心房颤动患者左房耳形态与血栓及短暂性脑缺血发作关系的研究

doi:10.3969/j.issn.1006-7795.2019.05.021

摘要/Abstract

摘要： 目的探讨心房颤动患者左房耳（left atrial appendage，LAA）形态与血栓形成及短暂性脑缺血发作（transient ischemic attack，TIA）发生的关系。方法选取2013年8月至2017年6月拟行射频消融手术的心房颤动患者687例，根据食道超声检查分为左房血栓组和无血栓组。所有患者术前行肺静脉及左心房增强扫描，所有CT扫描图像行后处理图像重建及左房耳解剖形态相关分型。计数资料组间比较采用χ²检验，多因素分析采用非条件Logistic回归模型。结果入选687例患者，仙人掌型135例（19.65%），鸡翅型275例（40.03%），风向标型80例（11.64%），菜花型197例（28.68%）；经单因素和多因素分析显示，鸡翅型左房耳是血栓形成（OR=0.323）和TIA （OR=0.254）的保护因素（P<0.05）；菜花型左房耳是血栓形成（OR=3.116）和TIA （OR=2.391）的危险因素（P<0.05）。结论左房耳形态学特征分为四型：仙人掌型、鸡翅型、风向标型、菜花型，其中鸡翅型所占的比例最高，该型发生血栓和TIA的危险性最低，菜花型是血栓发生和TIA的危险因素。因此，检测左房耳形态结构对于评估血栓形成及TIA发生的可能性从而指导治疗及评价预后可能具有一定临床意义。

关键词: 心房颤动, 左房耳血栓, 短暂性脑缺血发作

Abstract: Objective To investigate the relationship between left atrial appendage morphology and thrombus formation and transient ischemic attack (TIA) in patients with atrial fibrillation. Methods Totally 687 patients with atrial fibrillation scheduled for radiofrequency ablation from August 2013 to June 2017 were selected and divided into left atrial thrombosis group and non-thrombosis group according to esophageal ultrasonography. All patients received pre-operative pulmonary vein and left atrium enhancement scans. All CT scans were reconstructed by post-processing image reconstruction and left atrial appendage anatomical classification. The Pearson χ^t est was used for comparison among the enumeration data groups, and the unconditional Logistic regression model was used for multivariate analysis. Results 687 patients were enrolled, 135 patients (19.65%) were cactus type, 275 patients (40.03%) were chicken wing type, 80 patients (11.64%) were windsock type and 197 patients (28.68%) were cauliflower type. Univariate and multivariate analysis showed that chicken wing left atrial appendage was a protective factor for thrombosis (OR=0.323) and TIA (OR=0.254) (P<0.05); cauliflower left atrial appendage was a risk factor for thrombosis (OR=3.116) and TIA (OR=2.391) (P<0.05). Conclusion The morphological characteristics of left atrial appendage can be divided into four types:cactus type, chicken wing type, windsock type and cauliflower type. The proportion of chicken wing type is the highest, while the risk of thrombosis and TIA is the lowest. Cauliflower type is the risk factor of thrombosis and TIA. Therefore, the detection of left atrial appendage morphology may have certain clinical significance in evaluating the possibility of thrombosis and TIA, guiding treatment and evaluating prognosis.

Key words: atrial fibrillation, left atrial appendage thrombus, transient ischemic attack (TIA)

中图分类号:

张杨, 马展鸿, 蒋涛. 心房颤动患者左房耳形态与血栓及短暂性脑缺血发作关系的研究[J]. 首都医科大学学报, 2019, 40(5): 776-780.

Zhang Yang, Ma Zhanhong, Jiang Tao. Does the left atrial appendage morphology correlate with the risk of thrombus and transient ischemic attack in patients with atrial fibrillation?[J]. Journal of Capital Medical University, 2019, 40(5): 776-780.

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