老年心房颤动患者应用华法林个体化剂量的研究

A warfarin-dosing algorithm on atrial fibrillation in elderly patients

目的探讨老年心房颤动（房颤）患者应用华法林的个体化剂量。方法41例老年房颤患者，给予华法林抗凝治疗，治疗初始阶段每日监测国际标准化比值（INR），目标抗凝强度INR1．6～2．5。观察患者年龄、性别、身高、体质量等人口统计学指标以及合并用药、并存疾病等临床指标，测定血清白蛋白水平、INR等实验室指标，记录华法林剂量。结果单因素分析显示，个体华发林剂量分别与以下指标相关：年龄（r=-0．535，P〈0．01）、性别（rs=-0．494，P〈0．01）、身高（r=-0．484，P〈0．01）、体质量（r=-0．453，P〈0．01）、体表面积（r=-0．388，P〈0．05）、磺脲类降糖药物（rs=-0．446，P〈0．01）、白蛋白（r=-0．520，P〈0．01）；多元逐步回归分析中，年龄、白蛋白、性别、磺脲类依次进入回归方程，个体化剂量回归方程式可以解释65．4％的华法林个体剂量的变异（R=0．808，R^2=65．4％）。结论老年房颤患者应用华法林抗凝治疗的个体化剂量可在治疗的初始阶段，根据患者的年龄、性别、是否合用磺脲类降糖药物及血清白蛋白水平等因素预测得到。

Objective To study the individualized dose of warfarin in treating atrial fibrillation in elderly patients. Methods Forty-one elderly in-patients with atrial fibrillation were recruited. Warfarin was used to start anti-coagulation therapy with the target INR value 1.6-2.5. The data of demographic variables, concomitant diseases, medications and laboratory values were collected, then correlated these factors with the maintenance dose of warfarin. Results Warfarin dose requirements were significantly associated with age（r=-0. 535, P〈0.01）, sex（r=-0. 494, P〈0.01）, height （r=0. 484, P〈0.01）, weight （r= 0. 453, P〈0.01）, body surface area（r= 0. 388, P〈0.05）, concomitant use of a sulfonylurea medication （r = - 0. 446, P〈 0.01 ） and serum albumin level （r= 0. 520, P〈0.01）. The multivariate regression model included the variables of age, sex, serum albumin level and concomitant use of a sulfonylurea medication. This algorithm explained 65.4 %of the variance in the maintenance dose of warfarin （R = 0. 808,R^2 = 65.4%）. Conclusions The warfarin dose in treating atrial fibrillation in elderly patients can be estimated from demographic, clinical and laboratory factors that can be obtained at the time of warfarin initiation.