本文選題：心房顫動(dòng) + CHA2DS2-VASc評(píng)分��； 參考：《西安醫(yī)學(xué)院》2017年碩士論文

【摘要】：背景與目的血栓栓塞是房顫最嚴(yán)重的并發(fā)癥之一,對(duì)房顫患者血栓栓塞風(fēng)險(xiǎn)進(jìn)行預(yù)測(cè)具有非常重要的臨床意義。CHA2DS2-VASc評(píng)分作為目前公認(rèn)的血栓風(fēng)險(xiǎn)評(píng)價(jià)手段,雖已廣泛應(yīng)用于臨床,但其內(nèi)容僅限于患者的一般情況及病史資料,臨床應(yīng)用仍有一定的缺陷。血小板體積參數(shù)是衡量血小板體積大小分布的指標(biāo),既往研究發(fā)現(xiàn)血小板體積參數(shù)能夠反映血小板活性和功能,與患者發(fā)生長(zhǎng)期不良心血管事件相關(guān)。目前尚無(wú)研究對(duì)血小板體積參數(shù)與非瓣膜性房顫患者血栓栓塞風(fēng)險(xiǎn)之間關(guān)系進(jìn)行分析。本研究旨在對(duì)血小板體積參數(shù)與房顫患者血栓栓塞風(fēng)險(xiǎn)間的關(guān)系進(jìn)行探討,進(jìn)一步了解血小板體積參數(shù)是否可以作為新的指標(biāo)納入CHA2DS2-VASc評(píng)分系統(tǒng)。方法本研究連續(xù)入選2014年10月到2015年12月期間以“房顫”入住陜西省人民醫(yī)院心內(nèi)一科且符合入選和排除標(biāo)準(zhǔn)的患者182人。參考CHA2DS2-VASc評(píng)分對(duì)患者進(jìn)行評(píng)分并分組:中低危組2分,高危組≥2分。采集患者一般信息、既往病史及服藥情況、血生化指標(biāo)及超聲心動(dòng)圖參數(shù),并對(duì)所有患者隨訪其1年內(nèi)血栓栓塞事件的發(fā)生情況。統(tǒng)計(jì)分析兩組之間的差異。采用logistic回歸分析患者血栓栓塞風(fēng)險(xiǎn)增加的相關(guān)參數(shù)。應(yīng)用受試者工作特征(ROC)曲線描述其參考價(jià)值并計(jì)算cutoff值。結(jié)果1.本研究連續(xù)入選患者182人,平均年齡為(71.6±10.31)歲,其中女性占50.0%(91/182)。根據(jù)CHA2DS2-VASc評(píng)分對(duì)患者血栓栓塞風(fēng)險(xiǎn)進(jìn)行評(píng)分并分組:中低危組41人(22.5%),高危組141人(77.5%)。對(duì)患者一般資料、既往病史、入院生化等指標(biāo)進(jìn)行分析,結(jié)果顯示:(1)兩組之間的女性比例(33.33%vs.55.00%,p=0.011)、高血壓病史(11.90%vs.60.00%,p=0.010)、糖尿病病史(7.14%vs.23.57%,p=0.012)、缺血性疾病史(2.44%vs.40.00%,p=0.000)、他汀類使用(38.10%vs.62.86%,p=0.004)、高血壓病史長(zhǎng)短((1.19±5.01)vs.(9.50±12.57),p=0.000)差異有明顯統(tǒng)計(jì)學(xué)意義;(2)高危組和中低危組之間PDW[(16.45±2.37)vs.(14.24±2.81)(P0.05)],FDP[(2.79±0.41)vs.(5.16±8.03),p=0.010]之間存在統(tǒng)計(jì)學(xué)差異具(p0.05);(3)兩組患者舒張壓之間存在統(tǒng)計(jì)學(xué)差異[(74.55±8.82)vs.(76.84±11.07),p=0.047)];(4)logistic回歸分析顯示,年齡、高血壓、血栓性疾病、PDW是非瓣膜性房顫患者高血栓栓塞風(fēng)險(xiǎn)的獨(dú)立影響因素(p0.05)。2.所有患者經(jīng)1年隨訪,出現(xiàn)血栓栓塞事件者為40人(21.98%)。根據(jù)出現(xiàn)血栓事件與否分組,比較其一般資料、既往病史、入院生化指標(biāo),統(tǒng)計(jì)分析示:(1)兩組間年齡[(77.13±7.74)vs.(70.49±9.86),p=0.023]、高血壓病(67.50%vs.43.66%,p=0.027)及其病史長(zhǎng)短[(16.06±16.73)vs.(5.19±8.68),p=0.000]、缺血性疾病病史(53.33%vs.26.79%,p=0.005)的差異存在統(tǒng)計(jì)學(xué)意義(P0.05);(2)兩組在PDW[(16.62±2.27)vs.(15.77±2.71),P=0.026]、MPV/PLT[(0.07±0.02)vs.(0.07±0.03),P=0.033]、FDP[(7.27±11.70)vs.(3.86±5.10),P=0.001]、DD[(1.86±2.92)vs.(1.01±1.53),P=0.002]、HbA1c[(6.71±1.68)vs.(5.78±1.09),P=0.000]之間的差異存在統(tǒng)計(jì)學(xué)意義(p0.05);(3)logistic回歸分析顯示年齡是患者1年內(nèi)出現(xiàn)血栓栓塞事件的獨(dú)立影響因素(p0.05),PDW不是患者1年內(nèi)發(fā)生血栓事件的獨(dú)立影響因素。3.ROC曲線分析結(jié)果顯示:AUC=0.749(0.662-0.837,p=0.000),約登指數(shù)計(jì)算可知:PDW大于16.15%時(shí),對(duì)患者血栓栓塞高風(fēng)險(xiǎn)有較好的預(yù)測(cè)價(jià)值(靈敏度=0.771,特異度=0.714)。結(jié)論1.在非瓣膜性房顫患者中,PDW與高血栓栓塞風(fēng)險(xiǎn)顯著相關(guān),是非瓣膜性房顫患者高血栓栓塞風(fēng)險(xiǎn)的獨(dú)立預(yù)測(cè)因素;2.當(dāng)PDW大于16.15%時(shí),對(duì)患者血栓栓塞高風(fēng)險(xiǎn)有較好的預(yù)測(cè)價(jià)值;3.年齡是非瓣膜性房顫患者1年內(nèi)出現(xiàn)血栓事件的獨(dú)立影響因素。
[Abstract]:Background and objective thromboembolism is one of the most serious complications of atrial fibrillation. Predicting the risk of thromboembolism in patients with atrial fibrillation has a very important clinical significance as a widely accepted method of evaluation of thrombus risk. Although it has been widely used in clinical practice, the content of.CHA2DS2-VASc is limited to the general and medical history of patients. The application of platelet volume parameters is an indicator of the distribution of platelet volume. Previous studies have found that platelet volume parameters can reflect platelet activity and function and are associated with long-term adverse cardiovascular events in patients. There is no study on thromboembolic thrombus of platelet volume parameters and non valvular atrial fibrillation patients. This study aims to explore the relationship between platelet volume parameters and thromboembolic risk in patients with atrial fibrillation, and further understand whether the platelet volume parameters can be used as a new indicator for the CHA2DS2-VASc scoring system. Methods this study was continuously selected from October 2014 to December 2015 with "room". 182 patients who were admitted to the heart of the Shaanxi People's Hospital and were eligible for admission and exclusion criteria. The patients were scored by CHA2DS2-VASc scores and divided into groups: 2 in the middle and low risk groups and 2 in the high risk group. The general information, past medical history and medication, blood biochemical index and echocardiographic parameters were collected and followed up for all patients. The occurrence of thromboembolism events in 1 years. Statistical analysis of the differences between the two groups. Logistic regression was used to analyze the related parameters of the increased risk of thromboembolism in patients. The reference value of the subject (ROC) curve was used to describe the reference value and the value of cutoff was calculated. Results 1. patients were enrolled in the study, with an average age of (71.6 + 10.31). Age, women accounted for 50% (91/182). According to the CHA2DS2-VASc score, the risk of thromboembolism was scored and divided into groups: 41 in the middle and low risk group (22.5%) and 141 in high risk group (77.5%). The general data, previous history, and admission biochemical indexes were analyzed. The results showed: (1) the proportion of women (33.33%vs.55.00%, p=0.011), high blood between two groups. The history of 11.90%vs.60.00% (p=0.010), the history of diabetes (7.14%vs.23.57%, p=0.012), the history of ischemic disease (2.44%vs.40.00%, p=0.000), the use of statins (38.10%vs.62.86%, p=0.004), the history of hypertension (1.19 + 5.01) vs. (9.50 + 12.57), P =0.000) had significant statistical significance; (2) PDW[(16.45 + 2.37) between the high risk group and the middle and low risk group. Vs. (14.24 + 2.81) (P0.05)], FDP[(2.79 + 0.41) vs. (5.16 + 8.03), and p=0.010] with statistical difference (P0.05); (3) the diastolic blood pressure in the two groups was statistically different [(74.55 + 8.82) vs. (76.84 + 11.07), p=0.047)]; (4) logistic regression analysis showed that age, hypertension, thrombotic disease, PDW were hyperthrombotic in patients with non valvular atrial fibrillation. The independent influence factor of embolic risk (P0.05).2. all patients were followed up for 1 years, and there were 40 patients (21.98%) with thromboembolism events. According to the incidence of thrombosis or not, the general data, previous medical history and admission biochemical indexes were compared. (1) the age of two groups [(77.13 + 7.74) vs. (70.49 + 9.86), p=0.023], hypertension (67.50%vs) .43.66%, p=0.027) and the length of their medical history [(16.06 + 16.73) vs. (5.19 + 8.68), p=0.000], the difference in the history of ischemic disease (53.33%vs.26.79%, p=0.005) had statistical significance (P0.05); (2) two groups in PDW[(16.62 + 2.27) vs. (15.77 + 2.71), P=0.026], MPV/PLT[(0.07 + 0.02) vs.. The difference between DD[(1.86 + 2.92) vs. (1.01 + 1.53), P=0.002], HbA1c[(6.71 + 1.68) vs. (5.78 + 1.09) and P=0.000] was statistically significant (P0.05); (3) logistic regression analysis showed that age was an independent influence factor (P0.05) in patients with thromboembolism in 1 years, and PDW was not an independent factor of influence factors in thrombus events within 1 years. The results of curve analysis showed that AUC=0.749 (0.662-0.837, p=0.000), Jorden index calculated that when PDW was greater than 16.15%, there was a better predictive value for the high risk of thromboembolism in patients (sensitivity =0.771, specificity =0.714). Conclusion 1. in patients with non valvular atrial fibrillation, PDW is significantly associated with the risk of high thromboembolism, and is higher in patients with non valvular atrial fibrillation. An independent predictor of thromboembolism risk; 2. when PDW was greater than 16.15% had a better predictive value for a patient's high risk of thromboembolism; the 3. age was an independent factor in the occurrence of thrombus events in patients with non valvular atrial fibrillation within 1 years.
【學(xué)位授予單位】：西安醫(yī)學(xué)院
【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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本文編號(hào)：1900050