老年非瓣膜病心房颤动合并慢性肾脏病患者抗凝治疗现状分析  

Status quo of anticoagulant therapy for elderly nonvalvular AF patients with chronic kidney disease

作　　者：陈一文[1] 秦明照[1] 王宁[1] 杨红霞[2] 张洁[3] 邢云利[4] 马丽娜[5] 方向阳[6] 王灵娜 李新萍[8] 张铁梅[9] Chen Yiwen;Qin Mingzhao;Wang Ning;Yang Hongxia;Zhang Jie;Xing Yunli;Ma Lina;Fang Xiangyang;Wang Lingna;Li Xinping;Zhang Tiemei(Department of Geriatrics,Affiliated Beijing Tongren Hospital of Capital Medical University,Beijing 100730,China)

机构地区：[1]首都医科大学附属北京同仁医院老年医学科,100730 [2]首都医科大学附属北京安贞医院 [3]首都医科大学复兴医院 [4]首都医科大学附属北京友谊医院 [5]首都医科大学附属北京宣武医院 [6]首都医科大学附属北京朝阳医院 [7]民航总医院 [8]北京积水潭医院 [9]首都医科大学附属天坛医院

出　　处：《中华老年心脑血管病杂志》2021年第3期233-236,共4页Chinese Journal of Geriatric Heart,Brain and Vessel Diseases

基　　金：北京市科学技术委员会首都市民健康培育项目(Z16100000116079)。

摘　　要：目的调查北京部分地区三级综合医院老年非瓣膜病心房颤动(NVAF)合并慢性肾病(CKD)3~4期患者的抗凝治疗现状。方法收集2016年7月~2019年5月北京地区9家三级综合医院老年医学科门诊或住院的年龄≥60岁NVAF合并CKD3~4期患者371例,其中≥80岁258例,根据估算的肾小球滤过率(eGFR)分为CKD3a期组[eGFR 45~60 ml/(min·1.73 m2)]217例和CKD3b~4期组[eGFR 15~45 ml/(min·1.73 m2)]154例。收集患者一般临床资料,用查尔森共病指数(CCI)评价患者共病情况,用CHA2DS2-VASc评分评估血栓栓塞风险,采用HAS-BLED评分评估出血风险,logistic回归分析影响医师抗凝处方的因素。结果与CKD3a期组比较,CKD3b~4期组年龄[(83.3±6.9)岁vs(81.6±7.8)岁,P<0.05]和CCI更高(8.5±1.6 vs 8.0±1.7,P<0.01);抗凝治疗比例更低(36.4%vs 48.8%,P<0.05);2组单纯抗血小板治疗、未抗栓治疗、CHA2DS2-VASc评分≥2分和HAS-BLED评分≥3分比例比较,差异无统计学意义(P>0.05)。logistic回归分析显示,贫血、HAS-BLED评分≥3分、血清白蛋白<30 g/L是影响医师抗凝处方的相对危险因素(P<0.05)。结论老年NVAF合并CKD3~4期患者均处于血栓栓塞高风险状态,出血风险较普通老年心房颤动患者高,抗凝治疗比例仍偏低。Objective To investigate the status quo of anticoagulant therapy for elderly nonvalvular AF patients with chronic kidney disease stage 3-4(CKD 3-4)in tertiary general hospitals of Beijing.Methods Three hundred and seventy-one nonvalvular AF patients with their age≥60 years who visited the outpatient departments of 9 tertiary general hospitals of Beijing or were admitted to these hospitals from July 2016 to May 2019 were divided into CKD3a group or eGFR=45-60 ml/min·1.73 m2 group(n=217)and CKD3b-4 group or eGFR=15-45 ml/min·1.73 m2 group(n=154).Their general clinical data were recorded.The comorbidity in these patients was detected according to their Chalson's comorbidity index(CCI).The risk of thromboembolism in these patients was assessed according to their CHA2DS2-VASc score.The risk of bleeding in these patients was evaluated according to their HAS-BLED score.The factors influencing doctors to prescribe anticoagulants were analyzed by logistic regression analysis.Results The age was significantly older and the CCI was significantly higher while the ratio of anticoagulant therapy was significantly lower in CKD3b-4 group than in CKD3a group(83.3±6.9 years vs 81.6±7.8 years,P<0.05;8.5±1.6 vs 8.0±1.7,P<0.01;36.4%vs 48.8%,P<0.05).No significant difference was detected in simple antiplatelet therapy,nonantithrombotic therapy,CHA2DS2-VASc score≥2,and HAS-BLED score≥3 between the two groups(P>0.05).Conclusion Elderly nonvalvular AF patients with CKD 3-4 are at high risk of thromboembolism.The risk of bleeding is higher while the ratio of anticoagulant therapy is lower in elderly nonvalvular AF patients with CKD 3-4 than in general elderly AF patients.

关 键 词：心房颤动 肾病 肾功能不全 卒中 抗凝药 

分 类 号：R541.75[医药卫生—心血管疾病] R692[医药卫生—内科学]