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医学临床研究  2022, Vol. 39 Issue (11): 1650-1653    DOI: 10.3969/j.issn.1671-7171.2022.11.015
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超声影像学及实验室指标联合预测风湿性心脏病发生左心房血栓风险的价值
校王莉, 贾贝*
延安大学咸阳医院,陕西 咸阳 712000
Value of Ultrasound Imaging and Laboratory Indexes in Predicting the Risk of Left Atrial Thrombosis in Rheumatic Heart Disease
XIAO Wang-li, JIA Bei
Xianyang Hospital of Yan'an University,Xianyang Shaanxi 712000
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摘要 【目的】探讨超声影像学及实验室指标预测风湿性心脏病发生左心房血栓风险的价值。【方法】回顾性分析2020年8月至2021年8月本院收治的103例风湿性心脏病患者的临床资料,根据患者是否发生左心房血栓分为血栓组(n=27)和无血栓组(n=76)。比较两组患者的性别、年龄、体重指数(BMI)、病程、有无高血压、有无糖尿病、左心房收缩期内径、左心房面积、左房自发性回声、活化部分凝血活酶时间(APTT)、凝血酶原时间(PT)、凝血酶时间(TT)、纤维蛋白原(FIB)、溶血磷脂酸(LPA)、抗凝血酶-Ⅲ(AT-Ⅲ)。采用受试者工作特征(ROC)曲线分析超声影像学指标及实验室指标预测风湿性心脏病患者发生左心房血栓的价值;多因素分析采用Logistic逐步回归分析相关危险因素。【结果】血栓组左心房收缩期内径、左心房面积、LPA及有左房自发性回声的占比高于无血栓组,AT-Ⅲ低于无血栓组,差异有统计学意义(P<0.05)。ROC曲线分析显示,左心房收缩期内径、左心房面积、LPA、AT-Ⅲ预测风湿性心脏病患者发生左心房血栓的曲线下面积分别为0.851、0.825、0.790、0.844。多因素Logistic分析显示,左心房收缩期内径≥52.375 mm、左心房面积≥30.480 cm2、左房自发性回声、LPA≥3.700 μmol/L、AT-Ⅲ≤24.985%是风湿性心脏病患者发生左心房血栓的危险因素(P<0.05)。一致性分析显示,联合超声影像学及实验室指标预测风湿性心脏病患者合并左心房血栓的敏感度为0.926,特异性为0.961,准确率为0.951,Kappa=0.876。【结论】超声影像学及实验室指标联合预测风湿性心脏病发生左心房血栓风险的价值较高,有利于风湿性心脏病合并左心房血栓的早期诊断和治疗。
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校王莉
贾贝
关键词 风湿性心脏病/并发症血栓栓塞/并发症心房超声检查    
Abstract:【Objective】To explore the value of ultrasonic imaging and laboratory indexes in predicting the risk of left atrial thrombosis in rheumatic heart disease. 【Methods】 The clinical data of 103 patients with rheumatic heart disease admitted to our hospital from August 2020 to August 2021 were analyzed retrospectively. The patients were divided into thrombus group (n=27) and non thrombus group (n=76) according to whether they had left atrial thrombosis. Gender, age, body mass index (BMI), course of disease, hypertension, diabetes, left atrial systolic diameter, left atrial area, left atrial spontaneous echo, activated partial thromboplastin time (APTT), prothrombin time (PT), thrombin time (TT), fibrinogen (FIB), lysophosphatidic acid (LPA), antithrombin-Ⅲ (AT-Ⅲ) were compared between the two groups. The value of ultrasonic imaging and laboratory indexes in predicting left atrial thrombus in patients with rheumatic heart disease was analyzed by subject operating characteristic curve (ROC); Logistic stepwise regression was used to analyze related risk factors in multivariate analysis. 【Results】The ratio of left atrial systolic diameter, left atrial area, LPA and left atrial spontaneous echo in the thrombosis group was higher than that in the non thrombosis group, while AT-Ⅲ was lower than that in the non thrombosis group (P<0.05). ROC curve analysis showed that the area under the curve of left atrial systolic diameter, left atrial area, LPA, AT-Ⅲ predicting left atrial thrombosis in patients with rheumatic heart disease were 0.851, 0.825, 0.790, 0.844, respectively. Multivariate logistic analysis showed that left atrial systolic diameter ≥ 52.375 mm, left atrial area ≥ 30.480 cm2, left atrial spontaneous echo, LPA ≥ 3.700 μmol/L and AT-Ⅲ≤ 24.985% were risk factors for left atrial thrombosis in patients with rheumatic heart disease (P<0.05). The consistency analysis showed that the sensitivity, specificity and accuracy of predicting left atrial thrombosis in patients with rheumatic heart disease combined with ultrasonic imaging and laboratory indicators were 0.926, 0.961 and 0.951 respectively,Kappa=0.876. 【Conclusion】The combination of ultrasonic imaging and laboratory indexes has a high value in predicting the risk of left atrial thrombosis in rheumatic heart disease, which is conducive to the early diagnosis and treatment of rheumatic heart disease with left atrial thrombosis.
Key wordsRheumatic Heart Disease/CO    Thromboembolism/CO    Heart Atria    Ultrasonography
收稿日期: 2022-03-08     
中图分类号:  R541.2  
通讯作者: *E-mail:jiabei0528@163.com   
引用本文:   
校王莉, 贾贝. 超声影像学及实验室指标联合预测风湿性心脏病发生左心房血栓风险的价值[J]. 医学临床研究, 2022, 39(11): 1650-1653.
XIAO Wang-li, JIA Bei. Value of Ultrasound Imaging and Laboratory Indexes in Predicting the Risk of Left Atrial Thrombosis in Rheumatic Heart Disease. JOURNAL OF CLINICAL RESEARCH, 2022, 39(11): 1650-1653.
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http://journal07.magtech.org.cn/yxlcyj/CN/10.3969/j.issn.1671-7171.2022.11.015     或     http://journal07.magtech.org.cn/yxlcyj/CN/Y2022/V39/I11/1650
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