本文選題：心房顫動(dòng)　切入點(diǎn)：高密度脂蛋白膽固醇　出處：《鄭州大學(xué)》2017年碩士論文　論文類型：學(xué)位論文

【摘要】：背景心房顫動(dòng)(atrial fibrillation,AF)是臨床工作中最常見的心臟節(jié)律異常。隨著人口老齡化的進(jìn)展,房顫發(fā)病率呈逐年增長趨勢。持續(xù)快遞、且紊亂的心臟搏動(dòng)常常導(dǎo)致血流動(dòng)力學(xué)障礙和不良的生活質(zhì)量。心房顫動(dòng)與許多心血管疾病密切相關(guān),房顫患者伴發(fā)的冠心病、高血壓、心臟瓣膜病、心功能不全等疾病常導(dǎo)致心房結(jié)構(gòu)重構(gòu)和電重構(gòu),并與心房顫動(dòng)互為因果,參與或加劇房顫的發(fā)生及發(fā)展進(jìn)程。房顫時(shí)心房血栓脫落誘發(fā)的腦卒中等血栓栓塞事件具有較高的致殘率和致死率。房顫人群中約65.2%為非瓣膜病心房顫動(dòng)患者。國內(nèi)研究證實(shí)非抗凝情況下,非瓣膜性房顫患者心源性腦卒中的發(fā)生率為5.3%,是正常人群發(fā)生腦栓塞風(fēng)險(xiǎn)的5.6倍。超過90%的非瓣膜性房顫患者血栓來自于左心房尤其是左心耳,與其特殊的解剖及功能緊密相關(guān)。經(jīng)食道超聲心動(dòng)圖(transesophageal echocardiography,TEE)常被作為房顫患者射頻消融術(shù)前或電復(fù)律前的常規(guī)檢查,目前是排除心房血栓的金標(biāo)準(zhǔn)。眾所周知,血脂異常是動(dòng)脈粥樣硬化和冠心病的重要原因。低密度脂蛋白膽固醇(low-density lipoprotein cholesterol,LDL-C)水平增高和高密度脂蛋白膽固醇(high-density lipoprotein cholesterol,HDL-C)水平降低與冠心病風(fēng)險(xiǎn)增加直接相關(guān)。血脂異常作為心房顫動(dòng)的危險(xiǎn)因素,在其發(fā)生發(fā)展進(jìn)程中的作用尚不明確。近年來,血脂與心房顫動(dòng)的關(guān)系引起諸多學(xué)者的關(guān)注,成為一個(gè)新的研究熱點(diǎn)。來自美國的動(dòng)脈粥樣硬化多種族研究(the Multi-Ethnic Study of atherosclerosis,mesa)和弗明漢心臟病研究(theframinghamheartstudy,fhs)的數(shù)據(jù)表明,高甘油三酯和低水平的hdl-c與心房顫動(dòng)風(fēng)險(xiǎn)增加相關(guān)。在一項(xiàng)來自日本的隊(duì)列研究中,watanabe等也提出hdl-c能降低心房顫動(dòng)的發(fā)生風(fēng)險(xiǎn)。hdl-c除了是動(dòng)脈粥樣硬化的有效保護(hù)因子,同時(shí)具有抗動(dòng)、靜脈血栓的作用,其在腦卒中、肺栓塞、特發(fā)性靜脈血栓等栓塞事件中的保護(hù)作用相繼報(bào)道。而目前關(guān)于hdl-c水平與非瓣膜性房顫患者左心房血栓形成關(guān)系的報(bào)道尚少,仍需進(jìn)一步研究。目的分析非瓣膜性房顫患者左心房血栓形成的危險(xiǎn)因素,探討hdl-c與非瓣膜性房顫左心房血栓形成的關(guān)系,及危險(xiǎn)因素對(duì)心房血栓的預(yù)測價(jià)值。研究方法回顧性分析2014年1月至2016年4月在鄭州大學(xué)第一附屬醫(yī)院心血管內(nèi)科擬行房顫射頻消融術(shù)的非瓣膜性房顫患者共計(jì)473例,經(jīng)食道超聲心動(dòng)圖檢查確診左心房是否有血栓形成分為兩組:血栓組(n=60例)、非血栓組(n=413例)。比較兩組患者一般資料、cha2ds2-vasc積分、實(shí)驗(yàn)室檢查(包括hdl-c)、心臟彩超指標(biāo)的差異,對(duì)差異有統(tǒng)計(jì)學(xué)意義的指標(biāo)進(jìn)行單因素及多因素的logistic回歸分析,并繪制roc曲線分析危險(xiǎn)因素對(duì)左心房血栓形成的預(yù)測價(jià)值。結(jié)果(1)血栓組與非血栓組一般資料比較血栓組年齡、腦卒中比例、cha2ds2-vasc積分、非陣發(fā)性房顫比例、rdw水平、左心房內(nèi)徑高于非血栓組,hdl-c水平低于非血栓組。(2)左心房血栓形成的單因素logistic回歸分析結(jié)果表明高齡、腦卒中、高cha2ds2-vasc積分、高rdw水平、lad增大、非陣發(fā)性房顫是非瓣膜性房顫患者左心房血栓形成的危險(xiǎn)因素,而hdl-c是左心房血栓形成的保護(hù)因素。(3)左心房血栓形成的多因素Logistic回歸分析結(jié)果表明高CHA_2DS_2-VASc積分、非陣發(fā)性房顫是非瓣膜性房顫患者左心房血栓形成的獨(dú)立危險(xiǎn)因素,而HDL-C是左心房血栓形成獨(dú)立保護(hù)因素。(4)CHA_2DS_2-VASc積分及HDL-C水平聯(lián)合CHA_2DS_2-VASc積分、房顫類型的ROC曲線CHA_2DS_2-VASc積分預(yù)測非瓣膜性房顫患者左心房血栓的ROC曲線下面積為0.717(95%CI:0.671-0.759,p0.001),HDL-C水平聯(lián)合CHA_2DS_2-VASc積分、房顫類型的ROC曲線下面積為0.791(95%CI:0.749-0.829,p0.001)。且兩者曲線下面積相比差異有統(tǒng)計(jì)學(xué)意義(p=0.012)。結(jié)論低HDL-C水平是非瓣膜性房顫左心房血栓形成的危險(xiǎn)因素,HDL-C水平聯(lián)合CHA_2DS_2-VASc積分、房顫類型預(yù)測非瓣膜性房顫患者左心房血栓形成價(jià)值優(yōu)于CHA_2DS_2-VASc積分。
[Abstract]:Background atrial fibrillation (atrial fibrillation AF) is the most common heart rhythm abnormality in clinical work. With the progress of population aging, the incidence of atrial fibrillation increases year by year. Continue to express, and heart disorder often leads to disorder of hemodynamics and poor quality of life. Atrial fibrillation is associated with many cardiovascular diseases hair, coronary heart disease, atrial fibrillation in patients with hypertension, valvular heart disease, heart failure and other diseases often lead to atrial structural remodeling and electrical remodeling in atrial fibrillation, and reciprocal causation and the occurrence and development process, participate in or exacerbate atrial fibrillation. Atrial thrombosis induced by stroke and thromboembolic events with high disability rate and death rate. About 65.2% population of patients with atrial fibrillation for patients with non valvular atrial fibrillation. The study confirmed that non anticoagulant cases occurred in non valvular atrial fibrillation in patients with cardiac stroke. The rate is 5.3%, is 5.6 times the risk of occurrence of cerebral embolism in normal population. Thrombosis in patients with non valvular atrial fibrillation more than 90% from the left atrium especially the left heart ear, and is closely related to the special anatomy and function. Transesophageal echocardiography (transesophageal, echocardiography, TEE) are often regarded as real fibrillation RF ablation or electrical cardioversion before the routine examination, is currently the gold standard of exclusion of atrial thrombi. As everyone knows, dyslipidemia is an important cause of atherosclerosis and coronary heart disease. Low density lipoprotein cholesterol (low-density lipoprotein, cholesterol, LDL-C) and increased the level of high density lipoprotein cholesterol (high-density lipoprotein cholesterol, HDL-C) levels decreased is directly related with the risk of coronary heart disease increased. Dyslipidemia as a risk factor for atrial fibrillation, in the role of the development process is not clear. In recent years, with the blood lipid The relationship between atrial fibrillation aroused the concern of many scholars, has become a new research hotspot. The multi ethnic study of atherosclerosis from America (the Multi-Ethnic Study of atherosclerosis, MESA) and the Framingham Heart Study (theframinghamheartstudy, FHS) data show that the increased risk of high triglycerides and low levels of HDL-C and atrial fibrillation. In a Japanese cohort study, Watanabe of HDL-C can reduce the risk of atrial fibrillation in.Hdl-c is an effective protective factor of atherosclerosis, and resist, venous thrombosis, the stroke, pulmonary embolism, protective effect of idiopathic venous thrombosis and embolism events has been reported. At present, on the level of HDL-C and non valvular atrial fibrillation in patients with left atrial thrombosis are less reported, still need further study. The analysis of non valvular purpose The risk factors of left atrial thrombus formation in patients with atrial fibrillation, left atrial thrombus and explore the relationship between HDL-C and non valvular atrial fibrillation formation, value and risk factors to predict atrial thrombosis. Methods a retrospective analysis from January 2014 to April 2016 in the First Affiliated Hospital of Zhengzhou University of cardiovascular medicine to atrial fibrillation radiofrequency ablation in patients with non valvular atrial fibrillation a total of 473 Cases, transesophageal echocardiography of left atrial thrombosis diagnosed map check whether there are divided into two groups: thrombus group (n=60 cases), non thrombosis group (n=413 cases). Cha2ds2-vasc were compared between the two groups of patients with general information, integration, laboratory examination (including HDL-C), differences in echocardiographic parameters, single regression analysis factor and multi factor Logistic had significant difference on the index, and predictive value of ROC curve analysis of risk factors of left atrial thrombosis. Results (1) thrombosis group and non thrombus group General information of the thrombus group age, stroke scale, cha2ds2-vasc score, the proportion of non paroxysmal atrial fibrillation, RDW level, left atrial diameter is higher than that of the non thrombus group, the HDL-C level is lower than the non thrombosis group. (2) logistic single factors of left atrial thrombosis in the regression analysis results showed that the high age, stroke, high cha2ds2-vasc score, high the level of RDW, lad increased, non paroxysmal atrial fibrillation are risk factors of non valvular atrial fibrillation in patients with left atrial thrombosis, while HDL-C is a protective factor for left atrial thrombosis. (3) Logistic multi factors of left atrial thrombosis in the regression analysis results showed that the high CHA_2DS_2-VASc score, non paroxysmal atrial fibrillation were independent risk factors for non valvular atrial fibrillation in patients with left atrial thrombosis, and HDL-C were the independent protective factors of left atrial thrombus formation. (4) CHA_2DS_2-VASc integral and HDL-C level combined with CHA_2DS_2-VASc integral, ROC curve of CH type of atrial fibrillation The A_2DS_2-VASc score in predicting ROC curve in patients with non valvular atrial fibrillation of left atrial thrombus was 0.717 (95%CI:0.671-0.759, p0.001), combined with CHA_2DS_2-VASc HDL-C integral, ROC curve type of atrial fibrillation under 0.791 (95%CI:0.749-0.829, p0.001) and the area under the curve. Both had significant difference (p=0.012). Conclusion: low HDL-C level is a risk factor for non valvular atrial fibrillation left atrial thrombosis, combined with CHA_2DS_2-VASc HDL-C integral level, type of atrial fibrillation predicts non valvular atrial fibrillation in patients with left atrial thrombosis value than the CHA_2DS_2-VASc integral.

【學(xué)位授予單位】：鄭州大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類號(hào)】：R541.75

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