非瓣膜性房颤患者服用新型口服抗凝药致消化道出血的影响因素分析及预测模型建立

Analysis of influencing factors and establishment of prediction model for gastrointestinal bleeding caused by new oral anticoagulants in patients with nonvalvular atrial fibrillation

目的:分析非瓣膜性房颤(NVAF)患者服用新型口服抗凝药(NOACs)导致消化道出血的影响因素。方法:回顾性分析服用NOACs治疗NVAF的267例住院患者资料,对可能引起出血不良反应的危险因素进行单因素及logistic回归分析,并建立风险预测模型。结果:18例(6.74%)发生消化道出血。logistic回归分析显示,脑梗死史、低蛋白血症为NVAF患者服用NOACs致消化道出血的独立危险因素(P<0.05)。进一步得到消化道出血风险联合预测因子Y=1.837-0.131×X白蛋白+1.786×X脑梗死,其ROC曲线的AUC值为0.732。约登指数计算结果显示白蛋白值低于32.8 g易出现消化道出血。结论:在服用NOACs时应加强患者消化道出血风险因素的评估,以保证临床用药的安全性。

Objective:To analyze the influencing factors of gastrointestinal bleeding caused by the administration of new oral anticoagulants(NOACs)in patients with nonvalvular atrial fibrillation(NVAF).Methods:The data from 267 inpatients taking NOACs were retrospectively analyzed.The single factor and logistic regression analysis were performed on the risk factors correlated with gastrointestinal bleeding.The bleeding risk prediction model was established.Results:Gastrointestinal bleeding occurred in 18 cases(6.74%).Logistic regression analysis showed that history of cerebral infarction and hypoproteinemia were independent risk factors for gastrointestinal bleeding caused by NOACS in NVAF patients(P<0.05).Furthermore,the combined predictive factor of gastrointestinal bleeding risk Y=1.837−0.131×Xalbumin+1.786×Xcerebral infarction was obtained,and the AUC value of ROC curve was 0.732.The calculated results of Youden index showed that the value of albumin lower than 32.8 g was prone to gastrointestinal bleeding.Conclusion:The evaluation of gastrointestinal bleeding risk factors after taking NOACs should be strengthened so as to ensure the safety of clinical medication.