老年心房颤动患者慢性肾功能受损对血栓栓塞事件的影响

Effect of renal function damage on thromboembolism in elderly atrial fibrillation patients

目的探讨老年心房颤动（房颤）患者慢性肾功能受损对血栓栓塞事件的影响。方法选择无抗凝治疗的老年房颤患者265例,根据慢性肾脏疾病分级分为估算肾小球滤过率（eGFR）≥60ml/（min·1.73m2）152例、eGFR45～59ml/（min·1.73m2）69例、eGFR〈45ml/（min·1.73m2）44例,通过eGFR和尿蛋白的评估,观察其随访期间是否出现血栓栓塞事件。结果房颤血栓栓塞的发生与eGFR下降（RR=4.183,95%CI：2.571～6.805,P〈0.01）和尿蛋白（RR=3.692,95%CI：2.731～5.105,P〈0.01）相关。多因素分析显示,尿蛋白使血栓栓塞的危险性增加46.2%（HR=1.462,95%CI：1.215～1.904,P〈0.01）；将eGFR≥60ml/（min·1.73m2）作为参照,eGFR在45～59ml/（min·1.73m2）出现血栓栓塞事件增加17.2%（HR=1.172,95%CI：0.915～1.402,P〈0.01）,eGFR〈45ml/（min·1.73m2）则增加42.1%（HR=1.421,95%CI：1.211～1.816,P〈0.01）。结论慢性肾功能受损增加了不用抗凝药物的老年房颤患者血栓栓塞的危险性。

Objective To study the effect of renal function damage on thromboembolism in elderly AF patients.Methods Two hundred and sixty-five AF patients not receiving anticoagulation therapy were divided into eGFR≥60ml/（min·1.73m2）group（n=152）,eGFR=45-59ml/（min·1.73m2）group（n=69）and eGFR〈45ml/（min·1.73m2）group（n=44）according to their chronic renal disease severity.The thromboembolism events were observed during the follow-up period by calculating the eGFR and assessing the proteinuria.Results The incidence of AF was related with the decreased eGFR and proteinuria in AF patients（RR=4.183,95%CI： 2.571-6.805,P〈0.01;RR=3.692,95%CI：2.731-5.105,P〈0.01）.Multivariate analysis showed that proteinuria increased the risk of thromboembolism by 46.2%（HR=1.462,95%CI： 1.215-1.904,P〈0.01）,and by 17.2%and 42.1%respectively when the eGFR was 45-59ml/（min·1.73m2）and45ml/（min·1.73m2）（HR=1.172,95%CI：0.915-1.402,P〈0.01; HR=1.421,95%CI：1.211-1.816,P〈0.01）.Conclusion Chronic renal function damage increases the risk of thromboembolism in elderly AF patients not receiving anticoagulation therapy.