红细胞分布宽度对阵发性非瓣膜性房颤患者导管消融术后服用达比加群出血风险预测的研究

发布时间：2018-01-12 20:41

  本文关键词：红细胞分布宽度对阵发性非瓣膜性房颤患者导管消融术后服用达比加群出血风险预测的研究　出处：《南京医科大学》2017年博士论文　论文类型：学位论文

  更多相关文章： 红细胞分布宽度 非瓣膜性房颤 导管消融 HAS-BLED评分 达比加群 安全性

【摘要】：目的:诸多研究表明红细胞分布宽度(red cell distribution width,RDW)与心血管疾病如冠心病、心力衰竭、房颤等的发生及预后有关,HAS-BLED评分系统是目前使用最广泛的房颤出血风险评估体系,本研究旨在探讨RDW与HAS-BLED评分之间的相关性以及对阵发性非瓣膜性房颤患者导管消融术后服用达比加群酯(11Omg b.i.d)过程中发生真实出血事件的预测价值。方法:1.纳入2014年1月至2015年1月在江苏省人民医院住院行导管消融的阵发性非瓣膜性房颤(non-valvular atrial fibrillation,NVAF)患者172例,入院前均于门诊给予达比加群酯(Dabigatranetexilate,DE)110mg,一天两次,口服三周,所有患者入院时记录年龄、性别、身高、体重、高血压史、糖尿病史、脑卒中史等临床资料,计算入选患者入院时的HAS-BLED评分,入院后次日清晨空腹状态DE谷浓度时采集血液样本,主要的监测项目包括血常规、活化部分凝血酶原时间(activated partial thromboplastin time,APTT)、肝肾功能等。2.根据HAS-BLED评分将受试者分为高HAS-BLED评分组(≥3分)和低HAS-BLED评分组(3分),利用Sperman相关性分析比较RDW与HAS-BLED评分的相关性,利用受试者工作特征曲线(receiver operating characteristic curve,ROC)判断RDW对高HAS-BLED评分的预测价值。利用多因素Logistic回归分析判断RDW是否可以作为高HAS-BLED评分的独立预测因素。3.所有患者导管消融术后随诊3个月,观察终点为出血事件的发生,利用ROC曲线分析RDW对消融术后服用DE过程中发生出血事件的预测价值,多变量Cox回归分析用于评估RDW是否可以作为发生出血事件的独立预测因素。结果:1.高HAS-BLED评分组的RDW值明显高于低HAS-BLED评分(13.96±0.93%比13.08±1.03%,P=0.000)。PDW值与HAS-BLED评分呈正相关(r=0.393,P0.0001)。用RDW值预测高HAS-BLED评分的ROC曲线下面积为 0.796(95%CI:0.740-0.844,P0.0001)。多因素 Logistic 回归显示:高RDW值可作为高HAS-BLED评分的独立预测因素(OR:1.33,95%CI:1.10-1.56,p=0.031)。2.所有患者术后随诊3个月,共有13例出血事件,其中皮下出血4例,牙龈出血3例,泌尿道出血3例,球结膜出血3例。利用RDW值预测出血事件发生的 ROC 曲线下面积为 0.737(95%CI:0.616-0.875,P0.001),截点为 13.25%。多变量Cox回归分析显示:高RDW可作为发生出血事件的独立预测因素(HR:1.91,95%CI:1.03-3.98,P=0.031)。结论:1.RDW值与HAS-BLED评分呈正相关,对高HAS-BLED评分有一定的预测价值,且可作为高HAS-BLED评分的独立预测因素。2.RDW值与阵发性NVAF患者消融术后服用DE(11Omg,2/日)出血事件的发生有相关性,当RDW值≥13.25%时提示发生出血事件的风险增加。高RDW值可作为阵发性NVAF患者消融术后服用DE过程中发生出血事件的独立预测因素。
[Abstract]:Objective: many studies have shown that red cell distribution RDWs are associated with cardiovascular diseases such as coronary heart disease and heart failure. The occurrence and prognosis of atrial fibrillation are related to the HAS-BLED scoring system, which is currently the most widely used risk assessment system for atrial fibrillation bleeding. The purpose of this study was to investigate the correlation between RDW and HAS-BLED scores and to evaluate the effect of dabiganin 11Omg b.i.dafter catheter ablation in patients with paroxysmal non-valvular atrial fibrillation (PAF). Predictive value of true haemorrhage events during the course. Methods: 1.Paroxysmal non-valvular atrial fibrillation (PAF), including catheter ablation in Jiangsu Provincial people's Hospital from January 2014 to January 2015, was included. Non-valvular atrial fibrillation. 172 NVAFs were treated with Dabigatranetexilate (Dabigatranetexilate) 110mg before admission, twice a day for three weeks. Age, sex, height, weight, history of hypertension, history of diabetes, history of stroke and other clinical data were recorded at admission in all patients. The HAS-BLED scores were calculated on admission. Blood samples were collected early in the morning after admission to the fasting state of DE. The main monitoring items included blood routine. Activated partial prothrombin time and activated partial thromboplastin (APTT). According to the HAS-BLED score, the subjects were divided into high HAS-BLED score group (鈮，

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