2023 年第 9 期 第 18 卷

血清D-二聚体和纤维蛋白原对老年非瓣膜性心房颤动患者全因死亡的预测价值分析

Analysis of the predictive value of D-dimer and fibrinogen for all-cause mortality in elderly patients with non valvular atrial fibrillation

作者：邓爱华王晶王长远刘芳艳杨志鹏李思颉孟然

英文作者：Deng Aihua Wang Jing Wang Changyuan Liu Fangyan Yang Zhipeng Li Sijie Meng Ran

单位：首都医科大学宣武医院急诊科，北京100053

英文单位：Department of Emergency Xuanwu Hospital Capital Medical University Beijing 100053 China

关键词：老年非瓣膜性心房颤动；CHA2DS2-VASc评分；D-二聚体；纤维蛋白原

英文关键词：Elderlypatientswithnonvalvularatrialfibrillation;CHA2DS2-VAScscore;D-dimer;Fibrinogen

• 摘要：

• 目的  探讨血清D-二聚体、纤维蛋白原对老年非瓣膜性心房颤动患者全因死亡的预测价值。方法 选取2016年1月至2019年1月入住首都医科大学宣武医院心内科的老年非瓣膜性心房颤动患者218例，收集患者一般资料，将血栓风险评分CHA2DS2-VASc评分≤1分的病例分为低危组（71例），将CHA2DS2-VASc评分＞1分的病例分为高危组（147例）。对患者出院后生存情况进行随访，按是否发生全因死亡将患者分为死亡组和非死亡组。采用多因素Logistic回归方法分析患者血栓高危的危险因素；采用Cox比例风险回归法分析患者全因死亡的危险因素。采用受试者工作特征（ROC）曲线分析D-二聚体、纤维蛋白原对患者全因死亡的预测价值。结果 高危组D-二聚体、纤维蛋白原水平高于低危组（均P＜0.05）。多因素Logistic回归分析结果显示，高D-二聚体、高纤维蛋白原水平是老年非瓣膜性心房颤动患者血栓高危的独立危险因素（比值比=3.205、1.816，95%置信区间：1.117～9.202、1.065～3.096，P=0.030、0.028）。本研究218例患者中随访成功154例，其中死亡19例（死亡组），存活135例（非死亡组）。死亡组D-二聚体水平高于非死亡组（P＜0.05）。Cox比例风险回归分析结果显示，高D-二聚体水平是老年非瓣膜性心房颤动患者全因死亡的独立危险因素（比值比=3.912，95%置信区间：1.286～11.903，P=0.016）。ROC曲线分析结果显示，D-二聚体对老年非瓣膜性心房颤动患者全因死亡有一定的预测价值（曲线下面积=0.720，P=0.006）。结论 高D-二聚体、高纤维蛋白原水平是老年非瓣膜性心房颤动患者高血栓风险（CHA2DS2-VASc评分>1分）的独立危险因素，高D-二聚体水平对患者全因死亡也具有一定的预测价值。

• Objective To explore the predictive value of serum D-dimer and fibrinogen for all-cause mortality in elderly patients with non valvular atrial fibrillation (NVAF). Methods Totally 218 elderly patients with NVAF admitted to Department of Cardiology, Xuanwu Hospital Capital Medical University from January 2016 to January 2019 were selected. General information of patient was collected, and cases with a thrombus risk score of CHA2DS2-VASc ≤1 were divided into low-risk group (71 cases). Cases with CHA2DS2-VASc score ＞1 were divided into high-risk group (147 cases). Survival situation after discharge were followed-up, and they were divided into death group and non death group. Multivariate Logistic regression method was used to analyze the high-risk factors for thrombosis. The Cox proportional risk regression method was used to analyze the risk factors for all-cause mortality. The predictive value of D-dimer and fibrinogen on all-cause mortality in patients was analyzed using the receiver operating characteristic (ROC) curve. Results The levels of D-dimer and fibrinogen in high-risk group were higher than those in low-risk group (both P＜0.05). Multivariate Logistic regression analysis showed that high D-dimer and fibrinogen levels were independent risk factors for thrombosis in elderly patients with NVAF (odds ratio=3.205, 1.816; 95% confidence interval: 1.117-9.202, 1.065-3.096; P=0.030, 0.028). Out of 218 patients in this study, 154 were successfully followed-up, including 19 deaths (death group) and 135 survivors (non death group). The level of D-dimer in death group was higher than that in non death group (P＜0.05). Cox proportional risk regression analysis showed that high D-dimer level was an independent risk factor for all-cause mortality in elderly patients with NVAF (odds ratio=3.912, 95% confidence interval: 1.286-11.903, P=0.016). The ROC curve analysis showed that D-dimer had certain predictive value for all-cause mortality in elderly patients with NVAF (area under the curve=0.720, P=0.006). Conclusions  sHigh levels of D-dimer and fibrinogen are independent risk factors for high thrombosis risk (CHA2DS2-VASc score >1) in elderly patients with NVAF. The high D-dimer level also has certain predictive value for all-cause mortality.