风湿性心脏病并发左心房血栓的危险因素探讨

目的　探讨风湿性心脏病并发左心房血栓的发生率及危险因素。方法　采用非条件Logistic回归模型分析二尖瓣狭窄患者并发左心房血栓的危险因素。结果　风湿性心脏病并发左心房血栓的发生率为 10 .77% ;二尖瓣狭窄、二尖瓣关闭不全、主动脉瓣病变和联合瓣膜病的发生率分别为 15 .6 3%、1.2 5 %、0和 2 .11%。二尖瓣狭窄并发左心房血栓的预测因子是左房自发性超声对比现象 (leftatrialspontaneousechocontrast ,LASEC) (相对危险比3.0 9,P<0 .0 0 0 0 )和房颤 (相对危险比 1.74 ,P =0 .0 0 2 3)。结论　风湿性心脏病二尖瓣狭窄患者最易发生左心房血栓 ;LASEC和房颤是决定二尖瓣狭窄发生左心房血栓的危险因素。二尖瓣狭窄伴房颤、LASEC的患者应积极抗凝治疗

Risk factors of left atrial thrombus in patients with rheumatic valve disease

Objective To investigate the prevalence and predictors of left atrial thrombus in patients with rheumatic valve disease. Methods 613 consecutive patients with rheumatic valve disease underwent transesophageal echocardiographic examination. Multiple logistic regression analysis was used to determine independent predictors of left atrial thrombus in patients with rheumatic mitral valve disease.Results The prevalence of left atrial thrombus in patients with rheumatic valve disease was 10.77 %. The incident rate of left atrial thrombus in the patients with mitral stenosis, mitral regurgitation, aortic valvular disease and combined valve lesions was 15.63 %, 1.25 %, 0 and 2.11 %, respectively. Multiple logistic regression analysis showed that left atrial spontaneous echo contrast(LASEC) (relative risk ratio 3.09 , P< 0.0000 ) and atrial fibrillation (relative risk ratio 1.74 ,P= 0.0023 ) were independent predictors of the left atrial thrombus in patients with mitral stenosis. Conclusion Rheumatic mitral valve disease has a higher risk for left atrial thrombus complications. LASEC and atrial fibrillation were the predictors that determine the occurrence of the left atrial thrombus in patients with mitral stenosis. Therefore, preventive anticoagulation for left atrial thrombus should be more vigorously adhered to in patients with rheumatic mitral value disease and LASEC and atrial fibrillation.