在接受抗凝治疗的慢性心力衰竭合并心房颤动患者中，血管性血友病因子对静脉血栓形成的预测价值。
Predictive value of von Willebrand factor for venous thrombosis in patients with chronic heart failure complicated with atrial fibrillation after anticoagulant therapy.
机构信息
Department of Clinical Laboratory, People's Hospital of Xinjiang Uygur Autonomous Region, No. 91, Tianchi Road, Tianshan District, 830001, Urumqi, P.R. China.
出版信息
BMC Cardiovasc Disord. 2023 Jul 13;23(1):349. doi: 10.1186/s12872-023-03167-1.
BACKGROUND
We investigated the value of von Willebrand factor (vWF) in predicting venous thrombosis in patients with chronic heart failure complicated with atrial fibrillation after anticoagulation therapy.
METHODS
Totally, 126 patients with chronic heart failure complicated with atrial fibrillation who were treated with anticoagulant therapy and 60 healthy individuals were enrolled. One year after anticoagulant therapy, venous thrombosis occurred in 19 patients. Clinical data of patients were collected. The plasma vWF activity was detected and compared. The logistic regression analysis was used to analyze the influencing factors of vWF. ROC curve was used to evaluate the predictive value of plasma vWF.
RESULTS
Plasma vWF activity was significantly higher in patients with heart failure and atrial fibrillation than control subjects (P < 0.01). The vWF activity in patients with venous thrombosis was significantly higher than that in patients without venous thrombosis (P < 0.01). ROC curve analysis showed that the cut-off value of vWF activity for venous thrombosis within one year after anticoagulant therapy was 267.5%, and the AUC was 0.742 (95% CI: 0.764-0.921, P < 0.05). The sensitivity was 80.0%, and the specificity was 63.6%. Factors of diabetes, myocardial ischemia, old myocardial infarction, and lower extremity atherosclerosis, but not sex, age, coronary heart disease, hypertension, and cardiac function, had significant effect on vWF activity (P < 0.05). Logistic regression analysis showed that vWF activity was significantly related with atherosclerosis of lower limbs and old myocardial infarction, but not significantly related with diabetes and myocardial ischemia. The risk of venous thrombosis in patients with vWF activity greater than 267.5% was 10.667 times higher than that in patients with vWF activity less than 267.5% (P < 0.05).
CONCLUSION
The vWF activity greater than 267.5% has clinical predictive value for the risk of lower extremity venous thrombosis in patients with chronic heart failure complicated with atrial fibrillation within 1 year of anticoagulant therapy.
背景
我们研究了血管性血友病因子（vWF）在预测慢性心力衰竭合并心房颤动患者抗凝治疗后静脉血栓形成中的价值。
方法
共纳入 126 例接受抗凝治疗的慢性心力衰竭合并心房颤动患者和 60 例健康个体。抗凝治疗 1 年后，19 例患者发生静脉血栓形成。收集患者的临床资料。检测并比较血浆 vWF 活性。采用 logistic 回归分析分析 vWF 的影响因素。ROC 曲线评估血浆 vWF 的预测价值。
结果
心力衰竭伴心房颤动患者血浆 vWF 活性明显高于对照组（P<0.01）。静脉血栓形成患者的 vWF 活性明显高于无静脉血栓形成患者（P<0.01）。ROC 曲线分析显示，抗凝治疗后 1 年内静脉血栓形成的 vWF 活性截断值为 267.5%，AUC 为 0.742（95%CI：0.764-0.921，P<0.05）。灵敏度为 80.0%，特异度为 63.6%。糖尿病、心肌缺血、陈旧性心肌梗死和下肢动脉粥样硬化等因素对 vWF 活性有显著影响，但性别、年龄、冠心病、高血压和心功能无显著影响（P<0.05）。logistic 回归分析显示，vWF 活性与下肢动脉粥样硬化和陈旧性心肌梗死显著相关，与糖尿病和心肌缺血无显著相关。vWF 活性大于 267.5%的患者静脉血栓形成的风险是 vWF 活性小于 267.5%的患者的 10.667 倍（P<0.05）。
结论
vWF 活性大于 267.5%对慢性心力衰竭合并心房颤动患者抗凝治疗 1 年内下肢静脉血栓形成的风险具有临床预测价值。
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