CAJ | 학술논문

目的代谢综合征(MS)是脑卒中和血栓栓塞事件的危险因素之一.本研究旨在探讨MS对非瓣膜病性心房颤动(NVAF)左心房或左心耳血栓风险分层的附加效应.方法本研究纳入从2007年4月到2014年4月在中山大学孙逸仙纪念医院住院的共286例NVAF患者,经排除标准的筛选后最终纳入209例患者.所有患者在入选前均未服用抗凝药和降脂药.左心房和左心耳血栓通过经食管超声心动图诊断,血栓的风险分层分别通过CHADS2评分、CHA2DS2-VASc评分、MS评分、CHADS2-MS评分和CHA2DS2-VASc-MS评分来评估.以上各评分对血栓预测能力的差异度以受试者工作曲线的曲线下面积来比较.结果共39例患者(18.7％)存在左心房或左心耳血栓.MS是NVAF患者左心房或左心耳血栓的独立危险因素(OR=22.773,P=0.003).上述5个评分指标均可预测血栓形成,但附加了MS评分的CHADS2-MS或CHA2DS2-VASc-MS评分可分别提高CHADS2评分和CHA2DS2-VASc评分对血栓的预测能力(ROC曲线下面积比较:CHADS2-MS对CHADS2:0.792对0.736,P=0.043;CHA2DS2-VASc-MS对CHA2DS2-VASc:0.789对0.728,P=0.049).此外,MS评分可在脑卒中低危人群(CHADS2或CHA2DS2-VASc=0)中区分出易患血栓的高危患者.结论 MS与NVAF左心房或左心耳血栓有关.与CHADS2或CHA2DS2-VASc评分相比,CHADS2-MS或CHA2DS2-VASc-MS评分更适用于NVAF左心房或左心耳血栓的风险分层.
목적 대사종합정(MS)시뇌졸중화혈전전새사건적위험인소지일.본연구지재탐토MS대비판막병성심방전동(NVAF)좌심방혹좌심이혈전풍험분층적부가효응.방법 본연구납입종2007년4월도2014년4월재중산대학손일선기념의원주원적공286례NVAF환자,경배제표준적사선후최종납입209례환자.소유환자재입선전균미복용항응약화강지약.좌심방화좌심이혈전통과경식관초성심동도진단,혈전적풍험분층분별통과CHADS2평분、CHA2DS2-VASc평분、MS평분、CHADS2-MS평분화CHA2DS2-VASc-MS평분래평고.이상각평분대혈전예측능력적차이도이수시자공작곡선적곡선하면적래비교.결과 공39례환자(18.7％)존재좌심방혹좌심이혈전.MS시NVAF환자좌심방혹좌심이혈전적독립위험인소(OR=22.773,P=0.003).상술5개평분지표균가예측혈전형성,단부가료MS평분적CHADS2-MS혹CHA2DS2-VASc-MS평분가분별제고CHADS2평분화CHA2DS2-VASc평분대혈전적예측능력(ROC곡선하면적비교:CHADS2-MS대CHADS2:0.792대0.736,P=0.043;CHA2DS2-VASc-MS대CHA2DS2-VASc:0.789대0.728,P=0.049).차외,MS평분가재뇌졸중저위인군(CHADS2혹CHA2DS2-VASc=0)중구분출역환혈전적고위환자.결론 MS여NVAF좌심방혹좌심이혈전유관.여CHADS2혹CHA2DS2-VASc평분상비,CHADS2-MS혹CHA2DS2-VASc-MS평분경괄용우NVAF좌심방혹좌심이혈전적풍험분층.
Objective Metabolic syndrome (MS)is a risk factor of stroke and thromboembolism event.In this study,we investigated the additive effect of MS on left atrial (LA) or left atrial appendage (LAA) thrombus formation in patients with nonvalvular atrial fibrillation(NVAF).Methods This cross-sectional study enrolled 209 consecutive NVAF patients without prior anticoagulant and lipid-lowering therapy in Sun Yat-sen Memorial Hospital from Apr.2007 to Apr.2014.LA/LAA thrombus was diagnosed by transoesophageal echocardiography(TEE).Risk assessment of LA/LAA thrombus was performed using the CHADS2 and CHA2DS2-VASc scores,alone and alongside with the additive MS score.The differences of predictive abilities of LA/LAA thrombus for different scoring schemes were compared by receiver operating characteristic (ROC) analysis.Results LA/LAA thrombi were identified in 39 patients (18.7％) through TEE.MS was an independent risk factor of LA/LAA thrombus in NVAF patients (OR =22.773,P =0.003).All of the CHADS2,CHA2DS2-VASc,MS,CHADS2-MS,and CHA2DS2-VASc-MS scores had an acceptable predictive ability of LA/LAA thrombus formation.Additional MS scores improved predictive ability of the risk of LA/LAA thrombus for the CHADS2 and CHA2DS2-VASc scores(R OC area:CHADS2-MS vs.CHADS2,0.792 vs.0.736,P=0.043;CHA2 DS2-VASc-MS vs.CHA2 DS2-VASc,0.789 vs.0.728,P=0.049).Furthermore,MS helped to distinguish individuals with high risk of LA/LAA thrombi from traditional low-risk of stroke population (CHADS2 or CHA2DS2-VASc=0).Conclusions MS is associated with LA/LAA thrombus formation in NVAF patients.Compared with CHADS2 or CHA2DS2-VASc scores,the CHADS2-MS or CHA2DS2-VASc-MS scores are superior in LA/LAA thrombus risk stratification.