SAMe-TT_2R_2评分对非瓣膜性房颤患者应用华法林抗凝控制质量的预测能力评价  

Evaluation of SAMe-TT_2R_2 score for predicting the quality of anticoagulation control with warfarin in patients with nonvalvular atrial fibrillation

作　　者：陈文文[1] 党和勤[1] 耿涛[1] 刘燕琳[1] 李振山[1] 尹玲[1] 张秀珍[1] 

机构地区：[1]泰山医学院附属医院药剂科,山东泰安271000

出　　处：《中国医院药学杂志》2017年第20期2072-2076,共5页Chinese Journal of Hospital Pharmacy

基　　金：泰山医学院附属医院青年基金(编号:2014QN05)

摘　　要：目的:评估SAMe-TT_2R_2评分预测非瓣膜性房颤患者应用华法林抗凝控制质量的能力,探索SAMe-TT_2R_2评分与缺血性卒中和严重出血的关系。方法:对某院2014年1月-2015年6月初次应用华法林治疗的非瓣膜性房颤患者进行为期1年的随访,计算患者SAMe-TT_2R_2分数及抗凝治疗范围内时间百分比[the percentage time in therapeutic International Normalised Ratio(INR)range,TTR],运用ANOVA检验,ROC曲线分析评估SAMe-TT_2R_2评分对患者TTR的预测能力。记录随访期间缺血性卒中或严重出血事件发生情况以探寻SAMe-TT_2R_2分数与缺血性卒中和严重出血的关系。结果:178例患者平均TTR为57.79%±15.53%,随着SAMe-TT_2R_2分数增加,患者TTR逐渐下降(P=0.001),SAMe-TT_2R_2预测TTR<70%准确性较高(ROC曲线下面积为0.734,P<0.001),最佳临界值为2,敏感度和特异性分别为95%和36%,Youden指数为最高值0.31,提示当SAMe-TT_2R_2>2时患者抗凝控制质量较差(TTR<70%)。随访期间共有7例患者(3.93%/年)发生缺血性卒中,3例患者(1.69%/年)发生严重出血。Kaplan-Meier生存分析提示SAMe-TT_2R_2评分与患者缺血性卒中年发生率无明显相关(Log Rank=1.653,P=0.647)。结论:在应用华法林抗凝的非瓣膜性房颤患者中,SAMe-TT_2R_2评分具有预测TTR的能力,针对抗凝控制质量较差患者,临床药师应为其制定个体化用药方案,改善抗凝质量。OBJECTIVE To assess the ability of SAMe-TT2R2 to predict the quality of anticoagulation control with warfarin in patients with nonvalvular atrial fibrillation（NVAF）,and explore relationship between SAMe-TT2R2 and clinical outcomes,such as ischemic stroke and major bleeding.METHODS NVAF patients taking warfarin in our hospital from January 2014 through June 2015 were prospectively followed-up for 1 year.Individual SAMe-TT2R2 and percentage time in therapeutic International Normalized Ratio（INR）range（TTR）were both calculated,and the ability of SAMe-TT2R2 to predict TTR was assessed by ANOVA test and ROC curve.RESULTS The mean TTR was 57.79%±15.53%.There was a significant decline in mean TTR with increasing SAMe-TT2R2 score（P=0.001）.The score demonstrated good discrimination performance for predicting TTR at the best cut-off value of 2,the sensitivity and specificity to predict TTR70% were 95%and36%,respectively.The Youden index for the cut-off value of 2 was the highest（0.31）.During the follow-up,7 patients（3.93%/year）developed ischemic strokes and 3 patients（1.69%/year）developed major bleeding.Kaplan-Meier survival analysis suggested there was no significant association between SAMe-TT2R2 and ischemic stroke events（log rank=1.653,P=0.647）.CONCLUSION SAMe-TT2R2 score does well on predicting TTR and identifying the patients with poor quality of anticoagulation control（as reflected by TTR）.Such patients would benefit from individualized therapy strategies made by clinical pharmacists for improving quality of anticoagulation control.

关 键 词：非瓣膜性房颤 华法林 抗凝控制质量 治疗范围内时间百分比 SAMe-TT2R2分数 

分 类 号：R973.2[医药卫生—药品]