| Objective: To study the clinical characteristics and distribution of TCM symptoms and analyze the correlation between laboratory indicators such as ALB and TCM symptoms and D-dimer in patients with atrial fibrillation by retrospectively analyzing the inpatient medical records of 755 patients with non-valvular atrial fibrillation from the Affiliated Hospital of Shandong University of Traditional Chinese Medicine.The effective indicators and TCM symptoms affecting D-dimer in patients with atrial fibrillation were further explored to provide new ideas and references for clinical prevention of pre-thrombotic state and thromboembolic events in patients with atrial fibrillation.Methods: The study population was 755 patients with non-valvular atrial fibrillation and 468 sex-and age-matched patients with sinus rhythm without a history of atrial fibrillation who were hospitalized at the Affiliated Hospital of Shandong University of Traditional Chinese Medicine from 2005 to2022.The syndromes of TCM and general medical records of the patients were collected and the database was established by Excel 2019,and the relevant data were processed by statistical methods and using SPSS 21.0 software to analyze the correlation between ALB and other laboratory indicators and TCM syndromes and D-dimer in patients with atrial fibrillation.Results: 1.A total of 755 patients with non-valvular atrial fibrillation were included,including 386 males and 369 females,aged 33-80 years.In contrast,468 patients with sinus rhythm without a history of atrial fibrillation were included as controls during the same period,and they were matched for sex and age with atrial fibrillation.The history of coronary heart disease,hypertension,ischemic stroke and heart failure in patients with atrial fibrillation was significantly different from the control group(P<0.05),while there were no significant differences in gender,age and history of diabetes between the two groups(P>0.05).2.Compared with the control group,patients with atrial fibrillation showed higher levels of WBC,NLR,MPV,D-dimer,SUA,LAD and lower levels of HCT,ALB,CHOL,LVEF,all with statistically significant differences(P<0.05),while there was no significant difference in the levels of FIB,GLO,GLU between the two groups(P>0.05).3.After adjusting for confounders using logistic regression analysis,low ALB(OR=0.87,95% CI 0.83-0.92,P<0.001)and high D-dimer(OR=2.06,95% CI 1.27-3.36,P=0.004)levels were independent risk factors for the development of atrial fibrillation.4.The distribution pattern of TCM symptoms in atrial fibrillation is as follows: Qi deficiency and blood stasis syndrome(29%)> Qi and Yin deficiency syndrome(26%)> heart and blood stasis syndrome(21%)> phlegm-heat internal disturbance syndrome(17%)> drinking water and spirit heart syndrome(4%)> guilty conscience and timidity syndrome(3%).5.Among 755 patients with atrial fibrillation,there were 341 with abnormal D-dimer levels and 414 with normal D-dimer levels.Age,ischemic stroke,heart failure and CHA2DS2-VASc scores were significantly different between those with abnormal D-dimer levels and those with normal D-dimer levels in atrial fibrillation(P<0.05),and there was no significant difference in gender,history of coronary heart disease,hypertension and diabetes between the two(P>0.05).6.Compared with normal D-dimer,the patients with abnormal D-dimer showed higher levels of WBC,NLR,FIB,NT-pro BNP,LAD and lower levels of HCT,ALB,CHOL,LVEF with statistically significant differences(P<0.05),and there were no significant differences in MPV,GLO,SUA,GLU levels between the two(P>0.05).7.After adjusting for confounders using logistic regression analysis,low ALB was significantly associated with abnormal D-dimer levels in atrial fibrillation(OR=0.80,95%CI 0.76-0.84,P<0.001).ROC curve analysis showed that ALB could be used as a valid predictor of abnormal D-dimer levels in patients with atrial fibrillation(area under the curve 0.77(95% CI 0.74-0.80,P<0.001)),and the optimal cut-off point for ALB to predict abnormal D-dimer levels in patients with atrial fibrillation was 36.95 g/L.8.The distribution of D-dimer levels in the TCM syndromes was significantly different among the groups,and further comparative analysis showed that the distribution of D-dimer levels in the heart and blood stasis syndrome group was significantly different from that in the other syndrome groups(P<0.05),among them,the highest D-dimer levels were found in the heart-blood stasis type syndrome,followed by Qi deficiency and blood stasis syndrome and phlegm-heat internal disturbance syndrome.9.In patients with atrial fibrillation with abnormal D-dimer,the distribution of TCM symptoms was as follows: heart and blood stasis syndrome(98 cases)> Qi deficiency and blood stasis syndrome(95 cases)> Qi and Yin deficiency syndrome(81 cases)> phlegm-heat internal disturbance syndrome(54 cases)> drinking water and spirit heart syndrome(7 cases)> guilty conscience and timidity syndrome(6 cases),among those with abnormal D-dimer in each syndrome,the proportion of heart and blood stasis syndrome(62.0%)was the largest,followed by Qi deficiency and blood stasis syndrome(44.2%),phlegm-heat internal disturbance syndrome(42.2%),Qi and Yin deficiency syndrome(41.1%),drinking water and spirit heart syndrome(28.6%),and guilty conscience and timidity syndrome(24.0%).Conclusions: 1.In patients with atrial fibrillation,low ALB levels and high D-dimer levels are independent risk factors for the development of atrial fibrillation,presumably closely related to the inflammatory response and oxidative stress in atrial fibrillation.2.The distribution pattern of TCM symptoms in atrial fibrillation is as follows: Qi deficiency and blood stasis syndrome > Qi and Yin deficiency syndrome > heart and blood stasis syndrome> phlegm-heat internal disturbance syndrome > drinking water and spirit heart syndrome > guilty conscience and timidity syndrome.3.Low ALB levels are an independent risk factor and effective predictor of abnormal D-dimer(>0.5ug/m L)in atrial fibrillation,and the optimal cut-off point for ALB to predict abnormal D-dimer levels in patients with atrial fibrillation was 36.95g/L.Close clinical monitoring and supplementation of ALB may prevent the risk of pre-thrombotic state and thromboembolic events in atrial fibrillation.4.The distribution of D-dimer levels in patients with atrial fibrillation was significantly different between the heart and blood stasis syndrome and other groups.The highest D-dimer levels were found in the heart and blood stasis syndrome,followed by Qi deficiency and blood stasis syndrome and phlegm-heat internal disturbance syndrome.5.Among the patients with abnormal D-dimer,the highest percentage of patients with heart and blood stasis syndrome,followed by Qi deficiency and blood stasis syndrome,phlegm-heat internal disturbance syndrome,Qi and Yin deficiency syndrome,drinking water and spirit heart syndrome,and guilty conscience and timidity syndrome.The key syndromes of abnormal D-dimer levels are heart and blood stasis syndrome and Qi deficiency and blood stasis syndrome.The clinical use of Qi and blood activating herbs may prevent the pre-thrombotic state of atrial fibrillation and reduce the risk of thromboembolism. |
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