anti-FⅩa对服用利伐沙班抗凝的NVAF患者出血事件的预测价值  

Predictive value of anti-FⅩa for bleeding events in patients with NVAF taking rivaroxaban anticoagulation

作　　者：彭飞飞 蒋亚萍[2] PENG Feifei;JIANG Yaping(Department of Neurology,Taizhou First People’s Hospital,Taizhou 318020,Zhejiang,China;Department of Laboratory,Taizhou First People’s Hospital,Taizhou 318020,Zhejiang,China)

机构地区：[1]台州市第一人民医院神经内科,浙江台州318020 [2]台州市第一人民医院检验科,浙江台州318020

出　　处：《中国现代医生》2023年第22期22-25,共4页China Modern Doctor

基　　金：浙江省医药卫生科技计划项目(2020KY1043)。

摘　　要：目的探讨抗活化因子Ⅹ活性试验(anti-FⅩactivityassay,anti-FⅩa)对服用利伐沙班抗凝的非瓣膜性心房颤动(non-valvular atrial fibrillation,NVAF)患者出血事件的预测价值。方法选取2020年1月至2022年1月台州市第一人民医院收治的190例服用利伐沙班抗凝的NVAF患者,根据患者年龄将其分为<65岁组(40例)、65~75岁组(52例)和>75岁组(98例)。以发色底物法进行anti-FⅩa检测,测定利伐沙班的血药浓度。采用受试者操作特征曲线(receiver operating characteristic curve,ROC曲线)分析anti-FⅩa对出血事件的预测效能,采用Kaplan-Meier法进行生存分析。结果随着年龄的增加,患者利伐沙班峰值和谷值浓度及出血事件发生率均逐渐升高(P<0.05)。发生出血事件患者的峰值和谷值浓度均显著高于未发生出血事件患者(P<0.05)。峰值浓度对总体人群、65~75岁组、>75岁组患者出血事件预测的临界值分别为186.43ng/ml、201.18ng/ml和212.63ng/ml时,敏感度分别为81.62%、81.82%和91.89%;谷值浓度的预测临界值分别为34.36ng/ml、36.72ng/ml和38.42ng/ml时,敏感度分别为83.67%、90.91%和94.59%,但特异性均较低。以38.42ng/ml为谷值浓度的临界值,随访90d时谷值浓度高于临界值的患者出血事件风险大于低于临界值的患者,且出血事件随时间延长呈加重趋势(P<0.05)。结论高龄和发生出血事件患者的利伐沙班峰值和谷值浓度均升高,而谷值浓度的升高可预测90d内出血事件发生风险。Objective To investigate the predictive value of anti-FⅩactivity assay(anti-FⅩa)for bleeding events in patients with non-valvular atrial fibrillation(NVAF)taking rivaroxaban anticoagulation.Methods A total of 190 NVAF patients taking rivaroxaban anticoagulant treated in Taizhou First People’s Hospital from January 2020 to January 2022 were selected and divided into<65 years old group(40 cases),65-75 years old group(52 cases)and>75 years old group(98 cases)according to their age.The serum concentration of rivaroxaban was determined by anti-FⅩa assay using chromogenic substrate method.The predictive efficacy of anti-FⅩa on bleeding events was analyzed by receiver operating characteristic(ROC)curve,and survival analysis was performed by Kaplan-Meier method.Results With the increase of age,the peak and valley concentrations of rivaroxaban and the incidence of bleeding events were gradually increased(P<0.05).The peak and valley concentrations in patients with bleeding events were significantly higher than those in patients without bleeding events(P<0.05).The critical values of peak concentration for predicting bleeding events in the general population,65-75 years old group and>75 years old group were 186.43ng/ml,201.18ng/ml and 212.63ng/ml,and the sensitivities were 81.62%,81.82%and 91.89%,respectively.While the critical values of valley concentration were 34.36ng/ml,36.72ng/ml and 38.42ng/ml,the sensitivities were 83.67%,90.91%and 94.59%,respectively,but the specificities were all low.Taking 38.42ng/ml as the critical value of the valley concentration,the risk of bleeding events in the patients above the critical value was greater than that in the patients below the critical value at 90 days of follow-up,and the bleeding events showed an aggravating trend with the extension of time(P<0.05).Conclusion The peak and valley concentrations of rivaroxaban increased in the elderly and patients with bleeding events,and the increase of the valley concentration can predict the risk of bleeding events within 90 days.

关 键 词：抗活化因子Ⅹ活性试验 利伐沙班 非瓣膜性心房颤动 缺血性脑卒中 出血事件 

分 类 号：R541[医药卫生—心血管疾病]