HDL-C与非瓣膜性房颤左心房血栓形成的关系
Relationship between high-density lipoprotein cholesterol and left atrial thrombus in nonvalvular atrial fibrillation patients

目的:探讨血浆高密度脂蛋白胆固醇(HDL-C)与非瓣膜性房颤左心房血栓形成的关系。方法:回顾性分析拟行房颤射频消融术的非瓣膜性房颤患者473例,经食管超声心动图检查左心房是否有血栓形成后分为:血栓组(n=60例)、非血栓组(n=413例)。比较两组患者一般资料、CHA2DS2-VASc积分、实验室检查(包括HDL-C)、心脏彩超指标的差异。结果:高CHA2DS2-VASc积分(OR=1.649,95%CI:1.238～2.197,P=0.001)、持续性房颤(OR=3.424,95%CI:1.718～6.821,P＜0.001)是非瓣膜性房颤左心房血栓形成的独立危险因素,而HDL-C(OR=0.299,95%CI:0.097～0.924,P=0.036)是其形成的独立保护因素。CHA2DS2-VASc积分预测房颤左心房血栓形成的ROC曲线下面积为0.717(95%CI:0.671～0.759,P＜0.001),HDL-C水平联合CHA2DS2-VASc积分、房颤类型预测房颤左心房血栓形成的ROC曲线下面积为0.791(95%CI:0.749～0.829,P＜0.001)。结论:低HDL-C水平是左心房血栓形成的高危因素。HDL-C水平联合CHA2DS2-VASc积分、房颤类型预测房颤左心房血栓形成优于CHA2DS2-VASc积分。
Aim: To investigate the relationship between high-density lipoprotein cholesterol(HDL-C)and left atrial thrombus in nonvalvular atrial fibrillation(AF)patients.Methods: A total of 473 patients with nonvalvular AF who were admitted in our department for radiofrequency catheter ablation were enrolled. The patients were allocated into thrombus group(n=60)and non-thrombus group(n=413)according to transesophageal echocardiography. All baseline clinical characteristics, CHA2DS2-VASc score, laboratory examination results(HDL-C included)and echocardiographic parameters were analyzed.Results: Higher CHA2DS2-VASc score(OR=1.649,95%CI:1.238-2.197,P=0.001), persistent AF(OR=3.424,95%CI:1.718-6.821,P＜0.001)were the independent risk factors for left atrial thrombus, while HDL-C(OR=0.299,95%CI:0.097-0.924,P=0.036)was the independent protective factor. ROC curves showed that the AUC of CHA2DS2-VASc score to predict left atrial thrombus in nonvalvular atrial fibrillation patients was 0.717(95%CI:0.671-0.759,P＜0.001), and the AUC of HDL-C combined with CHA2DS2-VASc score and persistent AF was 0.791(95%CI:0.749-0.829,P＜0.001).Conclusion: Low HDL-C level is a high risk factor for left atrial thrombus. Combining HDL-C level with CHA2DS2-VASc score and persistent AF to predict left atrial thrombus in nonvalvular atrial fibrillation patients is superior to CHA2DS2-VASc score