【作者】 王婧；

【导师】 高海青；

【作者基本信息】 山东大学 ， 临床医学（老年医学）（专业学位）， 2016， 硕士

【摘要】 研究目的：1.探讨非瓣膜性房颤患者LAD(左房内径)与CHADS2评分、CHA2DS2-VASc评分的关系；2.探讨非瓣膜性房颤患者LADI (左房内径指数)与CHADS2评分、CHA2DS2-VASc评分的关系；3.分析经胸心动超声测量左房大小对非瓣膜性房颤患者卒中风险分层的预测价值。研究方法：1.应用回顾性分析方法,收集2010年1月-2015年6月于山东大学齐鲁医院住院的非瓣膜性心房颤动患者的临床资料,统计并描述其临床特征；2.分别用CHADS2评分系统和CHA2DS2-VASc评分系统对所有研究对象进行卒中风险评估；3.根据LAD大小将研究对象分为LAD正常组和增大组,比较NVAF患者不同组间一般情况、合并疾病、CHADS2评分、CHA2DS2-VASc评分等是否存在差异;4.根据LADI(左房内径除以体表面积)大小将研究对象分为LADI正常组和增大组,比较不同组间一般情况、合并疾病、CHADS2评分、CHA2DS2-VASc评分等是否存在差异。研究结果：1.本研究共纳入821例非瓣膜性心房颤动患者,男性493例(60%),平均年龄66.32±12.84岁；阵发性房颤396例(48.2%),持续性房颤230例(28%),永久性房颤195例(23.75%)；发生缺血性卒中的患者为108例(13.02%)。2.821例NVAF患者,CHADS2评分平均值为1.48±1.15分,低危组(0分)162例(19.7%)；中危组(1分)313例(38.1%)；高危组(>／2分)345例(42.0%)。3.821例NVAF患者,CHA2DS2-VASc评分平均值为2.69±1.63分,低危组(0分)81例(9.9%)；中危组(1分)124例(15.1%)；高危组(>12分)616例(75.0%)。4.821例NVAF患者左房内径(LAD)正常284例(34.6%),增大537例(65.4%),其中轻度增大252例(30.7*),中度增大133例(16.2%),重度增大152例(18.5%)。LAD增大组与正常组比较,增大组的年龄、持续性房颤比例以及高血压、糖尿病、冠心病、心肌梗死、慢性心力衰竭患病率高于正常组(P<0.05)；CHADS2评分(1.61±1.11 vs.1.23±1.19,P<0.0001)和CHA2DS2-VASc评分(2.89±1.57vs.2.31±1.68,P<0.0001)也高于正常组。进一步对不同增大程度的四组进行比较,发现随着LAD增大,CHADS2评分和CHA2DS2-VASc逐渐增大(P<0.05)。5.821例NVAF患者左房内径指数(LADI)正常449例(54.7%),轻度增大180例(21.90%),中度增大组103例(12.5%),重度增大组89例(10.8%)。LADI增大组冠心病、心肌梗死、慢性心力衰竭的患病率高于正常组(P<0.05); CHADS2评分(1.69±1.07 vs.1.31±1.19,P<0.0001)和CHA2DS2-VASc评分(3.16±1.44vs.2.30±1.68,P<0.0001)也高于正常组。进一步进行四组间比较,发现随着LADI增大,CHADS2评分和CHA2DS2-VASc逐渐增大(P<0.05)。研究结论：1.左心房增大在非瓣膜性房颤患者尤其是持续性房颤患者中发生的概率较高,且常合并基础疾病；2.左房增大的房颤患者有较高的CHADS2 和 CHA2DS2-VASc评分,且左心房越大,CHADS2和CHA2DS2-VASc评分越高,卒中发生的风险亦增大；3.经胸心动超声测量的左房大小有可能成为非瓣膜性房颤患者卒中风险分层的指标。更多还原

【Abstract】 Objective1. To explore the relationship between left atrial dimension (LAD) and CHADS2 score、CHA2DS2-VASc score in patients with NVAF;2. To explore the relationship between left atrial diameter index (LADI) and CHADS2 score、CHA2DS2-VASc score in patients with NVAF;3. To investigate the value of left atrial size measured by echocardiography in thromboembolic risk stratification of NVAF patients.Methods1. A retrospective, observational study was carried out. Inpatients diagnosed with non-valvular atrial fibrillation in Qilu hospital institution between 2010.01 and 2015.06 were included. Collect the clinical information of the cases and analyze the clinical character.;2. The stroke risk is assessed by CHADS2 score, CHA2DS2-VASC score;3. All subjects are divided into normal group and enlargement group according to the left atrial dimension,then compare the generalities, comorbidity, CHADS2 score and CHA2DS2-VASC score in different groups;4. All subjects are divided into normal group and enlargement group according to the left atrial diameter index (left atrial dimension divided by body surface area),then compare the generalities, comorbidity, CHADS2 score and CHA2DS2-VASC score in different groups.Result:1. This study included a total of 821 NVAF patients (40% female) at mean age of 66.32±12.84 years; patients with paroxysmal atrial fibrillation were 396(48.2%)cases, persistent AF were 230 (28%), permanent AF were195 (23.75%); patients with ischemic stroke were 108 (13.02%) cases.2. Of 821 NVAF patients mean CHADS2 score was 1.48 ±1.15points, as low risk group (0 score) in 162 (19.7%),moderate risk group (1 score) in 313 (38.1%) and high risk group (≥2 score) in 345 (42%)3. Of 821 NVAF patients mean CHA2DS2-VASc score was 2.69 ±1.63points, as low risk group (0 score) in 81 (9.9%). moderate risk group (1 score) in 124 (15.1%) and high risk group (≥2 score) in 616 (75%)4. Of 821 NVAF patients LAD normal in 284(34.6%) while enlarged in 152 (18.5%). Patients with enlarged LAD more often had history of hypertension, diabetes mellitus, ischemic heart disease, myocardial infarction and heart failure than patients with normal LAD(P<0.05), and had higher CHADS2,CHA2DS2-VASc score (1.61±1.11 vs.1.23±1.19, P<0.0001; 2.89±1.57vs.2.31±1.68, P<0.0001). After dividing patients into four categories:normal LAD, mildly, moderately, and severely enlarged LAD, we saw that along with the LAD also the risk in CHADS 2 and CHA2DS2-VAScscores rose.5. Of 821 NVAF patients LADI normal in 449 (54.7%) while enlarged in 372 (45.3%). Patients with enlarged LADI more often had history of ischemic heart disease, myocardial infarction and heart failure than patients with normal LADI(P< 0.05),and had higher CHADS2, CHA2DS2-VASc score (1.69±1.07 vs.1.31±1.19, P <0.0001; (3.16±1.44vs.2.30±1.68, P<0.0001).Then dividing patients into four categories, we also saw that both CHADS2 and CHA2DS2-VASc score increase with the increasing LADI.Conclusion:1. The enlargement of left atrial was highly prevalent in non paroxysmal atrial fibrillation patients, the bigger the left atrial size, the greater probability of persistent atrial fibrillation and basic diseases in patients with atrial fibrillation;2. Patients with LA enlargement have higher CHADS2 and CHA2DS2-VASc scores, mean CHADS2 and CHA2DS2-VASC scores rise with LA enlargement severity, the enlargement left atrial relates to a higher stroke risk assessed by both CHADS2 and CHA2DS2-VASc score; so enlargement LA can be used to identify patients with high risk of stroke and then guide anticoagulant therapy;3. Echocardiographically assessed LA size may be an additional parameter useful in thromboembolic risk stratification of NVAF patients.更多还原