Relationship of monocyte to HDL-C ratio and thromboxane B2 with LAAT of elderly patients with atrial fibrillation
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目的 观察老年心房颤动患者单核细胞与高密度脂蛋白胆固醇比值(monocyte to high density lipoprotein cholesterol ratio,MHR)、血栓素B2(thromboxane B2,TXB2)水平变化与左心耳血栓发生风险的关联性.方法 回顾性纳入2022年5月至2024年5月四川省人民医院收治的老年心房颤动患者152例,根据经食管超声心动图检出左心耳血栓情况将患者分为血栓组46例和非血栓组106例.测定患者MHR、TXB2水平,分析 MHR、TXB2水平对左心耳血栓风险的预测效能.结果 老年心房颤动伴左心耳血栓组年龄、左心房内径(left atrial diameter,LAD)、单核细胞计数及持续性心房颤动比例明显高于非血栓组(P＜0.01),而高密度脂蛋白胆固醇、左心室射血分数(left ventricular ejection fraction,LVEF)明显低于非血栓组(P＜0.05,P＜0.01),血栓组 MHR、TXB2 水平明显高于非血栓组(P＜0.01);多因素logistic回归分析显示,年龄(OR=1.244,95％CI:1.022～1.466,P=0.028)、持续性心房颤动(OR=29.290,95％CI:4.573～187.610,P=0.000)、LAD(OR=1.502,95％CI:1.203～1.876,P=0.000)、MHR(OR=1.115,95％CI:1.055～1.178,P=0.000)、TXB2(OR=1.064,95％CI:1.031～1.097,P=0.000)是影响老年心房颤动患者发生左心耳血栓的危险因素,LVEF(OR=0.813,95％CI:0.707～0.935,P=0.004)是老年心房颤动患者发生左心耳血栓的保护因素;ROC曲线显示,MHR、TXB2水平变化评估老年心房颤动患者左心耳血栓发生风险的曲线下面积分别为0.767和0.829.结论 MHR、TXB2在老年心房颤动伴左心耳血栓患者中异常升高,是影响患者左心耳血栓发生的危险因素,并对左心耳血栓风险具有一定的预测评估价值.
Objective To observe the association of the changes in monocyte to high density lipo-protein cholesterol ratio(MHR)and thromboxane B2(TXB2)with risk of left atrial appendage thrombus(LAAT)in elderly patients with atrial fibrillation(AF).Methods A retrospective study was conducted on 152 elderly AF patients admitted in our hospital from May 2022 to May 2024.According to the results of transesophageal echocardiography,they were divided into thrombus group(46 cases)and non-thrombus group(106 cases).Blood MHR and TXB2 levels were measured and calculated,and the predictive efficacy of MHR and TXB2 levels for the risk of LAAT was analyzed.Results The thrombus group had older age,larger left atrial diameter(LAD),higher monocyte count,and larger proportion of persistent AF(P＜0.01),while lower LVEF and HDL-C levels when compared with the non-thrombus group(P＜0.05,P＜0.01).The MHR and TXB2 level were significantly higher in the thrombus group than those in non-thrombus group(P＜0.01).Multivariate logistic regression analysis indicated that age(OR=1.244,95％CI:1.022-1.466,P=0.028),persistent AF(OR=29.290,95％CI:4.573-187.610,P=0.000),LAD(OR=1.502,95％CI:1.203-1.876,P=0.000),MHR(OR=1.115,95％CI:1.055-1.178,P=0.000)and TXB2(OR=1.064,95％CI:1.031-1.097,P=0.000)were risk fac-tors for LAAT in elderly AF patients,and LVEF(OR=0.813,95％CI:0.707-0.935,P=0.004)was a protective factor.ROC curve analysis suggested that the AUC value of MHR and TXB2 in evaluating the risk of LAAT in elderly AF patients was 0.767 and 0.829,respectively.Conclusion MHR and TXB2 are abnormally elevated in elderly AF patients with LAAT.They are risk factors affecting the occurrence of LAAT,and have certain predictive value for the risk of LAAT.
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