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目的:分析抗凝血酶Ⅲ(AT-Ⅲ)水平与评估非瓣膜性房颤人群血栓栓塞风险的CHA2DS2-VASc评分间的关系,探讨AT-Ⅲ在非瓣膜性房颤人群血栓风险评估中的价值。方法:收集2018年10月至2019年6月在中国医学科学院阜外医院住院诊断为非瓣膜性房颤人群(观察组)和同期住院非房颤人群(对照组)的抗凝血酶Ⅲ (AT-Ⅲ)、蛋白S、蛋白C及血脂[包括脂蛋白(a)、三酰甘油(TG)、总胆固醇(TC)、高密度脂蛋白胆固醇(HDL-C)、低密度脂蛋白胆固醇(LDL-C)]水平。根据CHA2DS2-VASc评分将非瓣膜性房颤人群分为2分以下的低中危组与2分及以上的高危组。用ROC分析AT-Ⅲ的诊断性能,采用Logistic回归分析高CHA2DS2-VASc评分的风险因素。结果:观察组206例,其中女性54例(26%),年龄(59.9±11.1)岁,对照组76例,女性19例(25%),年龄(59.3±9.8)岁,两组性别(n χ2=0.043,n P=0.836)、年龄(n t=0.352,n P=0.725)相匹配。观察组AT-Ⅲ活性[(98.68±11.37)%]明显低于对照组[(110.87±13.91)%],差异有统计学意义(n t=-6.841,n P<0.001)。非瓣膜性房颤人群中CHA2DS2-VASc评分高危组102例(49.5%),低中危组104例(50.5%),高危组AT-Ⅲ活性[(93.67±9.92)%]低于低中危组[(103.60±10.56)%],差异有统计学意义(n t=6.953,n P<0.001)。高危组蛋白C[(94.34±26.61)%比(102.63±22.74)%]、TC[(4.09±1.02)mmol/L比(4.69±0.97)mmol/L]和LDL-C[(2.18±0.83)mmol/L比(2.74±0.88)mmol/L]水平均低于低中危组,差异有统计学意义(n P均<0.05)。非瓣膜性房颤人群血栓风险筛查的AT-Ⅲ预警界值为96.5%,ROC曲线下面积为0.746(95%n CI:0.681~0.812,n P<0.001)。Logistic回归分析表明年龄(n OR=44.339,95%n CI:15.207~129.276)越大,AT-Ⅲ(n OR=7.282,95%n CI:3.098~17.117)、TC(n OR=4.349,95%n CI:1.739~10.875)水平越低,非瓣膜性房颤人群CHA2DS2-VASc评分越高,n P均<0.05。n 结论:高龄、低AT-Ⅲ活性水平、低TC水平与CHA2DS2-VASc评分正相关,对评估非瓣膜性房颤者血栓发生具有较高的参考价值。“,”Objective:To investigate the relationship between antithrombin Ⅲ (AT-Ⅲ) levels and CHA2DS2-VASc scores to assess the thromboembolism risk in patients with non-valvular atrial fibrillation (NVAF), and to explore the value of AT-Ⅲ in the risk assessment of thrombosis in these patients.Methods:We enrolled patients diagnosed with NVAF (observation group) and non-atrial fibrillation (control group), hospitalized in Fuwai Hospital of Chinese Academy of Medical Sciences from October 2018 to June 2019, and assessed the two groups for AT-Ⅲ, protein C, protein S, and lipid levels including lipoprotein (a), three acyl glycerin (TG), total cholesterol (TC), high-density lipoprotein cholesterol (HDL-C), and low-density lipoprotein cholesterol (LDL-C). Based on the CHA2DS2-VASc score, patients with NVAF and a score of less than 2 were assigned to the low-and middle-risk groups; the high-risk group consisted of patients with a score of 2 or more. The diagnostic performance of AT-Ⅲ was evaluated using receiver operating characteristic (ROC) curve analysis, and the risk factors for high CHA2DS2-VASc scores were analyzed using logistic regression.Results:Overall, 206 cases were enrolled in the observation group, including 54 women (26%; aged 59.85±11.06 years). The control group consisted of 76 cases, with 19 women (25%; aged 59.34±9.84 years). The two groups were gender (n χ2=0.043, n P=0.836) and age (n t=0.352, n P=0.725) matched. In the observation group, AT-Ⅲ activity (98.68%±11.37%) was significantly lower than that in the control group (110.87%±13.91%), demonstrating a statistically significant difference (n t=-6.841, n P<0.001). In total, 102 cases (49.5%) were assigned to the high-risk group, with 104 cases (50.5%) in the low-and medium-risk groups. In the high-risk group, the AT-Ⅲ activity (93.67%±9.92%) was significantly lower than that in the low-and middle-risk groups (103.60%±10.56%), with a statistically significant difference observed (n t=6.953, n P<0.001). In the high-risk group, protein C [(94.34±26.61)%n vs. (102.63±22.74)%], TC [(4.09±1.02) mmol/Ln vs. (4.69±0.97) mmol/L], and LDL-C [(2.18±0.83) mmol/L n vs. (2.74±0.88) mmol/L] levels were lower than those observed in the low-risk group (P<0.05). For NVAF screening, the AT-Ⅲ early warning threshold was 96.5%, and the area under the ROC curve was 0.746 (95%n CI: 0.681-0.812, n P<0.001). Based on logistic regression analysis, low AT-Ⅲ activity levels were an independent risk factor for high CHA2DS2-VASc scores in NVAF (n OR=7.282,95%n CI: 3.098-17.117,n P<0.001). Additionally, logistic regression analysis demonstrated that with increasing age (n OR=44.339, 95%n CI: 15.207-129.276), lower levels of AT-Ⅲ (n OR=7.282, 95%n CI: 3.098-17.117) and TC (n OR=4.349, 95%n CI: 1.739-10.875), and higher CHA2DS2-VASc scores were observed for non-valvular AF (n P<0.05).n Conclusion:A positive correlation exists between the CHA2DS2-VASc score and old age, low AT-Ⅲ activity, and low TC levels, indicating a high reference value for evaluating thrombosis in NVAF.