件的发病风险及其影响因素。方法:入选北京市出院患者信息系统中,出院日期在2007年1月1日至2009年12月31日之间,18岁及以上且出院诊断包含NVAF的北京市户籍病例,排除接受了射频消融术以及住院期间死亡的病例。通过将出院患者信息系统和北京市死因监测系统进行数据链接和查重,收集1年内这些NVAF患者中发生的血栓栓塞事件。采用Kaplan-Meier法比较不同性别和CHA_2DS_2-VASc评分患者血栓栓塞事件的发生风险,绘制风险曲线,并进行Log-rank检验。采用多因素Cox回归模型分析NVAF患者血栓栓塞事件发生的影响因素。结果:本研究共纳入NVAF患者28 871例,平均年龄(72.7±10.2)岁,其中女性占48.2%,女性患者伴随更多的高血压、充血性心力衰竭和糖尿病。在1年的随访期间,有2 313例(8.0%)患者发生了血栓栓塞事件;发生事件的患者年龄更大,CHA_2DS_2-VASc评分分值更高,伴随更多的高血压、缺血性脑卒中、短暂性脑缺血发作(TIA)、以及糖尿病(P均<0.001),而伴随充血性心力衰竭(P<0.001)、血管疾病(P=0.002)的患者更少。血栓栓塞事件的人年发病率为8.4/100人年,且随CHA_2DS_2-VASc评分分值的升高而升高。Log-rank检验结果显示,男性患者中,CHA_2DS_2-VASc评分在2分以上时血栓栓塞的风险显著增加(P<0.001),而女性患者CHA_2DS_2-VASc评分在3分以上时血栓栓塞的风险显著增加(P=0.004)。多因素Cox回归分析显示,高龄、基线伴随高血压、糖尿病、既往血栓栓塞病史是血栓栓塞事件发生的危险因素。讨论:北京市NVAF患者血栓栓塞事件的人年发病率高于国外人群水平,高龄、基线伴随高血压、糖尿病、既往血栓栓塞病史是事件发生的危险因素,提示应加强对NVAF患者的抗凝治疗和伴随疾病的防治,以降低血栓栓塞事件的发病风险。     

华法林预防瓣膜病伴心房颤动患者血栓栓塞临床研究

目的　观察不同抗凝强度的华法林对瓣膜病伴心房颤动 (房颤 )患者血栓栓塞发生的预防效果和安全性。方法　将确诊为二尖瓣狭窄伴房颤患者 197例分为华法林抗凝强度国际标准化比率 (INR) 2 5～ 3 5(中等强度 ,76例 )和INR1 8～ 2 4(低等强度 ,12 1例 )两组 ,给予抗凝治疗。观察两组血栓栓塞并发症及出血等不良反应的发生率。结果　低等强度组血栓栓塞年发生率为 0 55% ,中等强度组为 0 ,两组比较差异无显著性。两组病例中 96%的不良反应为出血 ,低等强度组出血不良反应的年发生率为 7% ,中等强度组为 16% ,两组比较差异有显著性 (P <0 0 5) ,但两组中无一例为严重出血。其他不良反应为皮疹及消化道症状。结论　华法林抗凝强度INR1 8～ 3 5能明显降低瓣膜病伴房颤患者血栓栓塞的发生率 ,其安全性好。INR1 8～ 2 4时有一定的血栓栓塞危险 ,INR2 5～ 3 5时有一定的严重出血危险性     

慢性非瓣膜病房颤患者血浆TM、D-D水平及意义

慢性心房颤动（AF）引起血栓前状态,促进左心房（LA）和／或左心耳（LAA）的血栓形成,由此引起的血栓栓塞并发症（尤其是脑卒中）是房颤致死致残的重要原因。2005年2月～2006年2月,我们检测了AF患者血浆血栓调节蛋白（TM）、D-二聚体（D—D）水平变化,旨在探讨房颤患者内皮损害及其对评估AF患者血栓栓塞危险性的价值。     

高龄非瓣膜病心房颤动患者抗栓治疗调查

目的调查华东医院心内科≥80岁非瓣膜病心房颤动患者临床特征及抗血栓药物治疗的情况,了解用药现状。方法调查≥80岁非瓣膜病房颤患者84例,对其危险因素等临床特征及抗血栓药物使用情况进行分析。结果非瓣膜性房颤的病因以冠心病、高血压病、肺源性心脏病、甲状腺功能亢进、孤立性房颤及扩张型心肌病为主。84例患者中,绝大多数合并多种危险因素,其中应用华法林者只有6例（7．1％）,应用阿司匹林者56例（66．7％）,其他抗血小板药物7例（8．3％）,未应用抗血栓药物15例（17．9％）。结论高龄非瓣膜病房颤患者华法林应用率低,抗血小板药使用率高。     

非瓣膜病心房颤动的抗血栓栓塞治疗

研究发现，心房颤动（房颤）随年龄的增加，栓塞并发症尤其是栓塞所致脑卒中的发生率也随之增加，老年患者的年发病率可高达５％，为无房颤者的６倍［１］。非瓣膜病房颤作为独立危险因素可使栓塞的发生率增加５０％［２］。因此针对非瓣膜病房颤栓塞并发症的抗凝治疗，近...     

左心耳封堵术在心房颤动患者中的应用价值

心房颤动是临床最常见的快速性心律失常。而血栓栓塞是心房颤动的主要危害之一,长期口服抗凝药物是预防栓塞的主要方法。但由于其存在较大的局限性,严重限制了其临床应用。     

唾液miRNA-144 miRNA-21联合检测对食管癌的诊断价值

目的 探讨唾液中miRNA-144、miRNA-21的表达水平及其联合检测对食管癌的诊断价值.方法 选择2015年1月至2019年5月暨南大学附属广州市红十字会医院心胸外科收治的食管癌患者85例(病例组),均经病理活检与免疫组化检查确诊;另选择同期健康志愿者32名(对照组),两组年龄均>60岁.采用聚合酶链式反应(PC...     

华法林预防瓣膜病伴心房颤动患者血栓栓塞疗效观察

2000年1月-2006年4月,我们应用华法林预防瓣膜病伴心房颤动（下称房颤）患者血栓栓塞,效果满意。现报告如下。     

布鲁菌感染患者T细胞亚群水平及外周血miRNA-21和miRNA-146a表达临床意义

目的 探讨布鲁菌感染患者T细胞亚群水平及外周血微小RNA(miRNA)-21和miRNA-146a表达临床意义。方法 选择本院于2020年5月至2022年5月布鲁菌感染患者35例作为研究对象,其中急性组21例,慢性组14例;另选择本院于2020年5月至2022年5月健康体检者30例作为对照组。采用流式细胞术测定T细胞亚群水平;采用实时荧光定量PCR法(qRT-PCR法)测定外周血miRNA-21和miRNA-146a表达。比较各组感染性指标变化,T细胞亚群,miRNA-21和miRNA-146a水平变化。结果 急性组和慢性组PCT和CRP水平高于对照组(P<0.05);且急性组PCT和CRP水平高于慢性组(P<0.05)。急性组和慢性组CD₃₊、CD₄₊和CD₄₊/CD₈₊低于对照组(P<0.05);且急性组CD₃₊、CD₄₊和CD₄₊/CD₈₊低于慢性组(P<0.05)。急性组和慢性组m...     

不同抗凝强度华法令预防非瓣膜病心房颤动患者血栓栓塞(附212例临床观察)

目的　探讨不同抗凝强度华法令预防非瓣膜病心房颤动 (Af)患者血栓栓塞事件的效果及其不良反应。方法　 2 12例非瓣膜病Af患者随机分为两组 ,分别给予华法令抗凝强度国际标准化比率 (INR) 1 80～2 . 4 0 (低等强度 ,12 3例 )和INR2. 4 1～ 3 .0 0 (中度强度 ,89例 )抗凝治疗。观察两组血栓栓塞并发症及出血等不良反应发生率。结果　低等强度抗凝组血栓栓塞年发生率为 0 . 6 6 % ,与中等强度抗凝组的 0 13%比较无显著差异 (P >0 . 0 5 )。低强度抗凝组的出血不良反应年发生率为 2 .4 % ,明显低于中等强度抗凝组的 7 9% (P <0 . 0 5 ) ,但两组均未见严重出血及其他严重不良反应。结论　华法令抗凝强度 1. 80～ 3. 0 0能明显降低非瓣膜病Af患者血栓栓塞发生率。INR 2 . 4 1～ 3 .0 0时自发出血危险性增加。     

Pathogenetic mechanism of stroke in non-valvular atrial fibrillation: follow-up of stroke patients with and without atrial fibrillation

Abstract. Stroke patients with brain infarction and non-valvular atrial fibrillation (NVAF, n = 88) or sinus rhythm (SR, n = 188), treated at a population-based stroke unit, were studied for 5 years. Within 1 month, 13% of NVAF and 2% of SR patients (P < 0.01) had either a stroke recurrence or systemic embolism. After 5 years, the corresponding figures were 26 and 25%, respectively. The 1-month and 5-year mortality values were 35 and 78% in the NVAF group vs. 7 and 52% in the SR group (P < 0.01). Age, ischaemic heart disease and function group on arrival at the hospital were independent risk factors for death. The main cause of death was ischaemic heart disease in the NVAF group, and complications to the initial stroke or a stroke recurrence in the SR group. Thus a higher risk of death, stroke recurrence and peripheral embolism was evident only during the first month after stroke.     

老年非瓣膜性心房颤动患者的血栓前状态

目的通过对心房颤动患者凝血因子的检测,观察不同临床因素对其凝血功能的影响。方法纳入慢性非瓣膜性老年心房颤动患者79例,并设立窦性心律患者61例作为对照组,同时检测凝血酶原时间（PT）、活化的部分凝血活酶时间（APTT）、纤维蛋白原（FG）、D-二聚体（DDI）水平及糖化血红蛋白（HbAlc）水平,由专人进行心脏超声检查,判断左心房内径、左心室射血分数（LVEF）。按有无心房颤动进行分组,比较两组PT、APTT、FG、DDI水平。结果心房颤动组患者PT、APTT、FG、DDI水平明显高于对照组;logistic回归分析发现,左心房内径、LVEF及HbAlc是DDI的预测因素;LVEF是FG的预测因素。结论老年非瓣膜性房颤患者明显处于血栓前状态,应加强抗凝治疗。     

Prevalence of atrial fibrillation and stroke in paced patients without prior atrial fibrillation: A prospective study

Background: Several reports suggest that the incidence of stroke and atrial fibrillation is reduced in patients receiving physiologic pacemakers, compared with patients receiving a ventricular pacemaker. Hypothesis: The study was undertaken to address the impact of different pacing modalities on the incidence of stroke and atrial fibrillation. Methods: We prospectively analyzed 210 consecutive patients. Those with previous episodes of cerebral ischemia and/ or atrial fibrillation were excluded from the study. The study population included 100 patients paced for total atrioventricular (AV) block or second-degree AV block (type II Mobitz) and 110 patients paced for sick sinus syndrome (SSS). The pacing mode was randomized. All patients underwent a brain computed tomography (CT) scan at the date of enrollment and after 1 and 2 years. Patients were followed for 2 years, and the incidence of atrial fibrillation and stroke was evaluated. Results: The incidence of atrial fibrillation was 10% at 1 year and 11% at 2 years. Comparing the different pacing modalities, we reported an increase in the incidence of atrial fibrillation in patients receiving ventricular pacing (p<0.05). On the other hand, no difference was found between patients paced for AV block and those paced for SSS. At the end of follow-up, we reported 29 cases of cerebral ischemia: 9 patients had AV block while 20 had SSS (p<0.05). Comparing the different pacing modalities, there was an increase in the incidence of stroke in patients receiving ventricular pacing (p< 0.05). Conclusion: There was an increase in the incidence of stroke and atrial fibrillation in patients with ventricular pacing.     

Left atrial appendage closure with amplatzer cardiac plug in atrial fibrillation: Initial european experience

Background: In most patients with atrial fibrillation (AF) and stroke, there is thrombotic embolization from the left atrial appendage (LAA). Percutaneous closure of the LAA is a novel alternative for the treatment of patients with AF at a high risk of stroke, in whom long‐term anticoagulation therapy is not possible or not desired. This study details the initial experience with the Amplatzer Cardiac Plug (ACP) in humans. Methods: Investigator‐initiated retrospective preregistry data collection to evaluate procedural feasibility and safety up to 24 hr after implantation of the ACP, a nitinol device designed for percutaneous trans‐septal implantation in LAA of patients with paroxysmal, permanent, or persistent AF. Results: In 137 of 143 patients, LAA occlusion was attempted, and successfully performed in 132 (96%). There were serious complications in 10 (7.0%) patients (three patients with ischemic stroke; two patients experienced device embolization, both percutaneously recaptured; and five patients with clinically significant pericardial effusions). Minor complications were insignificant pericardial effusions in four, transient myocardial ischemia in two, and loss of the implant in the venous system in one patient. Conclusion: The implantation of the ACP device is a feasible method for percutaneous occlusion of the LAA. © 2011 Wiley‐Liss, Inc.     

Predictors of stroke or systemic embolism in patients with non-valvular atrial fibrillation with CHA2DS2-VASc score of 0

Background

Anticoagulant therapy has been important for stroke prevention in patients with atrial fibrillation (AF). However, it was not recommended due to its relatively higher risk of bleeding than its lower risk of stroke in patients with a CHA₂DS₂-VASc score of 0.

Hypothesis

This study aimed to evaluate the predictors of stroke in AF patients with very low risk of stroke.

Methods

Between 1990 and 2020, 542 patients with non-valvular AF (NVAF) with a CHA₂DS₂-VASc score of 0 followed up for at least 6 months were enrolled. Patients with only being woman as a risk factor were included as a CHA₂DS₂-VASc score of 0 in this study. The primary outcome was stroke or systemic embolism.

Results

The primary outcome rate was 0.78%/year. In Cox hazard model, age of ≥50 years at diagnosis (hazard ratio [HR] 6.710, 95% confidence interval [CI] 1.811–24.860, p = .004), LVEDD of ≥46 mm (HR 4.513, 95% CI 1.038–19.626, p = .045), and non-paroxysmal AF (HR 5.575, 95% CI 1.621–19.175, p = .006) were identified as independent predictors of stroke or systemic embolism. Patients with all three independent predictors had a higher risk of stroke or systemic embolism (4.21%/year), whereas those without did not have a stroke or systemic embolism.

Conclusion

The annual stroke or systemic embolism rate in NVAF patients with CHA₂DS₂-VASc score of 0 was 0.78%/year, and age at AF diagnosis, LVEDD, and non-paroxysmal AF were independent predictors of stroke or systemic embolism in patients considered to have a very low risk of stroke.     

血清白细胞介素17A与非心脏瓣膜病性心房颤动合并血栓事件的关联研究

目的探讨白细胞介素17A(IL-17A)水平与非心脏瓣膜病性心房颤动的关系及对血栓事件发生的临床价值。方法比较67例对照者(男性38例,女性29例,年龄60.37±9.51岁)、65例阵发性房颤患者(男性35例,女性30例,年龄58.92±8.59岁)、88例持续性房颤患者(男性57例,女性31例,年龄61.45±8.32岁)血清IL-17A水平变化,通过受试者工作曲线(ROC)分析其对房颤患者的诊断意义,并检测房颤患者血清基质金属蛋白酶9(MMP-9)、Ⅲ型前胶原蛋白(procollagen typeⅢ)表达。对合并血栓事件的房颤患者进行随访,分析IL-17A对心房颤动合并血栓事件的预测价值。结果 IL-17A水平在对照组中明显低于房颤患者,IL-17A受试者工作曲线下面积为0.784(P0.01),敏感度为78.6%,特异度为69.1%。发生血栓事件的房颤患者血清IL-17A水平显著升高,正规抗凝治疗后IL-17A水平明显降低;血清IL-17A水平与心肌纤维化指标(MMP-9、Ⅲ型前胶原蛋白)表达呈正相关,IL-17A与左心房射血分数(LAEF)水平呈负相关。结论 IL-17A是提示心房纤维化以及血栓事件的血清学指标。     

Stroke event rates in anticoagulated patients with paroxysmal atrial fibrillation

Aims. To test the hypothesis that stroke and systemic embolic events (SEE) in the stroke prevention using an oral thrombin inhibitor in atrial fibrillation (SPORTIF) III and V trials are different between paroxysmal and persistent atrial fibrillation (AF). Methods. Data analysis from two cohorts of patients enroled in the prospective SPORTIF III and V clinical trials (n = 7329); 836 subjects (11.4%) with paroxysmal AF [mean age 70.1 years (SD = 9.5)] were compared with 6493 subjects with persistent AF for this ancillary study. Results. The annual event rates for stroke/SEE are 1.73% for persistent AF and 0.93% for paroxysmal AF. In a multivariate analysis, after adjusting for stroke risk factors, gender and aspirin usage, the differences remained statistically significant with a higher hazard ratio (HR) for stroke/SEE in persistent AF [vs. paroxysmal AF, HR 1.87, 95% confidence interval (CI) 1.04–3.36; P = 0.037]. In ‘high risk’ patients (with ≥2 stroke risk factors) annual event rates for stroke/SEE were 2.08% for persistent AF and 1.27% for paroxysmal AF (adjusted HR = 1.68, 95% CI 0.91–3.1, P = 0.098). Elderly patients had annual event rates for stroke/SEE of 2.38% for persistent AF and 1.13% for paroxysmal AF (adjusted HR = 2.27, 95% CI 0.92–5.59, P = 0.075). Vitamin K antagonist (VKA)‐naïve paroxysmal AF patients had a 1.89%/year stroke/SEE rate, compared with 0.61% for previous VKA takers (HR = 0.33, 95% CI 0.11–1.01, P = 0.052). Conclusion. In this large clinical trial cohort of anticoagulated AF patients, those with paroxysmal AF had stroke rates which were lower than for patients with persistent AF, although both groups had broadly similar stroke risk factors. Subjects with paroxysmal AF at ‘high risk’ had stroke/SEE rates that were not significantly different to persistent AF subjects.     

年龄对非瓣膜病心房颤动患者左心房血栓的影响

目的评价年龄对非瓣膜病心房颤动(房颤)患者左心房血栓的影响。方法选择拟行导管射频消融完成经食管超声检查的房颤患者421例,根据年龄分为老年组(108例)和年轻组(313例)。根据是否存在左心房血栓又分为血栓组(26例)和无血栓组(395例)。各组间进行一般临床资料比较。结果老年组年龄、高血压、服用血管紧张素转换酶抑制剂(ACEI)/血管紧张素Ⅱ受体拮抗剂(ARB)的比例明显高于年轻组,非阵发性房颤的比例明显低于年轻组。老年组LVEF明显高于年轻组。血栓组非阵发性房颤、心力衰竭、栓塞史、服用ACEI/ARB的比例明显高于无血栓组。血栓组左心房直径明显大于无血栓组,LVEF明显低于无血栓组。logistic多因素分析显示,校正LVEF、心力衰竭、高血压、糖尿病、服用ACEI/ARB,左心房直径、非阵发性房颤、既往栓塞史是左心房血栓独立预测因素,老年不是左心房血栓独立危险因素。结论年龄不是非瓣膜病房颤患者心房血栓的预测因素。