Objective: To explore the related risk factors for systemic embolism (SE) in patients aged≥75 years with non-valvular atrial fibrillation (NVAF). Methods: A case-control study. NVAF patients aged≥75 years who were hospitalized at the First Affiliated Hospital of Xinjiang Medical University from October 2018 to October 2020 were divided into no SE (n=1 127) and SE (n=433) groups according to the occurrence of SE after NVAF. Multivariate logistic regression was used to analyze SE-related factors in patients with NVAF without anticoagulation treatment. Results: In the multivariate model, the following factors were associated with an increased risk of SE in patients with NVAF: history of AF≥5 years [odds ratio (OR)=2.75, 95% confidence interval (CI) 1.98-3.82, P<0.01], lipoprotein(a)>300 g/L (OR=2.07, 95%CI 1.50-2.84, P<0.01), apolipoprotein (Apo)B>1.2 g/L (OR=1.91, 95%CI 1.25-2.93, P=0.003), left ventricular ejection fraction (LVEF) of 30%-49% (OR=2.45, 95%CI 1.63-3.69, P<0.01), left atrial diameter>40 mm (OR=1.54, 95%CI 1.16-2.07, P=0.003), and CHA2DS2-VASc score≥3 (OR=15.14, 95%CI 2.05-112.13, P=0.01). ApoAI>1.6 g/L was negatively correlated with the occurrence of SE (OR=0.28, 95%CI 0.15-0.51, P<0.01). Conclusions: History of AF≥5 years, lipoprotein(a)>300 g/L, elevated ApoB, left atrial diameter>40 mm, LVEF of 30%-49%, and CHA2DS2-VASC score≥3 are independent risk factors for SE whereas ApoAI>1.6 g/L is a protective factor against SE in patients with NVAF.
目的： 探讨≥75岁非瓣膜性心房颤动（NVAF）患者体循环栓塞（SE）的相关危险因素，为临床中降低NVAF患者SE风险提供依据。 方法： 病例对照研究。收集2018年10月至2020年10月于新疆医科大学第一附属医院住院的≥75岁NVAF患者，根据NVAF后发生SE情况分为无SE组（1 127例）和SE组（433例）。应用多因素logistic回归对NVAF患者SE相关因素及未抗凝患者相关危险因素进行分析。 结果： 多因素回归分析表明房颤病史≥5年的OR值为2.75（95%CI 1.98~3.82，P<0.01），脂蛋白（a）>300 g/L的SE风险高于脂蛋白（a）≤300 g/L（OR=2.07，95%CI 1.50~2.84，P<0.01），载脂蛋白B>1.2 g/L的OR值为1.91（95%CI 1.25~2.93，P=0.003），左心室射血分数（LVEF）30%~49%的SE风险较高（OR=2.45，95%CI 1.63~3.69，P<0.01），左心房内径>40 mm的OR值为1.54（95%CI 1.16~2.07，P=0.003），CHA2DS2-VASc≥3分的OR值为15.14（95%CI 2.05~112.13，P=0.01）。载脂蛋白AI>1.6 g/L是SE的保护性因素（OR=0.28，95%CI 0.15~0.51，P<0.01）。 结论： 房颤病史≥5年、脂蛋白（a）>300 g/L、载脂蛋白B升高、左心房内径>40 mm、LVEF 30%~49%、CHA2DS2-VASc评分、HAS-BLED评分是NVAF患者SE的独立相关危险因素。其中载脂蛋白AI>1.6 g/L与NVAF患者SE风险呈负相关。.