Analysis Of The Relationship Between The Cardiogenic Cerebral Embolism After Non-valvular Atrial Fibrillation And Blood Routine Test And Coagulation Function

Objective:To explore the relationship between the occurrence of cardiogenic cerebral embolism(CCE)in patients with non-valvular atrial fibrillation(NVAF)and blood routine test and coagulation function,which include red blood cell distribution width(RDW),platelet count(PLT),platelet distribution width(PDW),mean platelet volume(MPV),large-platelet ratio(P-LCR),the ratio of neutrophil to lymphocyte(NLR),activated partial thromboplastin time(APTT),prothrombin time(PT),thrombin time(TT),fibrinogen(FIB),international normalized ratio(INR),D-dimer and C-reactive protein(CRP).Through the analysis of the more easily available clinical data,patients with non-valvular atrial fibrillation at greater risk for cardiogenic cerebral embolism will be picked out.Methods:Patients with NVAF hospitalized in the Department of Cardioligy of Liaoning Provincial People’s Hospital from September 1,2018 to December 31,2020 and patients with CCE after NVAF hospitalized in the Department of Neurology of the same hospital during the same time whose onset time was less than 3 hours upon admission were retrospectively analyzed.244 cases were collected according to inclusion and exclusion criteria,including 148 cases in the NVAF without CCE and 96 cases in the NVAF with CCE group.1.The patients’ personal information and associated diseases were counted,including gender,age,duration of atrial fibrillation,the type of atrial fibrillation,hypertension,diabetes,heart failure,previous thromboembolism,history of TIA and stroke,peripheral vascular disease,ect.2.Record relevant assay index,including RDW,PLT,PDW,MPV,P-LCR,NLR,APTT,PT,TT,FIB,INR,D-dimer and CRP.For patients without CCE,the above indicators were obtained by venous blood extraction within 24 hours after admission and before the application of anticoagulant and antiplatelet drugs.For patients with CCE,blood should be drawn immediately after admission.3.SPSS 22.0 statistical software was used for statistical description of the distribution of sample characteristics of the tested variables.Counting data were expressed by frequency and percentage.Chi-square test was used for comparison between groups.Measurement data were expressed as mean ± standard deviation((?)±s),and comparisons between groups were performed by independent sample T test.Point two-column correlation analysis was used for correlation test,and binary Logistic regression analysis was used for correlation analysis of risk factors.The prediction value was evaluated by ROC curve.P<0.05 was considered statistically significant..Result:1.Comparison between the two groups:gender,age,duration of atrial fibrillation,the type of atrial fibrillation,hypertension,diabetes mellitus,heart failure and peripheral vascular disease were not statistically significant(P>0.05).PLT,CRP,APTT,PT,TT and INR had no statistical significance(P>0.05).CHA2DS2-VASc score,RDW,WBC,NLR,PDW,MPV,P-LCR,D-dimer and FIB were statistically significant(P<0.05).2.Point two-column analysis was performed on the relevant indexes of blood routine and coagulation function with statistical significance,the result suggested that the occurrence of CCE in patients with NVAF was positively correlated with RDW,WBC,NLR,PDW,MPV,P-LCR,D-dimer and FIB(P<0.05).3.Binary logistic regression analysis was performed on the relevant indicators,and the result suggested that RDW,PDW and D-dimer were risk factors for the occurrence of CCE in patients with NVAF(P<0.05).4.Comparison of the predictive value of risk factors:ROC curve showed : the areas under the curve of RDW and PDW were 0.637 and 0.655,P<0.05,which had certain value,but the accuracy was low.The area under the D-dimer curve was 0.728,P <0.05,which was of certain value for the assessment of the risk of CCE in patients with NVAF.When the Youden idex was maximized,the optimal critical points of D-dimer,RDW and PDW were 0.685mg/l,40.85 fl and 12.95 fl.The predictive sensitivity were 64.6%,82.3% and 54.2%.And the specificity were 75%,45.3% and 82.4%.Conclusion:RDW,WBC,NLR,PDW,MPV,P-LCR,D-dimer and FIB are closely associated with the occurrence of CCE in patients with NVAF.And the higher the above indexes are,the higher the possibility of CCE is.RDW,PDW and D-dimer are the risk factors for CCE in patients with NVAF.D-dimer has certain value in the assessment of the risk of CCE in patients with NVAF.The prediction of RDW and PDW has some value,but the accuracy is low.The sensitivity and specificity of D-dimer are similar,while the sensitivity and specificity of RDW are higher and lower,and the sensitivity and specificity of PDW are lower and higher.In clinical practice,a combination of risk factors above should be considered,which can more accurately screen patients with high-risk atrial fibrillation prone to CCE.