红细胞分布宽度对老年阵发性非瓣膜性房颤病人导管消融术后服用达比加群酯出血事件的预测价值  

Prognostic value of red blood cell distribution width on bleeding events in elderly patients with nonvalvular atrial fibrillation taking dabigatran after catheter ablation

作　　者：郭贺杰 林刚[1] 陆丽[1] 周蕾[2] 赵东升 张清[1] GUO He-jie;LIN Gang;LU Li;ZHAO Dong-sheng;ZHANG Qing;ZHOU Lei(Department of Cardiology,the Second Affiliated Hospital of Nantong University,Nantong 226001,China;Department of Cardiology,the First Affiliated Hospital of Nanjing Medical University,Nanjing 210029,China)

机构地区：[1]南通大学第二附属医院心内科,江苏省南通市226001 [2]南京医科大学第一附属医院心内科,江苏省南京市210029

出　　处：《实用老年医学》2020年第7期683-686,共4页Practical Geriatrics

基　　金：南通市科技项目(MS12017003-5)。

摘　　要：目的探讨红细胞分布宽度(red blood cell distribution width,RDW)对老年阵发性非瓣膜性房颤(non-valvular atrial fibrillation,NVAF)病人导管消融术后服用达比加群酯安全性的预测价值。方法纳入119例行导管消融术的老年阵发性NVAF病人,年龄均≥60岁,按照RDW的中位数将研究对象分为低RDW组(<13.0%)和高RDW组(≥13.0%)。术前术后所有病人均口服达比加群酯110 mg,2次/d。术后随访3个月,观察出血事件的发生情况。结果随访3个月共发生18例出血事件,包括牙龈出血5例、口腔出血4例、鼻腔出血5例、泌尿道出血3例、消化道出血1例。高RDW组出血事件的发生率高于低RDW组(21.7%比8.5%,P=0.045)。用RDW值预测出血事件发生的ROC曲线下面积为0.808(界值为13.0%,P<0.001)。多因素Logistic回归分析显示,高RDW值是老年阵发性NVAF病人导管消融术后口服达比加群酯发生出血事件的独立预测因素(OR=3.386,95%CI:1.083~10.583,P=0.03)。结论高RDW值有潜力成为老年阵发性NVAF病人导管消融术后服用达比加群酯发生出血事件的预测指标。Objective To investigate the predictive value of red blood cell distribution width(RDW)for the safety of dapigatron in the elderly patients with paroxysmal non-valvular atrial fibrillation(NVAF)after catheter ablation.Methods A total of 119 patients with paroxysmal NVAF who underwent catheter ablation were enrolled.They were all over 60 years old.The subjects were divided into low RDW group(<13.0%)and high RDW group(≥13.0%)according to the median of RDW.All patients were given orally 110 mg dabigartan twice a day before operation.The patients were followed up for three months to observe the occurrence of bleeding events.Results Eighteen cases of bleeding occurred during three months follow-up,including gingival bleeding,oral bleeding,nasal bleeding,urinary tract bleeding and gastrointestinal bleeding.The incidence of bleeding events in high RDW group was higher than that in low RDW group(21.7%vs 8.5%,P=0.045).The area under ROC curve predicted by RDW value was 0.808(cut-off point=13.0%,P<0.001).Multivariate Logistic regression analysis showed that high RDW value was an independent predictor of bleeding events(OR=3.386,95%CI:1.083-10.583,P=0.03)in the elderly patients with paroxysmal NVAF after catheter ablation.Conclusions High RDW value has the potential to be a predictor of hemorrhage in the elderly patients with paroxysmal NVAF taking dabigatran after catheter ablation.

关 键 词：红细胞分布宽度 房颤 导管消融术 达比加群酯 安全性 

分 类 号：R542.5[医药卫生—心血管疾病]