服用达比加群的老年高血压伴非瓣膜性心房颤动患者估算肾小球滤过率与出血的相关性  

Association Between Estimated Glomerular Filtration Rate and Bleeding in Elderly Hypertensive Patients Complicating With Non-valvular Atrial Fibrillation Under Dabigatran Treatment

作　　者：石雨蒙 周伟[2] 李明辉 鲍慧慧[1] 程晓曙[1] SHI Yumeng;ZHOU Wei;LI Minghui;BAO Huihui;CHENG Xiaoshu(Department of Cardiology,Cardiovascular Disease Prevention Center,The Second Affiliated Hospital of Nanchang University,Nanchang 330006,Jiangxi,China)

机构地区：[1]南昌大学第二附属医院心血管内科,江西省南昌市330006 [2]南昌大学第二附属医院心血管病防治中心,江西省南昌市330006

出　　处：《中国循环杂志》2020年第10期967-972,共6页Chinese Circulation Journal

基　　金：国家十二五“重大新药创制”科技重大专项(2014ZX09303305);江西省科技创新平台计划项目(0165BCD41005)。

摘　　要：目的:探讨服用达比加群的老年高血压伴非瓣膜性心房颤动患者估算肾小球滤过率(eGFR)与出血的关系。方法:本研究为2015年2月至2017年12月在全国12家医院开展的前瞻性观察队列研究,纳入服用达比加群(110 mg,2次/d)的老年高血压伴非瓣膜性心房颤动患者528例,平均年龄为(71.49±7.09)岁,其中男性271例(51.33%)。根据患者的eGFR值分为两组:eGFR≥60 ml/(min·1.73 m^2)组(n=433)和eGFR<60 ml/(min·1.73 m^2)组(n=95)。收集患者的基线资料(如年龄、性别、身高、体重等)、生化和凝血功能指标,随访3个月后,收集生化、凝血功能指标和出血事件信息。eGFR <60 ml/(min·1.73 m^2)定义为肾损伤。通过多因素Cox回归模型分析患者eGFR与出血事件的相关性。结果:528例患者的eGFR平均值为(76.17±16.07)ml/(min·1.73 m^2),其中eGFR <60 ml/(min·1.73 m^2)95例,占17.99%。60例(11.36%)患者发生出血事件。eGFR <60 ml/(min·1.73 m^2)组和eGFR≥60 ml/(min·1.73 m^2)组的出血发生率分别为20.00%(19/95)和9.47%(41/433),差异有统计学意义(P=0.003)。多因素分析显示,与eGFR≥60 ml/(min·1.73 m^2)组患者相比,eGFR<60 ml/(min·1.73 m^2)组患者的出血风险增加1.07倍(HR=2.07,95%CI:1.14~3.78)。结论:服用达比加群的老年高血压伴非瓣膜性心房颤动患者肾损伤时出血风险增加,因此针对该人群应密切监测肾功能,以减少出血风险。Objectives:To investigate the relationship between estimated glomerular filtration rate(eGFR)and hemorrhage in elderly hypertensive patients complicating with non-valvular atrial fibrillation under dabigatran treatment.Methods:This study was a prospective observational cohort study.Elderly hypertensive patients with non-valvular atrial fibrillation,who received dabigatran(dose 110 mg twice daily),were enrolled and baseline data,biochemical and coagulation function indicators were obtained.After 3 months,biochemical,coagulation function indicators and bleeding events were obtained.Renal function of the study subjects is quantified by the estimated glomerular filtration rate(eGFR),and eGFR<60 ml/(min·1.73 m^2)was defined as renal impairment.Correlation between patient eGFR and bleeding events was analyzed by Cox regression model.Results:A total of 528 patients were enrolled in the study.The mean age was(71.49±7.09)years,including 271 males(51.33%);the mean eGFR was(76.17±16.07)ml/(min·1.73 m^2).Patients were divided into eGFR≥60 ml/(min·1.73 m2)group(n=433)and eGFR<60 ml/(min·1.73 m2)group(n=95).During the 3 months follow up,minor bleeding was reported in 60 patients(11.36%).The incidence of bleeding was significantly higher in eGFR<60 ml/(min·1.73 m^2)group than in eGFR≥60 ml/(min·1.73 m^2)group(20.00%[19/95]vs.9.47%[41/433],P=0.005).Multivariate analysis showed that patients with eGFR<60 ml/(min·1.73 m^2)faced significantly higher risk of bleeding as compared to patients with eGFR>60 ml/(min·1.73 m^2)(HR=2.07,95%CI:1.14-3.78).Conclusions:Renal impairment in elderly hypertensive patients with non-valvular atrial fibrillation is associated with increased bleeding risk under the treatment of dabigatran.Monitoring the renal function and bleeding events are of importance in this population.

关 键 词：高血压 心房颤动 出血事件 估算肾小球滤过率 达比加群 老年人 

分 类 号：R541.4[医药卫生—心血管疾病]