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目的评价经颅多普勒监测微栓子评估心房颤动(简称房颤)患者抗栓疗效的价值。方法持续性房颤患者96例,其中40例给予华法林抗凝治疗(华法林组),56例给予阿斯匹林抗血小板治疗(阿斯匹林组),每例患者治疗前后分别行微栓子监测,比较治疗前后两组结果差异,两组治疗前后同时检测血浆D-二聚体水平作为微栓子监测的平行对照观察。结果华法林组治疗前,微栓子阳性14例,阴性26例,治疗后微栓子阳性5例,阴性35例,治疗后微栓子检出率显著降低(35.0%vs 12.5%,P﹤0.05);阿斯匹林组治疗前,微栓子阳性21例,阴性35例,治疗后微栓子阳性17例,阴性39例,治疗前后微栓子检出率降低无显著性差异(37.5%vs 30.4%,P=0.42);华法林组治疗后微栓子检出率显著低于阿司匹林组(P﹤0.05)。治疗前所有微栓子阳性患者血浆D-二聚体水平显著高于阴性患者[(353±71)μg/L vs(261±58)μg/L,P﹤0.05];两组治疗前后血浆D-二聚体水平均有显著降低[分别为(313±81)μg/L vs(170±67)μg/L、(327±73)μg/L vs(235±61)μg/L,P﹤0.05];华法林组治疗后血浆D-二聚体水平降低更明显(P<0.05)。结论研究初步表明,微栓子可以作为房颤患者抗栓治疗的一个指标。
Objective To evaluate the value of transcranial Doppler monitoring of micro-emboli in the evaluation of antithrombotic effect in patients with atrial fibrillation (AF). Methods A total of 96 patients with persistent AF were enrolled. Forty patients were given warfarin anticoagulation (warfarin) and 56 aspirin (aspirin). Before and after each treatment, Emboli monitoring, comparison of the results before and after treatment differences between the two groups before and after treatment of plasma D-dimer levels as a parallel monitoring of microembolic monitoring. Results Before warfarin treatment, the positive rate of micro-emboli in 14 patients was 26, the positive rate of micro-emboli in 5 patients and the negative rate in 35 patients after treatment were significantly lower (35.0% vs 12.5%, P <0.05). Before aspirin treatment, 21 cases were positive for micro-emboli and 35 cases were negative. After treatment, 17 cases were positive for micro-emboli and 39 cases were negative. There was no significant difference in the detection rate of micro-emboli before and after treatment 37.5% vs 30.4%, P = 0.42). The detection rate of microemboli in warfarin group was significantly lower than that in aspirin group (P <0.05). The levels of plasma D-dimer in all patients with positive micro-emboli before treatment were significantly higher than those in patients with negative [(353 ± 71) μg / L vs (261 ± 58) μg / L, P <0.05] - dimer levels were significantly lower (313 ± 81 μg / L vs 170 ± 67 μg / L, 327 ± 73 μg / L vs 235 ± 61 μg / L, P < 0.05]. The plasma D-dimer level decreased more significantly in warfarin group after treatment (P <0.05). Conclusions Preliminary studies have shown that microemboli can be used as an indicator of antithrombotic therapy in patients with AF.