【摘要】 目的观察血浆血管性血友病因子抗原(v WF:Ag)评估择期经皮冠状动脉介入治疗(PCI)后新发心房颤动(简称房颤)患者的卒中风险。方法选择天津医科大学总医院2016年2月至2017年2月PCI后新发非瓣膜性心房纤维性颤动患者127例(PCI后新发房颤组)、初入院尚未接受PCI的ACS患者50例(ACS对照组)、PCI后未发生房颤的ACS患者50例(PCI对照组)、体检健康者50例(健康人对照组)进行回顾性队列分析。检测上述研究对象血浆v WF:Ag,用ROC曲线评价v WF:Ag预测PCI后新发房颤患者发生卒中风险的性能。用χ2检验评估PCI后新发房颤患者v WF:Ag与临床病理因素的关联。用Kaplan-Meier曲线进行生存分析。结果健康人对照组血浆v WF:Ag测定结果为104.5%(88.0%,133.7%),ACS对照组161.7%(120.7%,270.5%),PCI对照组208.0%(125.2%,360.7%),PCI后新发房颤组284.9%(172.4%,494.2%);其中,PCI对照组高于ACS对照组(U=526.0,P<0.01);PCI后新发房颤组高于PCI对照组(U=824.0,P<0.01)。血浆v WF:Ag水平预测PCI后新发房颤患者发生卒中风险的ROC曲线下面积为0.882(95%CI:0.811~0.854),v WF:Ag医学决定水平设定为312.0%时,预测PCI后新发房颤患者发生卒中风险的敏感性为94.4%,特异性为60.6%。与低于312.0%的PCI后新发房颤患者比较,高于312.0%的患者在90 d随访期内的卒中累积概率增高(Log-rankχ2=44.308,P<0.01)。PCI后新发房颤患者血浆v WF:Ag水平与慢性心力衰竭/左室功能障碍、高血压、年龄、卒中/短暂性脑缺血发作/血栓栓塞病史和血管疾病有关联(P<0.01)。接受双联抗栓治疗患者的血浆v WF:Ag水平和卒中事件发生率高于接受三联抗栓治疗的患者(U=1 075.5,P<0.01;χ2=10.45,P<0.01)。结论血浆v WF:Ag水平能敏感地反映PCI后新发房颤患者的血管内皮细胞损伤状态、卒中风险以及抗凝药物治疗效果。更多还原

【Abstract】 Objective To assess stroke risk in the patients with new-onset atrial fibrillation( AF) after elective percutaneous coronary intervention( PCI) by von Willebrand factor antigen( v WF: Ag). Methods A total of 127 patients with new-onset atrial fibrillation after PCI( new-onset AF after PCI group),50 new inpatients with acute coronary syndrome without undergoing PCI( ACS control),50 patients without AF after PCI( PCI control) and 50 healthy individuals( healthy control) were selected in Tianjin Medical University General Hospital from 2016 February to 2017 February for retrospective cohort study. To assay the plasma v WF: Ag for all objects,receiver operating characteristic curve( ROC) was used to analyze the predicting performance of v WF: Ag with stroke risk in the patients with new-onset AF. χ2 test was used to analyze the relevance between v WF: Ag and clinical pathological factors in the patients with new-onset AF. Kaplan-Meier curve was used to implement survival analysis. Results The results of plasma v WF: Ag were as follows:104. 5%( 88. 0%,133. 7%) for the control group,161. 7%( 120. 7%,270. 5%) for ACS control group,208%( 125. 2%,360. 7%) for PCI control group and 284. 9%( 172. 4%,494. 2%) for new-onset AF after PCI group,respectively. The level of plasma v WF: Ag of PCI control was higher than that of ACS control( U = 526. 0,P < 0. 01) and the level in new-onset AF after PCI group was higher than that of PCI control( U = 824. 0,P < 0. 01). The area under the curve was 0. 882( 95% CI: 0. 811-0. 854) for plasma v WF: Ag level predicting stroke risk with new-onset AF. When the cut-off value of v WF: Ag was defined as 312. 0%,the sensitivity was 94. 4% and specificity was 60. 6%. Compared with the patients whose v WF: Ag was less than 312. 0%,the cumulative probability increased significantly( Log-rank χ2= 44. 308,P < 0. 01) during 90 days of follow-up period in the patients with new-onset AF after PCI whose v WF: Ag was over 312. 0%. There were relevances between the v WF: Ag level and chronic heart failure/left ventricular dysfunction,hypertension,age,stroke/transient ischemic attack( TIA)/history of thromboembolism and vascular disease( P < 0. 01).The level of plasma v WF: Ag and risk of stroke event in the patients with dual antithrombotic therapy were higher than those of the patients with triple antithrombotic therapy( U = 1 075. 5,P < 0. 01; χ2= 10. 45,P < 0. 01). Conclusion The level of plasma v WF: Ag could reflect the damage condition of vascular endothelial cells,stroke risk and the efficacy of anticoagulant therapy in the patients with new-onset atrial fibrillation after PCI.更多还原