华法林对心房颤动患者脑卒中严重程度的影响  

The effect of Preadmission warfarin on ischemic stroke severity in Chinese patients with atrial fibrillation

作　　者：卢尚欣 杜昕[1] 常三帅 郭雪原[1] 夏时俊 贾朝旭[1] 刘嘉鹏 李景业[1] 井然[1] 董建增[1] 马长生[1] 

机构地区：[1]首都医科大学附属北京安贞医院-北京市心肺血管疾病研究所心血管内科,100029

出　　处：《心肺血管病杂志》2017年第9期750-753,757,共5页Journal of Cardiovascular and Pulmonary Diseases

基　　金：国家自然科学基金项目(81470464;81530016);北京市医院管理局临床医学发展专项经费资助(ZYLX201302)

摘　　要：目的:本研究旨在评价服用华法林与未服用华法林的非瓣膜性心房颤动患者若发生脑卒中,其脑卒中严重程度的差别,为预防心房颤动脑卒中减轻疾病负担提供参考依据。方法:在位于北京市的7家三级医院和2家非三级医院中,回顾性连续入选2012年1月至2014年3月,在神经科住院治疗且主要诊断为脑卒中或短暂性脑缺血发作(TIA)的心房颤动患者,依据其脑卒中前是否服用华法林分为两组,收集并比较两组患者的人口学特征、合并疾病、检查结果、住院当天的美国国立卫生院神经功能缺损评分(NIHSS)等;通过Logistic单因素及多因素回归校正年龄、性别等资料后,分析服用华法林与脑卒中严重程度的关系。结果:共纳入260例患者,其中服用华法林组51例(19.6%),未服用华法林组209例(80.4%)。服用华法林组NIHSS评分小于未服用华法林组(0.52±0.36)vs.(0.72±0.46),差异有统计学意义(P<0.05)。多因素分析显示服用华法林且INR≥2可降低NIHSS评分(odds ratio=0.24,95%CI:0.07~0.85,P=0.027),差异有统计学意义。结论:服用华法林且INR≥2的心房颤动患者若发生脑卒中其严重程度轻于未服用华法林的患者。Objective： To provide evidence for reducing disease burden of stroke in patients with atrial fibrillation ,we evaluated the association between preadmissiou antithrombotie treatment and stroke severity in patients with ischemic stroke and atrial fibrillation. Methods： In 9 hospitals involved in Chinese Atrial Fibrillation Registry, We identified consecutive atrial fibrillation patients who suffered ischemic stroke or transient ischemic attack from January 1, 2012 to March 31,2014. Clinical data of the groups was collected and compared, including baseline data, laboratory examination and hospitalization costs. Stroke severity was measured using the NIHSS. Independent risk factors for NIHSS were also analyzed. Results： Totally 260 patients were enrolled,51 （ 19. 6% ）were receiving warfarin and 209 （80.4%）were without warfarin treatment. NHISS scores of warfarin treatment group were less than the group without warfarin treatment （0.52 ± 0.36 ） vs. （0.72 ±0. 46 ） , difference was statistically significant （ P 〈 0. 05 ）. Besides, Muhivariable analysis showed INR ≥2 could reduce the NIHSS score （ odds ratio = 0. 24,95% CI： 0. 07-0. 85, P = 0. 027 ）. Conclusion ： Warfarin treatment may reduce severity of ischemic stroke in patients with atrial fibrillation.

关 键 词：华法林 心房颤动 脑卒中 NIHSS评分 

分 类 号：R54[医药卫生—心血管疾病]