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目的:探讨心电图f波特点在评估持续性非瓣膜性心房颤动(Af)患者血栓栓塞危险性中的临床价值。方法:85例非瓣膜性Af患者分为血栓栓塞事件组(事件组,26例)和无血栓栓塞事件组(无事件组,59例)。所有患者均描记心电图V1导联;行经胸超声心动图测得左心房内径、左心室舒张末期内径及左心室射血分数;采用ELISA法测定血浆血管性血友病因子(vWF)、α-颗粒膜蛋白(GMP-140)及D-二聚体(DD)含量,发色底物法测定血浆抗凝血酶Ⅲ(AT-Ⅲ)活性。结果:①事件组患者细颤发生率明显高于无事件组,f波振幅明显小于无事件组。事件组血浆GMP-140水平、DD及AT-Ⅲ活性明显高于无事件组,其差异均有统计学意义(P<0.05)。②相关分析显示:f波振幅与年龄呈负相关(r=-0.41,P<0.05),与f-f间期呈正相关(r=0.28,P<0.05)。③多元Logistic回归分析显示:f波振幅是非瓣膜性Af患者血栓栓塞事件的独立危险因素。结论:心电图f波特点有助于评估持续性非瓣膜性Af患者血栓栓塞的危险性。
Objective: To investigate the clinical value of f-wave electrocardiogram in assessing the risk of thromboembolism in patients with persistent non-valvular atrial fibrillation (Af). Methods: Eighty-five patients with non-valvular Af were divided into thromboembolism group (event group, n = 26) and no thromboembolism group (n = 59). All patients were recorded ECG lead V1; measured by transthoracic echocardiography left atrial diameter, left ventricular end-diastolic diameter and left ventricular ejection fraction; ELISA vWF, α-particles (GMP-140) and D-dimer (DD), and the activity of antithrombin Ⅲ (AT-Ⅲ) was measured by the chromogenic substrate method. Results: ① The incidence of sequelae in the event group was significantly higher than that of the no-event group, and the amplitude of f-wave was significantly smaller than that of the no-event group. The levels of plasma GMP-140, DD and AT-III in the event group were significantly higher than those in the non-event group (P <0.05). ② Correlation analysis showed that the amplitude of f wave was negatively correlated with age (r = -0.41, P <0.05), and positively correlated with f-f interval (r = 0.28, P <0.05). Multiple logistic regression analysis showed that the amplitude of f-wave was an independent risk factor for thromboembolism in patients with nonvalvular Af. CONCLUSIONS: The f-wave characteristics of ECG may be useful in assessing the risk of thromboembolism in patients with persistent non-valvular Af.