不同类型NOACs治疗老年房颤的效果及安全性研究  

Study on the efficacy and safety of different types of NOACs in the treatment of elderly atrial fibrillation

作　　者：冯磊 谢秀乐 张亚琦 Feng Lei;Xie Xiule;Zhang Yaqi(Cardiovascular Department of Xinyang Central Hospital,Xinyang,Henan,464000,China)

机构地区：[1]信阳市中心医院心血管内科,河南信阳464000

出　　处：《青岛医药卫生》2023年第5期378-382,共5页Qingdao Medical Journal

基　　金：河南省医学科技攻关项目(LHGJ2020021837):基于赖氨酸甲基转移酶SetD7调控在心血管疾病细胞损伤中的作用机制研究。

摘　　要：目的 观察不同新型口服抗凝药(NOACs)治疗老年心房颤动的效果及安全性。方法 本文为前瞻性研究,病例纳入信阳市中心医院2022年1月~2023年3月收治的109例老年房颤患者,采用电脑随机分组法将入组患者分为两组,分别列为达比加群酯组(55例)和利伐沙班组(54例),达比加群酯组按110mg/次,2次/d剂量服用达比加群酯治疗,利伐沙班组按2.5mg/次,2次/d剂量服用利伐沙班片治疗,比较两组患者的治疗效果及安全性。结果 在不同治疗方案下,达比加群酯组的活化部分凝血活酶时间(APTT)为(37.25±5.17)s,凝血酶原时间(PT)为(14.33±4.14)s,凝血酶时间(TT)为(14.39±4.25)s,略高于利伐沙班组[(36.44±5.11)s、(13.29±4.25)s、(13.66±4.11)s],差异无统计学意义(P>0.05)。达比加群酯组的内皮素-1(ET-1)为(15.25±5.16)pg/ml,一氧化氮(NO)为(30.25±5.17)ppb,略低于利伐沙班组[(16.62±5.41)pg/ml、(31.33±5.51)ppb],差异无统计学意义(P>0.05)。达比加群酯组的β-血小板球蛋白(β-TG)为(17.44±5.23)ng/ml,颗粒膜蛋白CD62P为(56.24±10.35)%,CD63为(10.22±3.18)%,低于利伐沙班组[(20.26±5.17)ng/ml、(60.38±10.25)%、(12.46±3.41)%],差异具有统计学意义(P<0.05)。达比加群酯组的栓塞性事件发生率为9.09%(5/55),出血性事件发生率为10.91%(6/55),均低于利伐沙班组[20.37%(11/54)、24.07%(13/54)],差异具有统计学意义(P<0.05)。达比加群酯组的药物相关副反应发生率为10.91%(6/55),略低于利伐沙班组14.81%(8/54),差异无统计学意义(P>0.05)。结论 达比加群酯及利伐沙班均可用于治疗老年房颤,二者均不会对患者凝血时间及血管内皮功能造成明显影响且用药安全性较高;但相比之下,达比加群酯在抑制血小板活性及降低栓塞性事件、出血性事件发生风险方面更具优势,或可成为治疗房颤的主要NOCAs。Objective Observe the efficacy and safety of different NOACs in the treatment of elderly atrial fibrillation.Methods This article is a prospective study,with case enrollment from January 2022 to March 2023.The study subjects were 109 elderly patients with atrial fibrillation.The enrolled patients were randomly divided into two groups using computer randomization,namely the dabigatran ester group(55 cases)and the rivashaban group(54 cases).The dabigatran ester group was treated with dabigatran ester at a dose of 110mg/dose twice a day,while the rivashaban group was treated with rivashaban tablets at a dose of 2.5mg/dose twice a day,Compare the treatment efficacy and safety of two groups of patients.Results Under different treatment regimens,the APTT,PT,and TT of the dabigatran ester group were(37.25±5.17)s,(14.33±4.14)s,and(14.39±4.25)s,which were slightly higher than those of rivasaban[(36.44±5.11)s,(13.29±4.25)s,and(13.66±4.11)s](P>0.05).The ET-1 and NO levels of the dabigatran ester group were(15.25±5.16)pg/ml and(30.25±5.17)ppb,slightly lower than those of the rivasaparin group[(16.62±5.41)pg/ml and(31.33±5.51)ppb](P>0.05).Dabigatran ester groupβ-TG was(17.44±5.23)ng/ml,CD62P was(56.24±10.35)%,and CD63 was(10.22±3.18)%,which was lower than that of the rivasab group[(20.26±5.17)ng/ml,(60.38±10.25)%,(12.46±3.41)%](P<0.05).The incidence of embolic events in the dabigatran ester group was 9.09%(5/55),and the incidence of hemorrhagic events was 10.91%(6/55),both lower than that of rivasaparin[20.37%(11/54)and 24.07%(13/54)](P<0.05).The incidence of drug-related side effects in the dabigatran ester group was 10.91%(6/55),slightly lower than that in the rivasaban group(14.81%(8/54)(P>0.05).Conclusion Both dabigatran ester and rivaroxaban can be used to treat elderly atrial fibrillation,and both do not have a significant impact on coagulation time and vascular endothelial function in patients,with high drug safety;However,in comparison,dabigatran ester has more advantages in inhibiting platelet activi

关 键 词：老年房颤 新型口服抗凝药 凝血时间 血小板活性 用药安全性 

分 类 号：R541.7[医药卫生—心血管疾病]