房颤患者不良临床事件的发生与年龄增加的关系研究  

The relationship between the negative clinical events and age increase in patients with atrial fibrillation

作　　者：莫艳霞[1] 万翔[1] 

机构地区：[1]仙桃市第一人民医院心血管内科,湖北仙桃433000

出　　处：《现代医学》2015年第3期318-322,共5页Modern Medical Journal

摘　　要：目的：探讨高龄心房颤动（房颤）患者发生卒中、出血相关临床事件与年龄增加的关系。方法：将360例高龄房颤患者根据年龄分为70~79岁、80~89岁及≥90岁组3组,采用CHADS2、CHA2DS2-VASC和HAS-BLED评分方法进行出血和卒中风险评分,随访比较3组患者出血和卒中情况。结果：3组患者不良临床事件发生率随年龄增加而增加（P=0.000）。卒中风险的CHADS2评分和CHA2DS2-VASC评分均随年龄组依次增高,分别为（1.9±0.1）、（3.2±0.1）、（3.9±0.2）分（F=8.121,P=0.000）和（3.0±0.1）、（5.1±0.1）、（5.7±0.2）分（F=7.548,P=0.000）;出血风险的HAS-BLED评分也随年龄组依次增高,分别为（2.0±0.1）、（3.3±0.1）和（3.7±0.1）分（F=6.667,P=0.000）。24例发生血栓及出血＂双向事件＂的房颤患者中,有17例发生出血后再发血栓。结论：高龄房颤患者出血和卒中风险随年龄增加而增加;高龄房颤患者易发生＂双向事件＂,预后较差。Objective： To evaluate the relationship between the stroke and bleeding clinical events and the age increment in the elderly patients with atrial fibrillation（ AF）. Methods： A total of 360 elderly AF patients were enrolled. All patients were divided into 70- 79 years group,80- 89 years group and ≥90 years group. The CHADS2 score,CHA2DS2-VASC score and HAS-BLED score were analyzed. Comparison of the bleeding and stroke cases in the three groups of patients was also made. Results： The prevalence of the bleeding and the stroke were both significantly increased with aging,and the difference between groups were statistically significant（ P = 0. 000）. The CHADS2 score in the 70- 79,80- 89 and ≥90 years old groups were increasing,which respectively were 1. 9 ±0. 1,3. 2 ± 0. 1 and 3. 9 ± 0. 2（ F = 8. 121,P = 0. 000）; the CHA2DS2-VASC score in the three groups were increasing,which respectively were 3. 0 ± 0. 1,5. 1 ± 0. 1 and 5. 7 ± 0. 2（ F = 7. 548,P = 0. 000）; the HAS-BLED score in the three groups were increasing,which respectively were 2. 0 ± 0. 1,3. 3 ± 0. 1 and 3. 7 ± 0. 1（ F = 6. 667,P =0. 000）. 24 patients（ 6. 4%） experienced ＂bidirectional events＂[concomitant stroke / thromboembotic event（ TE） and hemorrhage],17 of whom（ 73. 9%） suffered recurrent TEs. Conclusion： The risks of stroke and bleeding increased with age in elderly patients with AF; elderly AF patients prone to ＂bidirectional event＂,leading to poor prognosis.

关 键 词：心房颤动 脑血管意外 出血 老年人 

分 类 号：R541.75[医药卫生—心血管疾病]