持续性非瓣膜性心房颤动患者血栓栓塞危险性评估

目的探讨血浆肿瘤坏死因子-α(TNF-α)、γ干扰素(IFN-γ)水平检测在评估非瓣膜性心房颤动(NVAF)患者血栓栓塞危险性中的价值。方法 85例NVAF患者分为血栓栓塞事件组(26例)和无血栓栓塞事件组(59例)。所有患者均行经胸心脏超声检测左心房内径(LAD);描记心电图V1导联,测量f波振幅,以f波振幅<0.1 mV为细颤、≥0.1 mV为粗颤;采用酶联免疫双抗体夹心法测定血浆D-二聚体(DD)、TNF-α及IFN-γ水平。结果血栓栓塞事件组患者细颤发生率为84.6%(22/26),显著高于无血栓栓塞事件组的59.3%(35/59),差异有统计学意义(P>0.05);血栓栓塞事件组患者f波振幅为(0.075±0.017)mV,明显低于无血栓栓塞事件组的(0.096±0.038)mV,差异有统计学意义(P>0.05);血栓栓塞事件组患者LAD为(46.77±6.72)mm,与无血栓栓塞事件组患者LAD的(46.93±8.12)mm比较,差异无统计学意义(P>0.05)。血栓栓塞事件组患者血浆DD、TNF-α、IFN-γ水平分别为(0.69±1.36)mg·L-1、(33.12±23.53)、(32.62±11.22)μg·L-1,显著高于无血栓栓塞事件组的(0.26±0.52)mg·L-1、(22.29±13.64)、(23.95±11.60)μg·L-1,差异有统计学意义(P>0.05、0.01)。多元logistic回归分析显示,心电图细颤、血浆TNF-α水平是NVAF患者血栓栓塞事件的危险因素。结论血浆TNF-α水平与心电图表现细颤有助于评估持续性NVAF患者血栓栓塞危险性。

Risk assessment of thromboembolism in patients with persistent non-valvular atrial fibrillation

Objective To explore the value of inflammation indexes tumor necrosis factor-α（ TNF-α） and interferon-γ（ IFN-γ） in assessment the risk of thromboembolism in patients with non-valvular atrial fibrillation（ NVAF）. Methods Eightyfive patients with NVAF were divided into thromboembolism events group（ n = 26） and non-thromboembolism events group（ n =59）. All patients underwent transthoracic echocardiography to detect the left atrial dimension（ LAD）. The V1 lead was recorded and amplitude of f wave was measured. The amplitude of f wave 0. 1 mV was fine atrial fibrillation（ AF） and ≥0. 1 mV was coarse AF. The levels of D-dimer（ DD）,TNF-α and IFN-γ were determined with enzyme-linked immunosorbent assay. Results The incidence of fine AF in the thromboembolism events group was significantly higher than that in non-thromboembolism events group（ 84. 6% vs 59. 3%,P〈0. 05）. The amplitude of f wave in thromboembolism events group and non-thromboembolism events group was（ 0. 075 ± 0. 017） and（ 0. 096 ± 0. 038） mV respectively,there was statistic difference of the amplitude of f wave between the two groups（ P〈0. 05）. The LAD in thromboembolism events group and non-thromboembolism events group was（ 46. 77 ± 6. 72） and（ 46. 93 ± 8. 12） mm respectively,there was no statistic difference of the LAD between the two groups（ P〈0. 05）. The DD,TNF-α and IFN-γ level in thromboembolism events group was（ 0. 69 ± 1. 36） mg·L^-1,（ 33.12 ±23. 53） and（ 32. 62 ± 11. 22） μg·L^-1 respectively; and in non-thromboembolism events group was（ 0. 26 ±0. 52） mg·L^-1,（ 22.29 ±13. 64）,（ 23. 95 ±11. 60） μg·L^-1 respectively; there were statistic differences of DD,TNF-α,IFN-γ between the two groups（ P〈0. 05,0. 01）. Multiple logistic regression analysis revealed that the fine AF of electrocardiogram and TNF-α were clinical risk factors of thromboembolism events. Conclusion Serum TNF-α level and fine AF are useful for evaluating the risk