房颤抗凝治疗后出血事件的预测因素分析

Analysis of predictive factors of bleeding after anticoagulant therapy in atrial fibrillation

目的:分析非瓣膜性心房颤动(non-valvular atrial fibrillation,NVAF)患者发生抗凝治疗出血事件的危险因素,以期为预测患者出血事件提供帮助。方法:收集2021年3月1日至2022年11月1日赣南医科大学第一附属医院住院的NVAF患者158例的临床资料、抗栓治疗策略及院内出血情况,根据是否发生出血事件分抗凝出血组和抗凝非出血组,对2组患者的各项指标进行单因素分析及多因素Logistic回归分析。结果:158例患者均应用抗凝药,其中出血组28例(17.72%),非出血组130例,出血组与未出血组患者在持续性房颤(P=0.005)、他汀类药物服用史(P=0.042)、β受体阻断剂服用史(P<0.001)、脑卒中病史(P=0.014)、冠心病病史(P=0.009)、低分子肝素(P=0.005)、华法林(P=0.001)、达比加群酯(P=0.017)、总胆固醇(Total cholesterol,TC)(P<0.001)、低密度脂蛋白胆固醇(Low density lipoprotein cholesterol,LDL-C)(P<0.001)、肌酐(Creatinine,CRE)(P<0.001)、谷草转氨酶(Aspartate transaminase,AST)(P<0.001)、谷丙转氨酶(Alanine transaminase,ALT)(P<0.001)、HAS-BLED评分(P=0.006)和中性粒细胞/淋巴细胞比值(neutrophil lymphocyte ratio,NLR)(P=0.049)等指标上,差异有统计学意义(P<0.05)。多因素二元Logistic向后逐步回归分析提示,CRE(P<0.001)、持续性房颤(P=0.005)、β受体阻断剂服用史(P=0.035)是影响NVAF患者出血事件发生的独立影响因素。进一步行预测诊断价值分析提示,肌酐ROC曲线下面积为0.892(95%CI 0.836~0.947),对抗凝后出血具有较高的预测性。结论:肌酐、持续性房颤、β受体阻断剂应用是影响NVAF患者抗凝出血事件发生的独立影响因素,且肌酐增高对抗凝后出血有较高的预测价值。

Objective:To analyze nonvalvular atrial fibrillation(NVAF)anticoagulation bleeding in patients with risk factors,in order to provide help to predict patients bleeding events.Methods:Clinical data,anti-thrombotic treatment strategies and in-hospital bleeding of 158 NVAF patients hospitalized in The First Affiliated Hospital of Gannan Medical University from March 1,2021 to November 1,2022 were collected.They were divided into anticoagulant bleeding group and anticoagulant non-bleeding group according to whether bleeding occurred.Univariate analysis and multivariate logistic regression analysis were performed for each index of the 2 groups.Results:A total of 158 patients were treated with anticoagulants,including 28 cases(17.72%)in bleeding group and 130 cases in non-bleeding group.Patients with persistent atrial fibrillation(P=0.005),history of statin use(P=0.042),history ofβ-blocker use(P<0.001),stroke history(P=0.014),coronary heart disease history(P=0.009),low molecular weight heparin(P=0.005),warfarin(P=0.001),dabigatran group(P=0.017),total cholesterol(TC)(P<0.001),low density lipoprotein cholesterol(LDL-C)(P<0.001),creatinine(CRE)(P<0.001),aspartate transaminase(AST)(P<0.001),alanine aminotransferase(ALT)(P<0.001),HAS-BLED score(P=0.006)and neutrophil lymphocyte ratio(NLR)(P=0.049)and other indicators,the difference was statistically significant(P<0.05).Multivariate logistic backward stepwise regression analysis showed that CRE(P<0.001),persistent atrial fibrillation(P=0.005)andβ-blocker history(P=0.035)were independent factors affecting bleeding in NVAF patients.Further analysis of predictive diagnostic value indicated that the area under ROC curve of creatinine was 0.892(95%CI 0.836~0.947),which had a high predictive value for bleeding after anticoagulation.Conclusion:High levels of creatinine,persistent atrial fibrillation andβ-blocker use are independent factors affecting the occurrence of anticoagulant bleeding in NVAF patients,and the increase of creatinine has a high predictive value for post-anticoagulant bleeding.