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目的:探讨左心房直径(left atrial dimension,LAD)、f波特点和D-二聚体(D-dimer,D-D)评估非瓣膜性心房纤颤(non-valvular atrial fibrillation,NVAF)患者血栓栓塞事件危险性的临床价值。方法:93例NVAF患者分为血栓栓塞事件阳性组32例和血栓栓塞事件阴性组61例,2组均检测LAD,f波振幅、f波时限、f-f间期,D-D,并进行统计学分析。结果:2组LAD、f波振幅、f波时限、f-f间期和D-D比较差异均有统计学意义(P<0.05)。NVAF患者血栓栓塞事件的独立危险因素为LAD增大、f波时限缩短和D-D浓度增高。在3个独立危险因素中,D-D的评估价值较高,LAD中等,f波时限较低。在LAD、f波时限和D-D 3个影响因素中,同时具备诊断标准越多,诊断的灵敏度和阴性预测值越低,但特异度和阳性预测值越高。结论:LAD、f波时限、D-D对评估NVAF患者血栓栓塞事件危险性有一定临床价值,多因素评估较单因素具有较高的特异度和阳性预测值。
Objective: To investigate the thromboembolic events in non-valvular atrial fibrillation (NVAF) patients with left atrial dimension (LAD), f-wave characteristics and D-dimer (DD) Dangerous clinical value. Methods: Ninety-three patients with NVAF were divided into thromboembolism-positive group (n = 32) and thromboembolic event-negative group (n = 61). LAD, f wave amplitude, f wave duration, f-f interval and D-D were measured in two groups. Results: The differences of LAD, f wave amplitude, f wave duration, f-f interval and D-D between the two groups were statistically significant (P <0.05). Independent risk factors for thromboembolic events in NVAF patients were increased LAD, shortened f-wave duration, and increased D-D concentrations. Of the three independent risk factors, D-D was assessed at higher values, with moderate LAD and lower f-wave duration. Among the three influencing factors of LAD, f-wave duration and D-D, the more concurrent diagnostic criteria, the lower the diagnostic sensitivity and negative predictive value, but the higher the specificity and positive predictive value. Conclusion: LAD, f-wave duration and D-D have some clinical value in assessing the risk of thromboembolism in patients with NVAF. Multivariate assessment has higher specificity and positive predictive value than single factor.