Study on the von Willebrand factor for assessing the stroke risk in the patients with atrial fibrillation / 中华检验医学杂志

ABSTRACT

Objective To investigate the value for the level mensuration of von Willebrand factor antigen (vWFAg) in stroke risk assessment in the patients with non-valvular atrial fibrillation (AF).Methods 180 non-valvular AF patients were selected from the Tianjin medical university general hospital from the 2009 to 2011 for retrospective cohort study,112 males and 68 females in the group,age 61-87 years.Using the IL ACL-9000 blood coagulation instrument assay the level of vWFAg.Using ROC curve to analyze the diagnosis performance of vWFAg,using Cox regression analysis model to evaluate the of vWFAg effect on prognosis,using x2 test to analyze the relevance between vWFAg and clinical pathological factors.Compared the patients group with CHADS2 score with the patients group with CHA2DS2VASc score date using t test.Results vWFAg levels were control group (112 ± 34)％,paroxysmal AF group (119 ±31)％,the persistent AF group (179 ± 47)％,permanent AF group (217 ± 56)％,atrial fibrillation associated with stroke group (235 ± 104)％ respectively.There was no difference between the paroxysmal AF group and control group (q =1.75,P ＞ 0.05) ; vWFAg level was higher in persistent atrial fibrillation group than in paroxysmal AF group (q =10.10,P ＜ 0.01); permanent atrial fibrillation group was higher than that of the persistent AF group (q =5.21,P ＜ 0.01).The optimum cut-off point with vWFAg for stroke diagnosis was 188.5％,the area under ROC curve =O.843 (95％ confidence interval0.785-0.901).In Cox regression multianalysis,the vWFAg (HR =0.405; 95％ CI =0.268-0.716; P =0.026),the congestive heart failure(HR =2.901 ; 95％ CI =1.837-3.951 ; P =0.001),stroke/transienl ischemic attack (HR =4.665 ; 95 ％ CI =2.837-7.291 ; P =0.000),age (HR =0.474 ; 95 ％ CI =0.211-0.765; P =0.039),the Cox analysis showed that vWFAg was the independent prognosis factor for stroke in AF patients.Inx2 analysis,there was the relationship between the level of the vWFAg and the congestive heart failure/LVdysfunction (x2 =8.227,P ＜ 0.01),hypertension (x2 =3.305,P ＜ 0.05),age (x2 =7.581,P ＜ 0.01),diabetes mellitus (x2 =6.730,P ＜ 0.01),stroke/ transient ischemic attack/thromboembolism (x2 =4.825,P ＜ 0.05),vascular disease (x2 =4.126,P ＜ 0.05).Compared the subjects with CHADS2 (score =1) with the CHA2DS2VASc(score =1),the level of the vWFAg was higher in patients with CHADS2 score =1 (t =4.283,P ＜ 0.01).Conclusion There was relationship between the level of vWFAg and main pathologic factors in patients with AF,and changed with the condition,high vWFAg level was an independent predictor of stroke risk,and had superior reference value for in assessment of stroke in patients with atrial fibrillation.