二尖瓣机械瓣置换术后凝血酶原时间-国际标准化比值检测频率与长期预后间关系的研究

Correlations between prothrombin time-international normalized ratio(PT-INR)monitoring frequency and long-term prognosis in patients with mechanical mitral valve replacement

目的探究凝血酶原时间-国际标准化比值(prothrombin time-international normalized ratio,PT-INR)检测频率与二尖瓣机械瓣置换术后长期预后之间的关系。方法纳入2013年6月至2018年5月于南京医科大学第一附属医院接受二尖瓣机械瓣置换并康复出院的患者。电话问卷调查患者,根据PT-INR检测间隔是否超过1个月分为频繁检测组(≤1个月)和不频繁检测组(>1个月)。主要终点为全因死亡,次要终点为缺血性卒中及大出血,比较两组之间终点事件发生情况。结果共收集249例患者信息,年龄(47.06±6.88)岁,其中男98例。共153例(61.4%,153/249)完成问卷者纳入分析。2013-2014年、2014-2015年、2015-2016年、2016-2017年、2017-2018年失访比例分别为76.1%,51.3%,26.7%,32.3%,15.8%;频繁检测比例分别为36.4%,36.8%,42.4%,35.7%,83.3%。随术后时间延长,失访和不频繁检测比例均显著增加(P<0.05)。80例(52.3%)纳入频繁检测组,73例(47.7%)纳入不频繁检测组。不频繁检测组共发生7例全因死亡,6例缺血性卒中,3例大出血;频繁检测组无死亡,1例缺血性卒中,2例大出血。频繁检测组累积死亡风险显著低于不频繁检测组(P=0.006)。结论随术后时间延长,失访比例和不频繁检测PT-INR比例均显著增加,不频繁检测总体预后差于频繁检测。

Objective To investigate correlations between monitoring frequency of prothrombin time-international normalized ratio(PT-INR)and long-term prognosis in patients after mechanical mitral valve(MMV)replacement.Methods Patients underwent MMV replacement in the First Affiliated Hospital with Nanjing Medical University and discharged from June 2013 to May 2018 were enrolled.Patients were followed with a telephone questionnaire survey.Based on monitoring intervals,patients were divided into frequent monitoring group(FMG)(monitoring intervals≤1 month)and infrequent monitoring group(IMG)(monitoring intervals>1 month).Primary endpoint was all-cause death'and secondary endpoints were ischemic stroke and major bleeding.Occurrences of endpoints in the two groups were analyzed.Results A total of 249 patients[age(47.06±6.88)years old,98 male]were enrolled,and 153(61.4%)patients who finished questionnaire were included to analysis.Based on the year of operation,proportions of loss to follow-up were 76.1%,51.3%,26.7%,32.3%,15.8%;proportions of frequent PT-INR monitoring were 36.4%,36.8%,42.4%,35.7%,83.3%,respectively.As post-operation time prolonged,proportions of loss to follow-up and infrequent PT-INR monitoring increased significantly(P<0.05).Eighty(52.3%)patients were grouped into FMG and 73 patients(47.7%)into IMG.There were 7 all-cause deaths,6 ischemic stokes and 3 major bleedings in IMG,while no all-cause death,1 ischemic stroke and 2 major bleedings happened in FMG.Compared with IMG,cumulative incidence of death in FMG was significantly lower(P=0.006).Conclusion As post-operation time prolonged,proportions of loss to follow-up and infrequent PT-INR monitoring increased significantly.Patients with infrequent monitoring had worse general prognosis than patients with frequent monitoring.