心房颤动患者左心耳血栓形成机制的研究进展

doi:10.11958/20251816

天津医药 ›› 2025, Vol. 53 ›› Issue (9): 1005-1008.doi: 10.11958/20251816

• 综述 • 上一篇

心房颤动患者左心耳血栓形成机制的研究进展

李文秀¹(), 朱振宇², 柴慧¹, 郑晓轩¹, 卢婧¹, 李润琴¹^,^△()

1 太原市中心医院/山西医科大学第九临床医学院心内科（邮编030009）
2 浙江省立同德医院心内科

收稿日期:2025-05-12 修回日期:2025-06-25 出版日期:2025-09-15 发布日期:2025-09-16
通讯作者: ^△E-mail：253494096@qq.com
作者简介:李文秀（1988），女，主治医师，主要从事心血管内科疾病方面研究。E-mail：m18947343069@163.com
基金资助:
太原市科技局，国家区域医疗中心科技创新计划项目(202230)

Advances in the mechanism of left auricular thrombosis in patients with atrial fibrillation

LI Wenxiu¹(), ZHU Zhenyu², CHAI Hui¹, ZHENG Xiaoxuan¹, LU Jing¹, LI Runqin¹^,^△()

1 Department of Cardiology, Taiyuan Central Hospital/the Ninth Clinical Medical College of Shanxi Medical University, Taiyuan 030009, China
2 Department of Cardiology, Zhejiang Provincial Tongde Hospital

Received:2025-05-12 Revised:2025-06-25 Published:2025-09-15 Online:2025-09-16
Contact: ^△E-mail: 253494096@qq.com

李文秀, 朱振宇, 柴慧, 郑晓轩, 卢婧, 李润琴. 心房颤动患者左心耳血栓形成机制的研究进展[J]. 天津医药, 2025, 53(9): 1005-1008.

LI Wenxiu, ZHU Zhenyu, CHAI Hui, ZHENG Xiaoxuan, LU Jing, LI Runqin. Advances in the mechanism of left auricular thrombosis in patients with atrial fibrillation[J]. Tianjin Medical Journal, 2025, 53(9): 1005-1008.

摘要/Abstract

摘要：

心房颤动（房颤）是临床最常见的心律失常之一，也是血栓栓塞的重要危险因素。左心耳是房颤患者血栓形成的主要部位。近年研究从解剖结构（左心耳形态与结构）、功能指标（血流动力学改变）、病理生理机制（内皮损伤、炎症激活）、系统性疾病（肾功能障碍）及遗传因素（基因多态性）等多维度深入探讨了左心耳血栓形成的机制，为临床精准抗栓提供了重要依据。该文系统综述了房颤患者左心耳血栓形成机制的最新研究进展，旨在为血栓栓塞风险的精准评估及个体化抗凝策略的制定提供理论支撑，同时为探索左心耳血流动力学与心力衰竭、血栓栓塞事件的内在关联及机制奠定基础。

关键词: 心房颤动, 心耳, 血栓形成

Abstract:

Atrial fibrillation (AF) is one of the most common clinical arrhythmias and a significant risk factor for thromboembolism. The left atrial appendage (LAA) is the primary site of thrombus formation in AF patients. Recent studies have explored the mechanisms of LAA thrombosis from multiple dimensions, including anatomical structure (LAA morphology and architecture), functional indicators (hemodynamic alterations), pathophysiological mechanisms (endothelial injury, inflammatory activation), systemic diseases (renal dysfunction) and genetic factors (gene polymorphisms), providing critical evidence for precise clinical anticoagulation. This article systematically reviews the latest research advances in the mechanisms of LAA thrombosis in AF patients, aiming to offer theoretical support for the accurate assessment of thromboembolic risk and the formulation of individualized anticoagulation strategies. Additionally, it lays the foundation for exploring the intrinsic relationship and mechanisms between LAA hemodynamics and heart failure as well as thromboembolic events.

Key words: atrial fibrillation, atrial appendage, thrombosis

中图分类号:

R541.7

参考文献 35

[1]	JOGLAR J A, CHUNG M K, ARMBRUSTER A L, et al. 2023 ACC/AHA/ACCP/HRS Guideline for the diagnosis and management of atrial fibrillation:a report of the American College of Cardiology/American Heart Association Joint Committee on clinical practice guidelines[J]. Circulation, 2024, 149(1):e1-e156. doi:10.1161/CIR.0000000000001193.
[2]	ZHOU X, DUDLEY S C. Evidence for inflammation as a driver of atrial fibrillation[J]. Front Cardiovasc Med, 2020, 7:62. doi:10.3389/fcvm.2020.00062.
[3]	IHARA K, SASANO T. Role of inflammation in the pathogenesis of atrial fibrillation[J]. Front Physiol, 2022, 13:862164. doi:10.3389/fphys.2022.862164.
[4]	霍家敏, 李学文. 非瓣膜性心房颤动患者左心耳结构与血栓形成的相关性[J]. 中华老年多器官疾病杂志, 2022, 21(8):561-566.
	HUO J M, LI X W. Correlation between left atrial appendage structure and thrombus formation in patients with atrial fibrillation[J]. Chinese Journal of Multiorgan Diseases in the Elderly, 2022, 21(8):561-566.
[5]	梁慧霞, 黄俊. 房颤-左心耳血栓的影像学研究进展[J]. 影像研究与医学应用, 2024, 8(15):1-3.
	LIANG H X, HUANG J. Research progress in imaging studies of atrial fibrillation-left atrial appendage thrombus[J]. Journal of Imaging Research and Medical Applications, 2024, 8(15):1-3.
[6]	WANG Y, XU B, LUO K, et al. The impact of left atrial morphology on thrombosis risk in atrial fibrillation[J]. Phys Fluids, 2024, 36(7):36. doi:10.1063/5.0214185.
[7]	IAN B, DRIES V. Clinical impact of preprocedural CT-based 3D computational simulation of left atrial appendage occlusion with amulet[J]. J Interv Cardiol, 2021, 2021:9972228. doi:10.1155/2021/9972228.
[8]	YAGHI S, CHANG A D, AKIKI R, et al. The left atrial appendage morphology is associated with embolic stroke subtypes using a simple classification system:a proof-of-concept study[J]. J Cardiovasc Comput Tomogr, 2020, 14(1):27-33. doi:10.1016/j.jcct.2019.04.005.
[9]	ABDELRADI A, ATIA A, KALOT M, et al. Left atrial appendage volumetric and functional assessment using cardiac computed tomography-derived three-dimensional models[J]. Am J Cardiol, 2023, 205:360-362. doi:10.1016/j.amjcard.2023.08.032.
[10]	KARIM N, HO S Y, NICOL E, et al. The left atrial appendage in humans:structure,physiology,and pathogenesis[J]. Europace, 2020, 22(1):5-18. doi:10.1093/europace/euz212.
[11]	HE J, FU Z, YANG L, et al. The predictive value of a concise classification of left atrial appendage morphology to thrombosis in non-valvular atrial fibrillation patients[J]. Clin Cardiol, 2020, 43(7):789-795. doi:10.1002/clc.23381.
[12]	KAUFMANN D, WABICH E, KAPŁON-CIEŚLICKA A, et al. Echocardiographic predictors of thrombus in left atrial appendage-the role of novel transthoracic parameters[J]. Front Cardiovasc Med, 2022, 9:1059111. doi:10.3389/fcvm.2022.1059111.
[13]	郭楚娴, 杨龙, 张敏, 等. 左心耳血流速度对非瓣膜性心房颤动患者左心耳血栓形成的预测价值评估[J]. 中国循环杂志, 2022, 37(8):831-835.
	GUO C X, YANG L, ZHANG M, et al. Predictive value of left atrial appendage flow velocity for thrombus formation in patients with non-valvular atrial fibrillation[J]. Chinese Circulation Journal, 2022, 37(8):831-835. doi:10.3969/j.issn.1000-3614.2022.08.012.
[14]	HADARI A, NGUADI J, JALAL H, et al. Enhancing thromboembolic risk prediction in non-valvular atrial fibrillation:the critical role of transesophageal echocardiography(TEE)[J]. Cureus, 2024, 16(12):e76064. doi:10.7759/cureus.76064.
[15]	CRESTI A, CAMARA O. Left atrial thrombus-are all atria and appendages equal?[J]. Card Electrophysiol Clin, 2023, 15(2):119-132. doi:10.1016/j.ccep.2023.01.008.
[16]	刘晓伟, 李彩英. 非瓣膜性房颤患者心脏CTA早期左心耳充盈不良与缺血性脑卒中相关性研究[D]. 石家庄: 河北医科大学, 2023.
	LIU X W, LI C Y. Correlation between early left atrial appendage filling defects on cardiac CTA and ischemic stroke in patients with non-valvular atrial fibrillation[D]. Shijiazhuang: Hebei Medical University, 2023.
[17]	ZHENG X M, RAN H T, REN J L, et al. Two-dimensional speckle tracking imaging analyses of the correlations between left atrial appendage function and stroke risk in nonvalvular atrial fibrillation patients[J]. Int J Cardiovasc Imaging, 2024, 40(3):613-623. doi:10.1007/s10554-023-03031-5.
[18]	UZIĘBŁO-ŻYCZKOWSKA B, KRZESIŃSKI P, JUREK A, et al. Left ventricular ejection fraction is associated with the risk of thrombus in the left atrial appendage in patients with atrial fibrillation[J]. Cardiovasc Ther, 2020, 2020:3501749. doi:10.1155/2020/3501749.
[19]	OSHITA T, MINE T, KISHIMA H, et al. Predictors of movable type left atrial appendage thrombi in patients with atrial fibrillation[J]. Heart Vessels, 2020, 35(9):1227-1233. doi:10.1016/S0735-1097(20)32217-8.
[20]	PIESZKO K, HICZKIEWICZ J, ŁOJEWSKA K, et al. Artificial intelligence in detecting left atrial appendage thrombus by transthoracic echocardiography and clinical features:the Left Atrial Thrombus on Transoesophageal Echocardiography (LATTEE) registry[J]. Eur Heart J, 2024, 45(1):32-41. doi:10.1093/ehjci/jeae333.049.
[21]	MJM A, MJBK A, CLV A, et al. Left atrial sphericity as a marker of atrial remodeling:comparison of atrial fibrillation patients and controls[J]. Int J Cardiol, 2020, 304:69-74. doi:10.1016/j.ijcard.2020.01.042.
[22]	QIAO Y, ZHAO Z, CAI X, et al. Prevalence,predictors and management of left atrial appendage thrombogenic milieu in atrial fibrillation with low thromboembolic risk[J]. Thromb J, 2023, 21(1):34. doi:10.1186/s12959-023-00478-3.
[23]	王金海, 谢东明. 非瓣膜性心房颤动合并高血压患者左心结构及功能与左心耳血栓的相关性研究[D]. 赣州: 赣南医科大学, 2024.
	WANG J H, XIE D M. Correlation between left cardiac structure/function and left atrial appendage thrombus in hypertensive patients with non-valvular atrial fibrillation[D]. Ganzhou: Gannan Medical University, 2024.
[24]	AARNINK E, ZABERN M, BOERSMA L, et al. Mechanisms and prediction of ischemic stroke in atrial fibrillation patients[J]. J Clin Med, 2023, 12(20):6491. doi:10.3390/jcm12206491.
[25]	杨尹, 张国美, 王静, 等. 低CHA2DS2-VASc评分非瓣膜性心房颤动病人左心耳血栓形成的危险因素分析[J]. 中西医结合心脑血管病杂志, 2024, 22(3):514-517.
	YANG Y, ZHANG G M, WANG J, et al. Risk factors analysis for left atrial appendage thrombus formation in non-valvular atrial fibrillation patients with low CHA2DS2-VASc scores[J]. Chinese Journal of Integrative Medicine on Cardio/Cerebrovascular Disease, 2024, 22(3):514-517. doi:10.12102/j.issn.1672-1349.2024.03.021.
[26]	DING W Y, PROTTY M B, DAVIES I G, et al. Relationship between lipoproteins,thrombosis,and atrial fibrillation[J]. Cardiovasc Res, 2022, 118(3):716-731. doi:10.1093/cvr/cvab017.
[27]	REDDY Y, OBOKATA M, VERBRUGGE F, et al. Atrial dysfunction in patients with heart failure with preserved ejection fraction and atrial fibrillation[J]. J Am Coll Cardiol, 2020, 76(9):1051-1064. doi:10.1016/j.jacc.2020.07.009.
[28]	LIU J, XU P, LIU D, et al. TCM regulates PI3K/Akt signal pathway to intervene atherosclerotic cardiovascular disease[J]. Evid Based Complement Alternat Med, 2021, 2021:4854755. doi:10.1155/2021/4854755.
[29]	CASTELLANI C, GAO Y, KIM H, et al. Left atrial appendage structural characteristics predict thrombus formation[J]. J Cardiovasc Electrophysiol, 2023, 34(8):1683-1689. doi:10.1111/jce.15994.
[30]	WEISS L, KEANEY J, SZKLANNA P B, et al. Nonvalvular atrial fibrillation patients anticoagulated with rivaroxaban compared with warfarin exhibit reduced circulating extracellular vesicles with attenuated pro-inflammatory protein signatures[J]. J Thromb Haemost, 2021, 19(10):2583-2595. doi:10.1111/jth.15434.
[31]	ZHU C, WANG B, XIAO L, et al. Mean platelet volume mediated the relationships between heavy metals exposure and atherosclerotic cardiovascular disease risk:a community-based study[J]. Eur J Prev Cardiol, 2020, 27(8):830-839. doi:10.1177/2047487319830536.
[32]	ARIEL C, ERWAN D, VICTORIA D, et al. EACVI recommendations on cardiovascular imaging for the detection of embolic sources:endorsed by the Canadian Society of Echocardiography[J]. Eur Heart J Cardiovasc Imaging, 2021, 22(6):e24-e57. doi:10.1093/ehjci/jeab008.
[33]	XU B, DU Y, XU C, et al. Left atrial appendage morphology and local thrombogenesis-related blood parameters in patients with atrial fibrillation[J]. J Am Heart Assoc, 2021, 10(12):e020406. doi:10.1161/JAHA.120.020406.
[34]	王兴鹏. 非瓣膜性心房颤动患者左心耳血栓形成的相关因素研究[D]. 重庆: 中国人民解放军陆军军医大学, 2023.
	WANG X P. Study on related factors of left atrial appendage thrombus formation in patients with non-valvular atrial fibrillation[D]. Chongqing: Army Medical University, 2023.
[35]	RAGHUBEER S, MATSHA T E. Methylenetetrahydrofolate (MTHFR),the one-carbon cycle,and cardiovascular risks[J]. Nutrients, 2021, 13(12):4562. doi:10.3390/nu13124562.

心房颤动患者左心耳血栓形成机制的研究进展

Advances in the mechanism of left auricular thrombosis in patients with atrial fibrillation

引用本文

RichHTML

PDF (PC)

可视化

摘要/Abstract

使用本文

参考文献 35

相关文章 15

编辑推荐

Metrics

本文评价

[1]	陈苗苗, 张亚征, 赵芳, 杨立恒, 焦丽娜, 赵晓赟. 阻塞性睡眠呼吸暂停和心房颤动因果关系的多组学孟德尔随机化分析[J]. 天津医药, 2025, 53(9): 946-951.
[2]	冯学武, 李景娟, 蒯婉君. 高龄非瓣膜性心房颤动患者新型口服抗凝药依从性分析[J]. 天津医药, 2025, 53(8): 884-888.
[3]	孙鲁生, 张丽芳, 高俊杰, 汤秀英. CT定量左心结构参数与肥厚型心肌病并心房颤动射频消融术后复发的关系[J]. 天津医药, 2025, 53(5): 533-536.
[4]	王国华, 陈保星, 李会朋, 郭鹏威, 张华. AcoStream与AngioJet治疗急性髂股静脉血栓形成的疗效比较[J]. 天津医药, 2025, 53(1): 52-56.
[5]	高攀, 谢冰歆, 周赞东, 刘彤. 慢性肾脏病循环中FGF23对心房纤维化的促进作用[J]. 天津医药, 2024, 52(9): 917-923.
[6]	徐杨, 袁宇, 高金妹. 超声检查对骨折患者下肢深静脉漂浮血栓脱落的诊断意义[J]. 天津医药, 2024, 52(5): 548-551.
[7]	张明龙, 方媛媛, 隋晓鹏, 陈欣欣, 李留东, 王海涛. Peguero-Lo-Presti指数诊断的左心室肥厚与阵发性心房颤动射频导管消融术后复发的关系[J]. 天津医药, 2024, 52(2): 210-214.
[8]	霍立巍, 刘军, 郑彬彬, 毕学娜. 血清FGF-23对心房颤动患者射频消融术后复发的预测价值[J]. 天津医药, 2023, 51(1): 74-77.
[9]	邢佳侬, 梁卓, 邢爱君, 刘俊兰, 彭宏超, 张天桦, 张春来. LncRNA MIAT靶向调节miR-128-3p对心房颤动大鼠心室重构和心肌纤维化的影响[J]. 天津医药, 2022, 50(9): 932-937.
[10]	贺宏梅, 孙健, 王欢欢, 马书静, 张海燕, 邹玉安, 薛茜, 宋爱霞. 非瓣膜性心房颤动患者血管性痴呆危险因素的病例对照研究[J]. 天津医药, 2022, 50(8): 840-843.
[11]	张续腾, 刘芳, 陈军, 刘晓萌, 靳乐, 高红梅△. PI3K/AKT信号通路在心房颤动中的研究进展[J]. 天津医药, 2022, 50(5): 556-560.
[12]	吕彦辉, 陈建华, 张丽, 王春杰, 田甜, 薄飞 . 降钙素原与维持性血液透析患者自体动静脉内瘘并发症的关系研究[J]. 天津医药, 2022, 50(4): 413-417.
[13]	章袁, 马景鑑, 拱忠影, 蒋森森, 汪志云. 缺血性脑卒中患者合并小腿肌间静脉血栓形成抗栓治疗效果的影响因素分析[J]. 天津医药, 2022, 50(3): 286-291.
[14]	霍宁, 詹晓萍, 周梦竹, 张跃, 梁雪, 李广平, 刘长乐. 格列本脲对糖尿病大鼠心房重构及心房颤动诱发的影响[J]. 天津医药, 2022, 50(3): 253-258.
[15]	卢洁, 张芯, 王涛, 杨宁. 环状RNA对房颤患者的影响及其作用机制研究[J]. 天津医药, 2022, 50(3): 333-336.