血清生长分化因子15及ABC出血风险评分在预测老年非瓣膜病心房颤动患者口服非维生素K拮抗剂抗凝药出血风险的临床应用初探  

Clinical application of plasma growth differentiation factor-15 and ABC bleeding risk score in predicting bleeding risk in elderly patients with non-valvular atrial fibrillation on non-vitamin K antagonist oral anticoagulants

作　　者：柯于梵 钟桃娟 萧湛潮 梁逸伦 梁立彤 伍卫[1] O U Fan;CHONG Tou Kun;SIO Cham Chio;LEONG Lat Lon;LEONG Lap Tong;WU Wei(Department of Cardiology,Sun Yat-sen Memorial Hospital of Sun Yat-sen University,Guangzhou,Guangdong 510123,China;Department of Cardiology,Kiang Wu Hospital,Macao 999078,China)

机构地区：[1]中山大学孙逸仙纪念医院心血管内科,广东省广州市510123 [2]镜湖医院心血管内科,中国澳门特别行政区999078

出　　处：《中国动脉硬化杂志》2022年第5期423-430,共8页Chinese Journal of Arteriosclerosis

基　　金：中国澳门特别行政区科学技术发展基金资助项目(087/2015/A3)。

摘　　要：目的探讨血清生长分化因子15(GDF-15)及以此为基础的ABC(年龄、生物标志物和临床病史)出血风险评分在老年(年龄≥65岁)非瓣膜病心房颤动(NVAF)患者使用非维生素K拮抗剂口服抗凝药物(NOAC)治疗后,随访期间发生出血事件的预测能力,并与传统HAS-BLED出血风险评分比较。方法选取心血管内科住院收治的、首次诊断为NVAF且接受NOAC治疗的老年患者,采集入选患者的临床资料并分析血清GDF-15水平,计算以GDF-15等心脏生物标志物为基础的ABC出血风险评分及HAS-BLED出血风险评分。对患者出院后进行随访,记录随访期间各种出血事件,按各出血事件的严重程度[重大出血事件、临床相关非重大出血的消化道出血事件(CRNM-GIB)、轻微出血事件、无出血事件]分组,分别评价及比较ABC出血风险评分与HAS-BLED出血风险评分对各种程度出血事件的预测能力。结果142例老年NVAF患者,CHA_(2)DS_(2)-VASc卒中风险评分为(4.86±1.75)分,HAS-BLED出血风险评分为(2.92±0.99)分,经ABC出血风险评分计算预测1年出血事件发生率为(5.72%±4.11%),平均随访(19.92±6.83)月,49例(49/142,34.5%)发生出血事件,其中脑出血3例,CRNM-GIB 19例,轻微出血27例。受试者工作特征(ROC)曲线显示,血清GDF-15水平对CRNM-GIB[曲线下面积(AUC)为0.718,95%CI为0.645~0.835,P<0.001]及全部出血事件有预测价值(AUC为0.670,95%CI为0.690~0.727,P<0.001),ABC出血风险评分对CRNM-GIB(AUC为0.688,95%CI为0.552~0.824,P<0.001)及全部出血事件有预测价值(AUC为0.679,95%CI为0.579~0.779,P<0.001)。与HAS-BLED出血风险评分相比,ABC出血风险评分预测脑出血能力较高(ABC出血风险评分AUC为0.868,95%CI为0.752~0.985;HAS-BLED出血风险评分AUC为0.745,95%CI为0.556~0.933,重分类改善指标(NRI)为84.17%,P=0.001),预测CRNM-GIB能力较低(ABC出血风险评分AUC为0.688,95%CI为0.552~0.824;HAS-BLED出血风险评分AUC为0.744,95%CI为0.639~0.849,NRI为-23.96%,P=0.025)。�Aim To explore the ability of serum growth differentiation factor-15(GDF-15)and the ABC(age,biomarkers,clinical history)bleeding risk score based on this in predicting hemorrhage events in elderly(age≥65 years)patients with non-valvular atrial fibrillation(NVAF)after oral administration of non-vitamin K antagonist oral anticoagulants(NOAC).Methods Elderly inpatients who were first diagnosed as NVAF and treated with NOAC were selected.The GDF-15 concentration in serum was analyzed and clinical data were collected in each enrolled patient.The ABC bleeding risk score was calculated,which is essential on biomarkers including GDF-15,and HAS-BLED bleeding risk score.The patients were divided into groups according to the occurrence of various bleeding events(major bleeding(MB),clinically relevant non-major gastrointestinal bleeding(CRNM-GIB),minor bleeding,and no bleeding events)during follow-up.The ABC bleeding risk score and HAS-BLED bleeding risk score were evaluated and compared for predicting various degrees of bleeding events groups.Results During the(19.92±6.83)months follow-up period,49 cases(49/142,34.5%)had bleeding events,including 3 cases of cerebral hemorrhage,19 cases of CRNM-GIB,and 27 cases of minor bleeding.Receiver operating characteristic(ROC)curve showed that serum GDF-15 concentration had predictive value in predicting CRNM-GIB(AUC 0.718,95%CI:0.645~0.835,P<0.001)and all bleeding events(AUC 0.670,95%CI:0.690~0.727,P<0.001),and ABC bleeding risk score had predictive value in predicting CRNM-GIB(AUC 0.688,95%CI:0.552~0.824,P<0.001)and all bleeding events(AUC 0.679,95%CI:0.579~0.779,P<0.001).Compared with the HAS-BLED bleeding risk score,the ABC bleeding risk score had a higher ability to predict cerebral hemorrhage(AUC 0.868,95%CI:0.752~0.985 for ABC score vs.AUC 0.745,95%CI:0.556~0.933 for HASBLED score,net reclassification improvement(NRI)84.17%,P=0.001),less ability to predict CRNM-GIB(AUC 0.688,95%CI:0.552~0.824 for ABC score vs.AUC 0.744,95%CI:0.639~0.849 for HAS-BLED score,NRI-23.96%,P=0.025)

关 键 词：血清生长分化因子15 ABC出血风险评分 非瓣膜病心房颤动 非维生素K拮抗剂口服抗凝药 出血风险 老年 

分 类 号：R5[医药卫生—内科学]