非瓣膜性持续性心房颤动患者华法林抗凝治疗稳定性达标情况及其五种计算方法的比较

Stability Compliance Situation of Warfarin Anticoagulant Therapy in Patients with Non-valvular Persistent Atrial Fibrillation and Comparison of Five Calculation Methods

目的分析非瓣膜性持续性心房颤动患者华法林抗凝治疗稳定性达标情况,并比较5种INR在治疗目标范围内的时间百分比(TTR)计算方法的应用情况。方法选取2015—2016年在九江市第一人民医院就诊的83例非瓣膜性持续性心房颤动患者作为A组,均采用随访次数达标计算法及HKU AF CAL应用软件计算TTR;另选取2018—2020年在九江市第一人民医院就诊的172例非瓣膜性持续性心房颤动患者作为B组,均采用随访次数达标计算法、随访天数达标计算法、抗凝助手软件、INR平均值浮动计算法计算TTR。本研究以TTR>65%为抗凝治疗稳定性达标,计算五种TTR计算方法得到的抗凝治疗稳定性达标率,比较A组患者随访次数达标计算法与HKU AF CAL应用软件计算的TTR;以随访次数达标计算法为参照,分别比较其与随访天数达标计算法、抗凝助手软件及INR平均值浮动计算法计算的TTR。结果A组患者随访次数达标计算法、HKU AF CAL应用软件计算的抗凝治疗稳定性达标率均为38.55%(32/83);随访次数达标计算法与HKU AF CAL应用软件计算的TTR比较,差异无统计学意义(P>0.05);Bland-Altman图分析结果显示,HKU AF CAL应用软件和随访次数达标计算法计算的TTR差值的均值为2.747%〔95%CI(-4.822%,5.948%)〕,绝大多数差值在95%CI范围内。B组患者随访次数达标计算法、随访天数达标计算法、抗凝助手软件及INR平均值浮动计算法计算的抗凝治疗稳定性达标率分别为26.74%(46/172)、11.05%(19/172)、40.69%(70/172)、26.16%(45/172)。随访天数达标计算法计算的TTR低于随访次数达标计算法,抗凝助手软件计算法计算的TTR高于随访次数达标计算法(P<0.05);平均INR浮动计算法与随访次数达标计算法计算的TTR比较,差异无统计学意义(P>0.05)。结论非瓣膜性持续性心房颤动患者华法林抗凝治疗稳定性达标率不高;与随访次数达标计算法相比,随访天数达标计算法计算的TTR较低,抗凝助手软件计算法计算的TTR较高,而HKU AF CAL应用软件及INR平均值浮动计算法计算的TTR相似。

Objective To analyze the stability compliance situation of warfarin anticoagulant therapy in patients with non-valvular persistent atrial fibrillation,and compare the five calculation methods of time within therapeutic range(TTR).Methods A total of 83 patients with non-valvular persistent atrial fibrillation treated in Jiu Jiang No.1 People's Hospital from 2015 to 2016 were selected as group A,and the TTR was calculated by follow-up times compliance calculation method and HKU AF CAL application software;172 patients with non-valvular persistent atrial fibrillation treated in Jiu Jiang No.1 People's Hospital from 2018 to 2020 were selected as group B,and the TTR was calculated by four calculation methods such as follow-up times compliance calculation method,follow-up days compliance calculation method,anticoagulant assistant software and INR average floating calculation method.In this study,taking TTR>65%as the standard of stability compliance of warfarin anticoagulant therapy,the incidence of stability compliance of warfarin anticoagulant therapy calculate by five calculation methods was compared;in the group A,TTR calculated by different calculation methods were compared;in the group B,TTR calculated by different calculation methods were compared.Results In the group A,the incidence of stability compliance of warfarin anticoagulant therapy calculated by follow-up times compliance calculation method and HKU AF CAL application software were all 38.55%(32/83);there was no significant difference in TTR calculated by follow-up times compliance calculation method and HKU AF CAL application software(P>0.05).Bland-Altman chart analysis result showed that the mean value of TTR difference calculated by follow-up times compliance calculation method and HKU AF CAL application software was 2.747%[95%CI(-4.822%,5.948%)],and most of the differences were within 95%CI.In the group B,the incidence of stability compliance of warfarin anticoagulant therapy calculated by follow-up times compliance calculation method,follow-up days compliance calculation method,anticoagulant assistant software and INR average floating calculation method was 26.74%(46/172),11.05%(19/172),40.69%(70/172)and 26.16%(45/172),respectively.Compared with the follow-up times compliance calculation method,the TTR calculated by follow-up days compliance calculation method was lower,and the TTR calculated by anticoagulant assistant software was higher(P<0.05).There was no significant difference in TTR calculated by follow-up times compliance calculation method and INR average floating calculation method(P>0.05).Conclusion The stability compliance of warfarin anticoagulant therapy in patients with non-valvular persistent heart fibrillation is not high;compared with the follow-up times compliance calculation method,the TTR calculated by follow-up days compliance calculation method is lower,the TTR calculated by anticoagulant assistant software is higher,the TTR calculated by HKU AF CAL application software and INR average floating calculation method is similar.