老年非瓣膜性心房颤动患者的血栓前状态

Prothrombotic state in elderly patients with non-valvular atrial fibrillation

摘要:

目的 通过对心房颤动患者凝血因子的检测，观察不同临床因素对其凝血功能的影响。方法 纳入慢性非瓣膜性老年心房颤动患者79例，并设立窦性心律患者61例作为对照组，同时检测凝血酶原时间（PT）、活化的部分凝血活酶时间（APTT）、纤维蛋白原（FG）、D-二聚体（DDI）水平及糖化血红蛋白（HbAlc）水平，由专人进行心脏超声检查，判断左心房内径、左心室射血分数（LVEF）。按有无心房颤动进行分组，比较两组PT、APTT、FG、DDI水平。结果 心房颤动组患者PT、APTT、FG、DDI水平明显高于对照组；logistic回归分析发现，左心房内径、LVEF及HbAlc是DDI的预测因素；LVEF是FG的预测因素。结论 老年非瓣膜性房颤患者明显处于血栓前状态，应加强抗凝治疗。

Abstract:

Objective To investigate the effects of different clinical factors on coagulation function in elderly patients with atrial fibrillation by detecting their coagulation factors. Methods Clinical data of 79 elderly patients with atrial fibrillation who were admitted to Department of Geriatrics, Bozhou Municipal People￠s Hospital from March 2011 to March 2012 were analyzed. Another 61 age-matched patients with normal sinus rhythm served as controls. Coagulation function was evaluated by prothrombin time (PT), activated partial thromboplastin time (APTT), and serum levels of fibrinogen (FG), D-Dimer (DDI) and glycosylated hemoglobin (HbAlc). Echocardiography was carried out for their left auricle internal dimension (LAID) and left ventricular ejection fraction (LVEF). Results The patients with atrial fibrillation had significantly higher levels on PT, APTT, FG and DDI than those with normal sinus rhythm (P＜0.05). Logistic regression analysis indicated that LAID, LVEF, and HbAlc were predictive factors for DDI, so was LVEF for FG. Conclusion Elderly patients with atrial fibrillation are in a prothrombotic state, and anticoagulant therapy should be strengthened for them.