利伐沙班与华法林对老年非瓣膜病心房颤动合并肾功能不全的疗效

Efficacy of rivaroxaban and warfarin in elderly patients with non-valvular atrial fibrillation complicated with renal insufficiency

目的探讨利伐沙班与华法林对老年非瓣膜病心房颤动合并肾功能不全的疗效。方法选取120例老年非瓣膜病心房颤动合并肾功能不全患者作为研究对象,根据患者服药意愿分为对照组与研究组,每组60例。对照组给予华法林治疗,研究组给予利伐沙班治疗。统计2组的治疗效果;比较2组治疗前后的凝血指标[纤维蛋白原(fibrinogen,FIB)、凝血酶时间(thrombin time,TT)、凝血酶原时间(prothrombin time,PT)、活化部分凝血活酶时间(activated partial thromboplastin time,APTT)、国际标准化比值(international normalized ratio,INR)]、血小板指标[P-选择素(P-selection,PS)、平均血小板体积(mean platelet volume,MPV)、血小板活化因子(platelet activating factor,PAF)]和N末端B型利钠肽前体(N-terminal pro-B-type natriuretic peptide,NTproBNP);比较2组血栓栓塞事件、出血事件的发生情况。结果研究组的总有效率(91.67%)高于对照组(76.67%),P<0.05。治疗后,对照组的PT、APTT延长,INR升高(P<0.05);研究组的TT、PT和APTT均延长(P<0.05),且研究组的TT、APTT较对照组均延长,INR较对照组降低(P<0.05);研究组的血清PS、MPV、PAF和NT-proBNP水平均低于对照组(P<0.05);研究组出血事件的发生率低于对照组(P<0.05)。结论利伐沙班治疗老年非瓣膜病心房颤动合并肾功能不全的疗效更佳,且在改善患者凝血功能和控制出血事件风险方面较华法林更理想。

Objective To investigate the efficacy of rivaroxaban and warfarin in the treatment of elderly patients with nonvalvular atrial fibrillation complicated with renal insufficiency.Methods 120 elderly patients with non-valvular fibrillation complicated with renal insufficiency were selected as the research object,and were divided into control group and research group according to their willingness to take drugs,with 60 cases in each group.The control group was treated with warfarin,while the study group was treated with rivaroxaban.The therapeutic effects of the 2 groups were counted,and the coagulation indexes[fibrinogen(FIB),thrombin time(TT),prothrombin time(PT),activated partial thromboplastin time(APTT),international normalized ratio(INR)],platelet index[P-selection(PS),mean platelet volume(MPV),platelet activating factor(PAF)]and N-terminal pro-B-type natriuretic peptide(NT-probnp),the occurrence of thromboembolic events and bleeding events were compared between the 2 groups.Results The total effective rate of the study group(91.67%)was higher than that of the control group(76.67%),P<0.05.After treatment,the PT and APTT were prolonged and INR was increased in the control group(P<0.05).The TT,PT and APTT in the study group were all prolonged(P<0.05),and TT and APTT in the study group were all prolonged,and INR was lower than that in the control group(P<0.05).The levels of serum PS,MPV,PAF and NT-proBNP in the study group were lowered than those in the control group(P<0.05).The incidence of bleeding in the study group was lower than that in the control group(P<0.05).Conclusion Rivaroxaban is more effective in the treatment of elderly patients with nonvalvular atrial fibrillation complicated with renal insufficiency,and it is more ideal than warfarin in improving coagulation function and controlling the risk of bleeding events.