老年人房颤与NT-ProBNP、左房大小的关系及抗凝现状分析

Clinical analysis on 120 elderly patients with atrial fibrillation

目的观察老年人房颤与N-末端脑钠肽前体(NT-proBNP)及左房大小的关系,并分析其抗凝现状。方法对120例老年房颤患者的临床资料进行回顾性分析,包括初发、阵发、持续性、持久性、长期持续性房颤患者的NT-proBNP水平、左房内径和抗凝方法。结果 120例老年房颤患者中,初诊房颤占15.0%,阵发性房颤占30.0%,持续性房颤、持久性房颤、长期持续性房颤占55.0%。使用华法林抗凝治疗占41%,房颤发生脑栓塞占9.1%。持续性房颤、持久性房颤、长期持续性老年房颤的患者NT-proBNP明显高于阵发性、初诊房颤患者,其左房内径明显大于阵发性、初诊房颤患者的左房内径。抗凝治疗中华法林组栓塞事件发生率(2.08%)低于阿司匹林组(13.89%),而两组出血事件发生率无显著差异。结论持续性房颤、永久性房颤、长期持续性房颤在老年患者中占主导地位。房颤时间越长,左房内径越大,NT-proBNP也越高。华法林抗凝效果优于阿司匹林,且获益超过出血风险。

Objective To study the clinical characteristics and treatment of elder patients with atrial fibrillation.Methods The clinical data of 120 elderly patients with atrial fibrillation including NT-proBNP levels,left atrial diameter and anticoagulation therapy of patients with paroxysmal atrial fibrillation,persistent atrial fibrillation and long-term atrial fibrillation were retrospectively analyzed.Results Atrial fibrillation in elder patients including 15% cases with primary atrial fibrillation,30% cases with paroxysmal atrial fibrillation,and 55% cases with permanent and long-standing persistent atrial fibrillation.Anticoagulation therapy with warfarin accounted for 41%.The incidence of stroke in patients with atrial fibrillation was 9.1%.Level of NT-proBNP was higher in patients with permanent and long-standing persistent atrial fibrillation than those with paroxysmal atrial fibrillation and primary atrial fibrillation.The left atrium diameter was bigger in patients with permanent and long-standing persistent atrial fibrillation than those in patients with paroxysmal and primary atrial fibrillation.The incidence of thromboembolic events in patients with warfarin（2.08%） was significantly lower than that of patients with aspirin（13.89%）.The incidence of bleeding events in patients with warfarin was as equal as in patients with aspirin.Conclusion Permanent and long-standing persistent atrial fibrillation was main arrhythmia in elder patients.The left atrium diameter,level of NT-proBNP and heart failure in patients with long-time atrial fibrillation were higher than those in patients with paroxysmal atrial fibrillation.Antithrombotic therapy with warfarin in patients with atrial fibrillation was better than those with aspirin.The application of warfarin was effective and safe in patients with atrial fibrillation.