摘要
目的 研究同型半胱氨酸(Hcy)、血小板微粒(PMP)、脂蛋白(a)[Lp(a)]与心房颤动(房颤)合并肺部感染患者心房内血栓形成(AT)的关联性.方法 选取2021年9月～2023年6月廊坊市人民医院收治的228例房颤患者,根据是否有AT分为血栓组和无血栓组.比较两组基线资料、Hcy、PMP、Lp(a),并比较是否伴有肺部感染对AT及Hcy、PMP、Lp(a)影响,Spearman相关性及偏相关性分析Hcy、PMP、Lp(a)与有和无肺部感染患者AT的关系,受试者工作特征曲线(ROC)分析不同方案预测是否伴肺部感染房颤患者AT的价值,采用DeLong检验比较不同方案的预测价值.结果 血栓组CHA2DS2-VASc评分高于无血栓组(P＜0.05);血栓组 Hcy、PMP、Lp(a)高于无血栓组[(20.50±6.14)μmol/L 比(16.25±5.38)μmol/L,(4.18±1.25)×105/ml 比(3.36±1.01)× 105/ml,(21.23±7.00)mg/dl 比(15.51±5.25)mg/dl,P＜0.05];在肺部感染和无肺部感染中,血栓组Hcy、PMP、Lp(a)、CHA2DS2-VASc评分均高于无血栓组(P＜0.05);肺部感染血栓组Hcy、PMP、Lp(a)高于无肺部感染血栓组,肺部感染无血栓组Hcy、PMP、Lp(a)高于无肺部感染无血栓组(P＜0.05);Spearman相关性分析,无论是否合并肺部感染,Hcy、PMP、Lp(a)均与AT呈正相关(P＜0.05),肺部感染时各指标对应的相关性系数r值高于无肺部感染;偏相关性分析显示,Hcy、PMP、Lp(a)与AT的相关性仍存在(P＜0.05);无肺部感染:联合的 AUC 高于 Hcy、PMP、Lp(a)(Z=4.182、4.203、3.677,均 P＜0.05);联合的 AUC 与 CHA2DS2-VASc评分的AUC比较无明显差异(Z=1.434,P=0.152＞0.05);肺部感染:联合的AUC高于Hcy、PMP、Lp(a)(Z=3.677、3.676、3.089,均P＜0.05);联合的AUC＞CHA2DS2-VASc评分(Z=2.291,P＜0.05).结论 肺部感染可导致房颤患者Hcy、PMP、Lp(a)进一步升高,加大AT的风险;无肺部感染人群联合检测Hcy、PMP、Lp(a)预警AT的作用与CHA2DS2-VASc评分类似,伴肺部感染时三者联合较CHA2DS2-VASc评分更优,能为房颤AT的个性化防治以及抗凝管理、血栓风险等级细化等提供一个补充性的手段.
Abstract
Objective To investigate the relationship between homocysteine(Hcy),platelet microparticles(PMP)and lipoprotein(a)[Lp(a)]and intra-atrial thrombosis(AT)in patients with atrial fibrillation complicated with pulmonary infection.Methods A total of 228 patients with atrial fibrillation admitted to Langfang People's Hospital from September 2021 to June 2023 were selected and divided into the thrombus group and no-thrombus group according to whether they had AT.The baseline data,Hcy,PMP and Lp(a)of the two groups were compared,and the effects of whether accompanied by lung infection on AT,Hcy,PMP,Lp(a)were compared.Spearman correlation and partial correlation analysis were performed to analyze the relationship between Hey,PMP and Lp(a)and AT patients with and without lung infection.Receiver operating characteristic curve(ROC)was used to asses the value of different schemes in predicting AT in patients with atrial fibrillation with pulmonary infection,and DeLong test was used to compare the predictive value of different schemes.Results The CHA2DS2-VASc score in the thrombus group was higher than that in the non-thrombus group(P＜0.05).The levels of Hcy,PMP and Lp(a)in the thrombus group were higher than those in the non-thrombus group[(20.5±6.14)μmol/L vs.(16.25±5.38)µmol/L,(4.18±1.25)×105/ml vs.(3.36±1.01)× 105/ml,(21.23±7.00)mg/dL vs.(15.51±5.25)mg/dL,P＜0.05].The scores of Hcy,PMP,Lp(a)and CHA2DS2-VASc in the thrombus group were higher than those in the non-thrombus group(P＜0.05).The Hcy,PMP and Lp(a)of the pulmonary infection group were higher than those of the group without pulmonary infection thrombosis;the Hcy,PMP and Lp(a)of the group with pulmonary infection thrombosis were higher than those of the group without pulmonary infection thrombosis(P＜0.05).Spearman correlation analysis showed that Hcy,PMP and Lp(a)were positively correlated with AT regardless of the presence of pulmonary infection(P＜0.05);and the correlation coefficient r value of each index in patients with pulmonary infection was higher than that in patients without pulmonary infection.Partial correlation analysis showed that Hcy,PMP and Lp(a)were still correlated with AT(P＜0.05).Without pulmonary infection,the combined AUC was higher than that of Hcy,PMP and Lp(a)(Z=4.182,4.203,3.677,all P＜0.05),alone.There was no significant difference between the combined AUC and the CHA2DS2-VASc score(Z=1.434,P=0.152＞0.05).With pulmonary infection,the combined AUC was higher than that of Hcy,PMP,Lp(a)(Z=3.677,3.676,3.089,all P＜0.05),alone;and the combined AUC was greater than the CHA2DS2-VASc score(Z=2.291,P＜0.05).Conclusion Pulmonary infection can further increase Hey,PMP and Lp(a)in patients with atrial fibrillation,and increase the risk of AT.The combined detection of Hey,PMP and Lp(a)for early warning AT in people without pulmonary infection is similar to the CHA2DS2-VASc score,and the combination of the three is better than the CHA2DS2-VASc score in patients with pulmonary infection,which can provide a complementary means for personalized prevention and treatment of atrial fibrillation AT,anticoagulation management,and thrombosis risk classification.
基金项目
河北省重点研发计划项目(22109003815D)
NETL
NSTL
万方数据