老年共病NVAF血栓形成高危患者出血评分相关因子分析

Analysis of related factors of bleeding score in elderly patients with high risk of thrombosis of comorbid non valvular atrial fibrillation

目的通过对老年共病非瓣膜性房颤(nonvalvular atrial fibrillation, NVAF)患者血低密度脂蛋白胆固醇(LDL-C)与HAS-BLED出血评分的相关性分析,进而为该类患者的调脂及抗凝治疗提供理论依据。方法根据纳入及排除标准,入选西安交通大学第二附属医院在2 018.01~2 020.06期间干二病区及心血管内科住院CHA2DS2-VASc≥2分的老年共病NVAF患者260例(女,156),根据HAS-BLED评分将其分为出血低危组(HAS-BLED<3分,n=156)和出血高危组(HAS-BLED≥3分,n=104),采用Logistic回归及Pearson相关分析LDL-C与HAS-BLED评分的相关关系。结果出血低危组LDL-C(2.3±0.8) mmol/L水平显著高于高危组(2.0±0.6)mmol/L(P<0.01)。Pearson相关分析显示,LDL-C(r=-0.197)与HAS-BLED呈显著负相关(P<0.01)。Logistic回归分析显示,LDL-C<1.8 mmol/L与HAS-BLED评分显著正相关,校正混杂因素后,该相关性仍然独立存在(OR=0.310,95%CI:0.117-0.820,P=0.018),而LDL-C<2.6 mmol/L与HAS-BLED出血风险无明显相关。结论血栓形成高危(CHA2DS2-VAS≥2分)的老年共病NVAF患者抗凝治疗中,LDL-C<1.80 mmol/L可能是其出血风险增加的危险因素之一,建议此类人群抗凝治疗中,如果LDL-C水平控制在1.8 mmol/L以下,需要慎重。

AIM To study the correlation between low density lipoprotein cholesterol(LDL-C) and HAS-BLED bleeding score in elderly patients with comorbid nonvalvular atrial fibrillation for lipidlowering and anticoagulant therapy. METHODS According to the criterion, 260 elderly patients of our hospital from January 2018 to June 2020 with comorbid nonvalvular atrial fibrillation(NVAF) and CHA2 DS2-VASc ≥ 2 were recruited. According to the HAS-BLED score, they were divided into lowrisk group(HAS-BLED < 3, n = 156) and high-risk group(HAS-BLED ≥ 3, n = 104), Binary logistic regression and Pearson correlation were used to analyze the correlation between the LDL-C and the HASBLED score. RESULTS The LDL-C level of low-bleed-risk group(2.3 ± 0.8) mmol/L was significantly higher than that in high-bleeding-risk group(2.0 ± 0.6 mmol/L). Pearson correlation analysis showed that there was a significant correlation between HAS-BLED and LDL-C(r =-0.197, P<0.01).Binary logistic regression analysis showed that LDL-C<1.8 mmol/l was positively correlated with the increased risk of bleeding. After adjusting for confounding variables, the correlation still existed independently(OR = 0.310, 95%CI: 0.117-0.820, P = 0.018). No significant association was found between lower LDL-C level(<2.6 mmol/L) and HAS-BLED groups. CONCLUSION LDL-C<1.8 mmol/L may be one of the risk factors of increased risk of bleeding in elderly patients with comorbidity non-valvular atrial fibrillation and high risk of thrombosis(CHA2 DS2-VASC ≥ 2). It is suggested that the level of LDL-C of patients with this disease should be carefully controlled less than 1.8 mmol/L.