非瓣膜性心房颤动与脑梗死的相关因素分析

目的：探讨非瓣膜性心房颤动患者血小板平均体积（MPV）、纤维蛋白原（FI）、左房内径（LAD）与缺血性脑梗死之间的关系。方法：选取165位平均年龄（75．8土7．6）岁的慢性心房颤动患者，根据cT和／或MRI检查确诊为脑梗死，分为心房颤动合并脑梗死（n=80）和单纯心房颤动（n=-85），分别评估两组患者CHA2DS2-vasc积分、MPV、FI、LAD、血压、血脂和肾功能之间的差异。结果：心房颤动合并脑梗死和单纯心房颤动患者在CHA2DS2-vasc积分（P〈0．001）、MPV（P〈0．001）、FI（P=-0．002）、血清脂蛋白（a）（P=-0．017）、LAD（P〈0．001）、空腹血浆葡萄糖（P=-0．034）之间存在明显的统计学差异，logistic回归分析显示CHA2DS2-vas、MPV、FI、LAD是心房颤动相关脑梗死的独立危险因素。结论：除CHA2DS2-vasc评分系统外，联合测定MPV、FI和LAD预测非瓣膜性心房颤动发生脑梗死具有重要的临床价值。

Analysis of the related factors between the nonvalvular atrial fibrillation and the cerebral infarction

Objective： To explore the relationship among the mean platelet volume, fibrinogen and left atrialsize and cerebral infarction in patients with nonvalvular atrial fibrillation （AF）. Methods： One hundred and sixty- five patients with AF were divided into AF with and without cerebral infarction diagnosed with computed tomography （CT） and/or magnetic resonance imaging （MRI）. CHA2DS2-vasc score, mean platelet volume, plasma fibrinogen, left atrial size, blood pressure, serum lipid level and renal function were detected in the enrolled population. Results： Compared with the patients without cerebral infarction, the AF patients with cerebral infarction showed higher level of CHA2DS2-vasc score （P〈0.001）, plasma fibrinogen （P=0.002）, mean plate- let volume （P〈0.001）, fasting plasma glucose （P=0.034）, lipoprotein （a） （P=0.017） and larger left atrial size （P 〈0.001）. After adjustment of multiple traditional cardiovascular risk factors, logistic regression analysis showed that mean platelet volume, plasma fibrinogen, left atrial size and CHA2DS2-vasc score were independent risk factors for AF-related cerebral infarction. Conclusion： Except CHA2DS2-vasc score, the combined index of mean platelet volume, plasma fibrinogen and left atrial size may also play an important role in predicting the occurrence of cerebral infarction in patients with AF.