| Objective: Left atrial thrombus is one of the serious complications in patients with rheumatic mitral valve stenosis,especially when the thrombus falls off and enters the systemic circulation to cause arterial embolism which has a high mortality disability.Inflammation plays an important role in the formation of atrial thrombus.Platelet-lymphocyte ratio(PLR)and neutrophil-lymphocyte ratio(NLR)are emerging serum markers of inflammation.This study analyzed the risk factors of the left atrial thrombosis in patients with rheumatic mitral valve stenosis and establish a risk nomogram model on predicting risk of the rheumatic mitral valve stenosis with left atrial thrombosis based on the NLR and PLR.Method: A total of 220 patients with rheumatic mitral valve stenosis with left atrial thrombosis who were admitted to Lanzhou University Second Hospital from September 2012 to September 2019 were enrolled,and according to the result of transthoracic echocardiography,these patients were divided into thrombus group(55patients)and non-thrombus group(165 patients).The chi-square test was used for comparison of categorical data between two groups,Independent-Sample test was used for comparison of measurement data,and the Mann-Whitney U test was used for comparison of ranked data between two groups.The receiver operating characteristic(ROC)curve was used to obtain the optimal cut-off values of continuous data.Logistic regression analysis was used to screen patients rheumatic mitral valve stenosis with left atrial thrombosis.The Nomogram model was established according to the results of the Logistic regression,and the consistency index(C-index)was calculated.Using the ROC curve to evaluate the prediction ability of the model.Result: There were significant differences between the two groups in age,atrial fibrillation(AF),left ventricular end diastolic dimension(LVEDD),left atrial diameter(LAD),mitral valve orifice area(MVA),mitral valve flow velocity(MV),mitral valve transmitral pressure gradient(MVPG),the degree of mitral valve stenosis,the degree of mitral valve regurgitation,lymphocyte count(LY),the red blood cell distribution width(RDW),platelets count(PLT),mean platelet volume(MPV),glucose(GLU),triglyceride(TG),NLR and PLR(P<0.05).The Logistic regression showed that age≥63.5year,AF,MVA≤1cm2,LAD≥64.5mm,the mild degree of mitral valve regurgitation,NLR≥3.08 and PLR≥116.6 were independent risk factors for the patients of rheumatic mitral valve stenosis with left atrial thrombus(P<0.05).Based on the above 7 independent risk factors to establish the Nomogram of predicting the patients of rheumatic mitral valve stenosis whether has the left atrial thrombus,the C-index is 0.859 and the 95% confidence interval is 0.809-0.909.The area under the ROC curve of nomogram based on independent risk factors above is0.859,which shows good accuracy.Conclusion: The nomogram prediction model has good predictive ability,good accuracy and discrimination,which can improve the diagnostic efficiency of the left atrial thrombus in patients with rheumatic valve stenosis. |
