非瓣膜性心房顫動患者心外膜脂肪組織體積與血栓栓塞事件相關(guān)性分析
[Abstract]:Objective: to investigate the relationship between the volume of epicardial adipose tissue (EAT) and thromboembolism in patients with non-valvular atrial fibrillation (AF). The total epicardial fat volume and epicardial fat volume of left atrium were measured by semi-manual spiral CT scanning. The diameter of left atrium, baseline data, associated diseases and anticoagulant use were recorded. According to the history of transient ischemic attack (TIA) and systemic circulation embolism, the subjects were divided into embolization group and non-embolization group, and the differences between the two groups were compared. To explore the relationship between epicardial adipose tissue and embolism events in patients with atrial fibrillation. 95 of 155 patients without anticoagulant therapy were included in the atrial fibrillation group. 50 patients with age-matched BMI and course of atrial fibrillation were selected as the normal control group to collect hematocrit. The mean platelet volume and coagulation state indexes such as D-dimer and fibrinogen (FIB), total epicardial fat volume and left atrial pericardial epicardial fat volume were measured, and the difference of coagulation state between the two groups was compared. The correlation between coagulation parameters and epicardial fat volume in patients with atrial fibrillation was analyzed. Results: (1) Atrial fibrillation patients with hypertension, diabetes, vascular disease and coronary heart disease had significantly higher volume of eat and EAT-LA than those without. Univariate correlation analysis showed that the volumes of eat and LA-EAT were positively correlated with age CHA2DS2-VASc scores (2) epicardial adipose tissue and embolism events occurred in 22 out of 155 patients with ischemic stroke or transient ischemic attack (TIA) and atrial fibrillation with systemic blood ring embolism. Patients were enrolled in the embolization event group (mean age 62.50 鹵10.42 years). The remaining 133 cases were used as control group (mean age 54.45 鹵10.81 years, female 38 cases). The study found that patients in the event group had greater left atrial diameter, higher average age and CHA2DS2-VASc score than those in the non-embolism event group, while gender, body mass index (BMI), hypertension, diabetes. There was no significant difference in coronary heart disease and blood lipid level between the two groups. The volume of eat and LA-EAT in the thromboembolism group was significantly higher than that in the control group (123.49 鹵31.25 cm3 vs.100.55 鹵35.36 cm 3, P < 0.005; 34.22 鹵6.84 cm3 vs.27.10 鹵9.55 cm 3, P 0.001). Multivariate correlation analysis showed that EAT (OR1. 10 P0. 039) and LA-EAT (OR1. 10 P0. 024) were independent risk factors between thromboembolism in patients with atrial fibrillation. (3) epicardial fat volume in AF group was significantly higher than that in normal control group. At the same time, atrial fibrillation group had higher D-dimer [0.26 (0.21-0.41) vs 0.22 (0.17-0.29) P0.001] and fibrinogen [2.85 (2.46-3.83) vs2.69 (2.42-3.36) P0.001]. Correlation analysis showed that the volume of epicardial adipose tissue was independent of D-dimer and fibrinogen levels. Conclusion: (1) the accumulation of epicardial adipose tissue is closely related to the risk factors of thromboembolism in atrial fibrillation. Vascular disease and elderly patients with atrial fibrillation with thromboembolism risk factors have greater epicardial fat volume. (2) epicardial adipose tissue volume is an independent risk factor for thromboembolism in patients with atrial fibrillation. The accumulation of epicardial adipose tissue may promote the occurrence of thromboembolism in patients with atrial fibrillation. (3) Non-valvular atrial fibrillation patients have significant prethrombotic state, and there is a correlation between epicardial fat volume and prethrombotic state in patients with atrial fibrillation.
【學(xué)位授予單位】:中國人民解放軍醫(yī)學(xué)院
【學(xué)位級別】:碩士
【學(xué)位授予年份】:2016
【分類號】:R541.75
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