新疆地区非瓣膜性心房颤动患者抗凝现状及CHADS2与CHA2DS2-VASc评分比较研究

A study on the evaluation of anticoagulation status comparing of CHADS2 versus CHA2DS2-VASc scores in patients with non valvular atrial fibrillation in Xinjiang area

目的 调查新疆地区心房颤动（房颤）患者抗凝现状,并对两种评分系统进行比较,找出更适合新疆地区房颤患者卒中风险评估方法.方法 采用查询电子病历及存档病历的方式,对2013年10月-2014年10月期间新疆地区35家医院的住院病历进行全面筛选,筛选出出院诊断为房颤的病例,随访10～ 12个月,统计卒中发生人数.结果 共入选5 953例房颤患者,年龄（67.9±12.0）岁,男∶女=1.44∶1.60 ～69岁与70 ～79岁两个年龄组人数最多,分别占23.92％及37.81％.CHADS2评分≤1分的患者改用CHA2 DS2-VASc重新评分后得分为0～3分,随访10～12个月后有22例新发卒中.需要接受抗凝的人数为4 742例,实际仅有1 460例患者接受抗凝治疗,抗凝率为30.79％.接受抗凝治疗的患者中,1 162例接受华法林治疗,298例接受新型口服抗凝药治疗.使用华法林患者中,进行国际标准化比值（INR）检测有1 110例,INR中位数为1.14,达到指南推荐INR值2.0～3.0稳态的仅为97例,达标率为8.74％.结论 新疆地区房颤抗凝现状表现为“低抗凝率”“低达标率”的特点;CHA2 DS2-VASc评分更适合新疆地区房颤患者卒中风险预测.

Objective To evaluate the current status of anticoagulation therapy in patients with atrial fibrillation（AF） in Xinjiang,and compare the two scoring systems （CHADS2 and CHA2DS2-VASc scores） in determining the risk of strokes in AF patients in Xinjiang.Methods Subjects with AF were collected by searching the electronic and paper medical records from 35 hospitals in Xinjiang area during October 2013 to October 2014,and followed up for the incident strokes after 10 to 12 months.Results Totally,5 953 AF patients were enrolled in the study with the age of （67.9 ± 12.0） years old,and men to women ratio of 1.44.Most patients were in age groups of 60-69 （23.92%） and 70-79 years （37.81%）.Among patients with a CHADS2 score of 1 or less,the CHA2 DS2-VASc scores of these subjects ranged from 0 to 3.After 10 to 12 months of follow-up,22 patients developed new strokes.Only 30.79% patients （n =1 460） received the anticoagulation treatment among those （n =4 742） who need to be treated with anticoagulation drugs.In patients receiving anticoagulant therapy,1 162 patients were treated with warfarin,and 298 patients with new oral anticoagulant drugs.Totally 1 110 patients treated with warfarin were monitored with international normalized ratio （INR）.The median INR was 1.14 with only 97 cases meeting the recommended INR ranging of 2.0-3.0 in the guidelines.The compliance rate was 8.74%.Conclusions The current status of anticoagulation for AF in Xinjiang area is characterized by ＂low anticoagulation rate＂ and ＂low compliance rate＂.The CHA2 DS2-VASc score is more suitable for predicting the risk of strokes in patients with non valvular atrial fibrillation in Xinjiang area.