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。     

非瓣膜病心房颤动患者循环miRNA-21水平及应用价值初探

目的：探索非瓣膜病心房颤动患者循环miRNA-21的水平及可能的应用价值。 方法：前瞻性的筛选连续收治的非瓣膜病心房颤动患者,收集患者的人口学特征,病史等资料。将CHA2DS2-VASc评分≥2分（男）或≥3分（女）定义为高卒中风险。采集患者空腹外周静脉血,ELISA法检测NT-proBNP;qRT-PCR法检测循环miRNA-21水平。评估miRNA-21水平与CHA2DS2-VASc评分和NT-proBNP之间的相关性,ROC曲线验证miRNA-21对高卒中风险的预测价值。 结果：共入选患者89例,高卒中风险患者41例（46.1%）,中位CHA2DS2-VASc评分4（2.5-5.5）分。,高卒中风险组与低卒中风险组血常规、肝肾功能、NT-proBNP等无显著差异;高卒中风险组循环miRNA-21表达量显著升高。Pearson相关分析显示循环miRNA-21表达量与CHA2DS2-VASc评分(r=0.461,p=0.002)和NT-proBNP（r=0.386, p=0.013）均显著相关。ROC分析提示miRNA-21表达量对高卒中风险具有较高预测价值（AUC=0.843, p＜0.001）。 结论：循环miRNA-21可能用于预测非瓣膜病心房颤动患者高卒中风险。     

非瓣膜病房颤患者脑卒中风险评估方法的探讨

【摘要】目的：探索非瓣膜病房颤患者发生脑卒中的危险因素,建立房颤脑卒中风险评估模型（NewScore）,评价NewScore、CHADS2评分和CHA2DS2-VASC评分三种方法在卒中预测方面的差异,比较三种评分对非瓣膜病房颤患者脑卒中的风险评估能力。方法：对华北理工大学附属煤炭总医院和首都医科大学附属北京市朝阳医院共2家附属教学医院2012年1月至2012年12月收治的首次诊断为非瓣膜病心房颤动的患者进行同群队列研究,收集相关资料,以缺血性脑卒中为终点事件平均随访时间为（27±5）个月。采用χ2检验、wilcoxon 秩和检验（非参方法检验）分析卒中相关危险因素,采用二元logistic回归分析（Enter法）对经单因素分析有统计学意义的参数计算其对模型影响的大小（OR）,组建新的卒中风险评分模型（NewScore）,采用CHADS2、CHA2DS2-VASc和NewScore评分方法对患者依次评分,采用受试者工作特征曲线ROC（Receiver Operating Characteristic）分析比较NewScore、CHADS2评分、CHA2DS2-VASc评分对非瓣膜病房颤患者卒中的预测能力,并记录3个评分系统的95%置信区间、P值、灵敏度、特异度。结果：比较新发脑卒中组和无新发脑卒中组,两组间比较的结果显示年龄、房颤类型、高脂血症病史、冠心病病史、高血压病史、糖尿病病史、既往脑梗死、心肌梗死病史、血管性疾病病史、NT-proBNP、ALT、DBIL、CRP、D-dimer等化验指标存在显著差异（P＜0.05）。将有显著差异的因素进行二元logistic回归分析,结果显示,高脂血症、SBP＞160mmHg、糖尿病、既往脑梗死、血管性疾病与卒中风险独立相关（P＜0.05,OR＞1）,根据各因素的OR值建立NewScore评分,受试者工作特征曲线比较CHADS2评分、CHA2DS2-VASc评分、NewScore评分预测房颤患者随访期间内发生脑卒中的能力,显示受试者工作特征曲线下面积（AUCROC）分别为0.877（0.855-0.900）、0.842（0.817～0.866）和0.850（0.827～0.873）,CHADS2评分的Youden指数0.591,灵敏度0.85,特异度0.741,假阳性率0.259;CHA2DS2-VASc评分的Youden指数0.54,灵敏度0.88,特异度0.66,假阳性率0.34;NewScore评分的Youden指数0.381,灵敏度0.423,特异度0.958,假阳性率0.042。结论：1、高脂血症、SBP＞160mmHg可能为房颤相关脑卒中新的预测因素,心功能不全病史、年龄、性别因素不能增加非瓣膜病房颤患者的脑卒中风险。2、CHADS2评分优于NewScore,NewScore优于CHA2DS2-VASc评分,CHADS2可能更符合住院的非瓣膜病房颤患者的脑卒中风险评估,CHA2DS2-VASc评分在我国的推广使用可能需更多验证。     

非瓣膜性心房颤动患者冠状动脉造影的结果分析

目的通过冠状动脉造影术调查非瓣膜性心房颤动患者冠状动脉粥样硬化性心脏病发生情况。方法研究入选536例非瓣膜性心房颤动患者(持续性或阵发性)作为观察组,在年龄、性别、症状、冠心病可能性等方面按照配比原则入选536例非心房颤动患者为对照组。住院期间对两组患者分别进行冠状动脉造影检查,结果分为冠状动脉粥样硬化性心脏病(≥50%管腔狭窄)或冠状动脉粥样硬化。通过逻辑回归分析评估患者临床资料与冠状动脉粥样硬化的相关性。结果观察组48%(257/536)为冠心病,对照组31%(166/536)为冠心病(P<0.01)。在多因素Logistic回归分析中,性别、年龄和心房颤动均与冠状动脉粥样硬化有相关性(均为P<0.05)。结论在本研究样本人群中,非瓣膜性心房颤动者冠心病患病率明显高于非心房颤动者,且与冠状动脉粥样硬化有相关性。     

非瓣膜病房颤患者脑卒中风险评估的现状

非瓣膜病心房颤动（non-valvular atrial fibrillation,NVAF）是最常见的心律失常之一,其患病率随着年龄的增长而升高,从60岁年龄段的1％增高至85岁以上年龄段的15％[1].房颤可导致心功能恶化、血栓事件的发生.研究显示,NVAF是缺血性脑卒中的独立危险因素,增加卒中风险5倍[2],是房颤患者致残、致死的主要原因.因此对房颤患者如何准确、有效、简单地评估其血栓事件风险,并根据指征进行相应的临床干预显得十分重要.本文在复习国内外文献的基础上,就非瓣膜病房颤患者卒中风险评估的现状作一综述.     

非瓣膜性心房颤动患者的卒中危险因素分析

卒中是非瓣膜性心房颤动(以下简称为房颤)的主要并发症。心力衰竭、高龄、高血压、糖尿病及卒中或短暂性脑缺血发作史与房颤患者卒中的风险相关,此外,临床上其他原因所致的缺血性卒中的危险因素也与房颤患者的卒中风险相关。筛选房颤患者并发卒中的危险因素,并采取有效方法评估其卒中的危险性,无论是对于抗凝治疗预防卒中事件,还是对于减少抗凝治疗引起的出血风险,都具有十分重要的意义。     

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。     

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.     

非瓣膜性心房颤动患者血栓形成相关危险因素的评价

目的:对非瓣膜性心房颤动动患者发生左心房或左心耳血栓的相关临床危险因素进行评估。方法:选取住院非瓣膜性心房颤动患者217例为研究对象,根据左心房或左心耳是否发生血栓将其分为血栓组(60例)与非血栓组(157例),分析两组患者在性别、年龄、BMI、患病时间、CHA_2DS_2-VASc评分、hs-CRP、血脂、凝血功能,尿酸、左心房前后径、LVEF、左心耳血流速度等指标的差异。结果:与非血栓组比较,血栓组患者心率、收缩压、CHA_2DS_2-VASc评分、尿酸、hs-CRP、血清游离三碘甲腺原氨酸(FT3)、凝血酶原时间(PT)、凝血酶原活动度(PTA)、纤维蛋白降解产物(FDP)水平、左心房前后径、左心耳长径明显升高,而HDL-C水平、LVEF、左心耳血液流速明显降低(P均0.05);血栓组患者使用胺碘酮比例显著低于非血栓组(P0.05)。多因素Logistic回归分析显示:CHA_2DS_2-VASc评分≥2、hs-CRP≥1.3 mg/L、左心房前后径≥4 cm、左心耳血液流速≤48 cm/s以及未使用胺碘酮是血栓形成的危险因素(P均0.05)。结论:心房颤动患者CHA_2DS_2-VASc评分≥2、hs-CRP≥1.3 mg/L、左心房前后径≥4 cm、左心耳血液流速≤48 cm/s是血栓形成的危险因素,服用胺碘酮对预防心房颤动血栓形成有一定作用。     

Emerging oral anticoagulants for stroke prevention in patients with non-valvular atrial fibrillation

In patients with atrial fibrillation (AF) warfarin has been the mainstay therapy for stroke prevention. In recent randomized clinical trials (RCTs) oral direct thrombin inhibitor (Dabigatran) and factor Xa inhibitors (Rivaroxaban and Apixaban) challenged the efficacy and safety benchmarks set by warfarin. These drugs boast a rapid onset of action, shorter half-life and fewer drug and dietary interactions. Moreover, these new anticoagulants do not require monitoring, titration or dose adjustments. These agents have already been approved for prevention of stroke or systemic embolism in patients with AF. Uncertainty regarding suitability, efficacy and safety in certain patient subsets and issues related to the ability effectively monitor the pharmacodynamic effects and reverse the therapeutic effects of these drugs should be addressed as we engage in a widespread use of these agents in various patient subsets.     

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。     

高龄非瓣膜性房颤的华法林治疗11例体会

目的:探讨华法林治疗高龄非瓣膜性房颤患者安全有效的抗凝强度。方法:对11例高龄非瓣膜房颤有抗凝适应证者予华法林治疗,将抗凝强度控制在INR为1.5~2.0,观察疗效和出血并发症。结果:观察期间11例患者无致命性出血,仅1例皮肤出血且未停药。7例患者反复发作的短暂性脑缺血发作和脑梗塞症状得到控制。3例有2种以上危险因素的患者未出现栓塞并发症。结论:低抗凝强度(INR1.5~2.0)抗凝对高龄非瓣膜性房颤患者安全有效。     

合并非瓣膜性心房颤动的老年脑白质病变患者认知功能的研究

目的:探讨合并非瓣膜性心房颤动老年脑白质病变(WMLs)患者认知功能。方法:连续收集2015年1月1日至2015年12月31日,在我院神经内科门诊和住院老年患者,经头颅MRI扫描确诊(Fazekas分级≥1级)的WMLs患者204例,按照是否伴有非瓣膜性心房颤动,将患者分为心房颤动组80例,无心房颤动患者124例为对照组。收集患者人口学资料,北京版蒙特利尔认知评估量表(Mo CA)和影像学Fazekas分级评分,进行统计学分析。结果:心房颤动组患者年龄较对照组大(P0.01),高血压和心功能不全的患病率较对照组高(P0.01)。性别、受教育年限、糖尿病、冠心病、高脂血症、吸烟、饮酒、高血压控制率以及WMLs的Fazekas评分差异无统计学意义。心房颤动组患者有39例(48.8%)患者有认知功能障碍,对照组有29例(23.4%)患者有认知功能障碍(χ2=14.08,P=0.000)。两组患者在Mo CA总分、视空间与执行能力、命名、注意力与计算力、抽象理解以及延迟记忆部分差异有统计学意义(P0.01)。以是否认知障碍作为结局变量(MMSE评分27分为认知障碍,定义为1,Mo CA评分≥26分为无认知障碍,定义为0)。将年龄、高血压、心功能不全、是否存在非瓣膜性心房颤动为自变量,采用向后逐步回归方法拟合方程。发现高血压病史、心功能不全以及是否存在非瓣膜性心房颤动为WMLs患者认知障碍的危险因素(OR=5.234,3.280和8.414,P=0.000,0.004及0.000)。结论:合并有非瓣膜性心房颤动的老年WMLs患者认知障碍较无心房颤动老年WMLs患者更明显。老年非瓣膜性心房颤动病史是认知障碍发生的危险因素,对伴有非瓣膜性心房颤动的WMLs老年患者要进行认知筛查,以便早期干预治疗。     

非瓣膜性心房颤动患者左心耳结构与血栓形成的相关性

目的 探讨非瓣膜性心房颤动(NVAF)患者左心耳(LAA)结构与血栓形成的相关性。方法 选取2012年1月至2021年1月于山西医科大学第三医院因NVAF拟行射频消融术的患者283例。收集患者病历资料及影像学检查结果。依据经食管超声心动图将患者分为血栓组和非血栓组,分析血栓形成相关危险因素。采用SPSS 24.0软件进行数据分析。根据数据类型,组间比较分别采用t检验、Wilcoxon检验及χ²检验。采用单因素分析发现具有预测能力的变量,然后进行多因素分析探讨血栓形成的独立危险因素。构建受试者工作特征(ROC)曲线,评价各危险因素对血栓形成的预测价值。结果 血栓组与非血栓组间体质量指数、心房颤动病程、CHA2DS2-VASc评分、持续性心房颤动比例、尿酸、脑钠肽、左室射血分数、左房前后径(LAD)、左心耳容积(LAA-V)、左心耳长径(LAA-L)、左心耳第一弯曲度和左心耳叶数比较,差异均有统计学意义(均P<0.05)。多因素logistic回归分析显示,CHA2DS2-VASc评分(OR=1.898,95%CI 1.223～2.944)、LAD(OR=1.2...     

Prescription patterns of oral anticoagulants for patients with non-valvular atrial fibrillation: experience at a Japanese single institution

New oral anticoagulants (NOACs) are now clinically available. However, few studies have demonstrated which patients with non-valvular atrial fibrillation (NVAF) actually receive NOACs in a clinical setting. We analyzed 182 NVAF patients who received oral anticoagulants. Clinical backgrounds and the risk of stroke, systemic embolism, and bleeding associated with oral anticoagulants were investigated. Seventy-three (40 %) patients were treated with NOACs and 109 (60 %) patients were treated with warfarin. A significantly lower mean number of bleeding risk factors was observed among the patients treated with NOACs than among those treated with warfarin (P = 0.010). Of the bleeding risk factors, NOACs were significantly less frequently prescribed in patients with a bleeding history and elderly subjects (>65 years) than in those who received warfarin (P < 0.001 and P = 0.029). A multivariate logistic regression analysis revealed that CHF and bleeding history were independently and significantly associated with the administration of NOACs (P = 0.047 and P = 0.003). The rate of a history of intracranial hemorrhage was comparable between the patients treated with NOACs and those treated with warfarin (P = 1.000). Significantly lower rates of a history of gastrointestinal and other minor bleeding were observed in the patients who received NOACs versus those who received warfarin (P = 0.001 and P = 0.026). NOACs were less frequently prescribed in patients with a history of bleeding, especially those with a history of gastrointestinal bleeding in a clinical setting.     

Three-year outcomes of patients with non-valvular atrial fibrillation: the COOL-AF registry

BACKGROUND Clinical outcomes of patients with non-valvular atrial fibrillation(AF) in Asian populations may be different from non-Asians. In this study, we aimed to determine the incidence of ischemic stroke/systemic embolism(SSE), major bleeding,and death, and the predictors for clinical outcomes in a contemporary Asian cohort of newly diagnosed AF patients.METHODS This is a prospective multicenter nationwide registry of patients with AF from 27 hospitals in Thailand. Baseline data and follow-u...     

Quality of direct oral anticoagulant therapy in elderly patients with non-valvular atrial fibrillation

Journal of Thrombosis and Thrombolysis -     

Predictors of dementia amongst newly diagnosed non-valvular atrial fibrillation patients

Atrial fibrillation (AF) confers a 2-to-3-fold increased risk of developing cognitive dysfunction and dementia, independent of age and past stroke. The purpose of study was to identify risk factors for developing dementia amongst AF patients in India. This was a single-centre, prospective, observational study wherein recently diagnosed, treatment naïve, persistent non-valvular AF patients were enrolled. All patients were screened for dementia using the Mini-Mental state exam. Amongst a total of 108 patients enrolled, 40 (37%) had dementia. The most common cognitive deficits were in attention and calculation followed by memory deficits. Factors independently contributing to dementia were advanced age, female sex, presence of diabetes, elevated pulmonary artery pressures and a lower serum albumin.