| Objective: This study is to make a multivariate analysis for risk of thromboembolism in nonvaluvlar atrial fibrillation(NVAF) patients , by combining several sensentive thrombus molecular markers,clinical and echocardiographic factors,then compare anticoagulation therapy with double-antiplatelet therapy for intervention of prethrombotic state.Methods:66 NVAF patients that never received anticoagulation or antiplatelet therapy or have stopped in recent two weeks,were divided into two groups:ischemic stroke group(n=26) and non-ischemic stroke group(n=40). 20 patients with heart disease but in sinus rhythm were selected as control. The plasma GMP-140,vWF,D-D levels were determined by ELISA to all subjects,and so were chemical check and echocardiography.In the end, the multivariate anlysis was made for the results.Then 40 patients from 66 NVAF cases were divided into two randomised groups to give anticoagulation therapy and double antiplatelet therapy respectively. The plasma GMP-140,vWF,D-D levels were determined before and after therapy.Results: (1) There was no significant difference in gender,AF duration and associated diseases(hypertention,coronary heart disease,dilated cardiomyopathy and pulmonary heart disease)among three groups;The age and ratio of diabete disease of stroke group(74.5±9.7,19.2%) were higher than non-ischemic group(68.3±8.8,12.5%,P<0.05). (2) The left atrial dimension(LAD) of stroke group(51.36±6.5mm)was greatly larger than the latter groups(46.15±6.23mm,36.92±8.98mm,P<0.05).Total cholesterol(TC),low density lipoprotein cholesterol(LDL-C),systolic blood pressure(SBP) of stroke group were higher than non-ischemic group.In the thrombus molecular markers,the plasma levels of GMP-140,vWF,D-D in stroke group were higher than the latter groups(GMP-140:20.94±5.81ng/ml VS 15.67±4.08ng/ml VS 9.28±5.37 ng/ml;vWF:226.65±44.96% VS 193.67±45.35% VS 150.70±23.23%;D-D 1.81±3.46 mg/l VS 0.72±0.73 mg/l VS 0.22±0.27 mg/l , P<0.05). (3) The age(P=0.033) , increase of LAD(P=0.025) ,GMP-140(P=0.030) and D-D(P=0.004) were independently assosicated with thromboembolism;the related risk degree of increase of D-D(OR=4.296 95%CI 0.697～6.465) was greater than age(OR=1.003 95%CI 0.923～1.090), LAD(OR=1.019 95%CI 0.861～1.204) and GMP-140(OR=1.208 95%CI 0.939～1.552).The regression modle based on these four independent factors predicted the occurrence of stroke in NVAF patients to some degrees,with predicted accurate ratio being 83.3%. (4) ROC Curve showed that Area Under the Curve(AUC) of D-D was 0.856(95%CI 0.742-0.971),and GMP-140 was 0.800(95%CI 0.666-0.934),all larger than 0.7,P<0.01,so D-D and GMP-140 had higher predicted value.The AUC of age and LAD were 0.685(95%CI 0.410-0.076),0.647(95%CI 0.482-0.812),so these index had pedicted value to some extent. (5) In dose-adjusted warfarin anticoagulation group and dual antiplatelet group, the levels of GMP-140, vWF and D-D (16.83±5.64ng/ml, 190.78±45.35%,0.71±0.86mg/l VS 15.95±3.81ng/ml,193.71±38.745,0.75±0.71mg/l respectively,P<0.05), significantly descended to 10.78±2.16 ng/ml,147.11±72.59%,0.24±0.23mg/l VS 10.28±2.75 ng/ml,137.05±47.64%,0.25±0.21mg/l after therapy.Conclusions: 1. The single risk factor analysis in NVAF patients shows that: age, diabetes,increase of SBP,TC,LDL-C,LAD,GMP-140,vWF and D-D are risk factors.2. Increase of age,LAD,GMP-140 and D-D are independent risk factors for stroke. Moreover,the assessment value of increase of D-D is higher than others.The regression modle can predict the occurrence of stroke to some extent.3. The anticoagulation therapy and dual antiplatelet therapy all can improve PTS in NVAF patients,but the long term effect should be observed.
|
PDF Full Text Request