摘要
目的探讨非瓣膜性房颤(non-valvul aratrial fibrillation)患者华法林抗凝效果的影响因素。方法对天津市北辰医院2019年9月-2023年9月医院住院或门诊病历系统(HIS)中的非瓣膜性房颤患者进行回顾性筛选。根据是否发生主要不良心脑血管事件(脑梗塞或脑出血、心肌梗死或急性冠脉综合征住院)分为有效组(未发生上述不良事件)和无效组(发生了上述不良事件)。首先采用单因素方差分析筛选影响非瓣膜性房颤患者华法林抗凝效果的可能因素。对筛选出的可能因素采用多元Logistic回归模型进一步明确影响华法林抗凝效果的独立因素。结果最终纳入数据完整并符合要求的患者248例,其中有效组202例,无效组46例。单因素分析显示,年龄、冠心病病史、高血压病史、糖尿病病史和INR监测情况是影响抗凝效果的潜在因素(P<0.05)。多因素Logistic回归分析影响抗凝效果独立危险因素分别为年龄、高血压和INR监测情况。其中年龄≥60岁(OR=2.87)、高血压病史(OR=2.41)和很少INR监测(OR=3.89)是导致抗凝效果不佳的独立危险因素(P<0.05)。无效组和有效组患者INR平均值分别为(3.25±1.11)和(2.36±0.56),无效组显著高于有效组,且差异有统计学意义(P<0.05)。以INR为参考,预测用药期间主要不良心脑血管事件的敏感性为72.7%,特异性为76.1%,R0C曲线下面积为0.77(95%CI:0.68-0.88)。结论较少监测INR的非瓣膜性房颤合并高龄高血压患者,口服华法林抗凝过程中容易出现脑梗塞或脑出血、心肌梗死或急性冠脉综合征等严重不良事件。INR监测可有效预测和预防上述不良事件的发生。
Objective To explore the influencing factors of anticoagulant effect of warfarin in patients with non valvular atrial fibrillation.Method Retrospective screening was conducted on non valvular atrial fibrillation patients in our hospital's inpatient medical record system or outpatient record system(HIS)from September 2019 to September 2023.According to whether major adverse cardiovascular events(cerebral infarction or hemorrhage,myocardial infarction or hospitalization for acute coronary syndrome)have occurred,they are divided into an effective group(without the occurrence of the aforementioned adverse events)and an ineffective group(with the occurrence of the aforementioned adverse events).Firstly,one-way ANOVA was used to screen for possible factors that may affect the anticoagulant effect of warfarin in patients with non valvular atrial fibrllation.Multiple logistic regression models were used to further clarify the independent factors that affect the anticoagulant effect of warfarin on the screened possible factors.Result 248 patients with complete and compliant data were included,including 202 in the effective group and 46 in the ineffective group.Univariate analysis showed that age,history of coronary heart disease,history of hypertension,history of diabetes and INR monitoring were the potential factors affecting the anticoagulant effect(P<0.05).The independent risk factors affecting anticoagulation efficacy in multivariate Logistic regression analysis are age,hypertension,and INR monitoring status.The main risk factors for poor anticoagulation efficacy were age≥60 years old(OR=2.87),a history of hypertension(OR=2.41),and minimal INR monitoring(OR=3.89)(P<0.05).The average INR values of patients in the ineffective and effective groups were(3.25±1.11)and(2.36±0.56),respectively.The ineffective group was significantly higher than the effective group,and the difference was statistically significant(P<0.05).Using INR as a reference,the sensitivity and specificity of predicting major adverse cardiovascular and cerebrovascular events during medication were 72.7%,76.1%,and the area under the ROC curve was 0.77(95%CI:0.68-0.88).Conclusion Non valvular atrial fibrillation combined with elderly hypertension with less monitoring of INR is prone to serious adverse events such as cerebral infarction or hemorrhage,myocardial infarction,or acute coronary syndrome during oral anticoagulation with warfarin.INR monitoring can effectively predict and prevent the occurrence of the aforementioned adverse events.
作者
齐杰
Qi Jie(Department of Cardiology,Tianjin Beichen Hospital,Tianjin 300400,China)
出处
《首都食品与医药》
2024年第12期69-71,共3页
Capital Food Medicine
关键词
非瓣膜性房颤
华法林
抗凝效果
逻辑回归
Non valvular atrial fibrillation
Warfarin
Anticoagulant effect
Logistic regression
