达比加群酯治疗老年非瓣膜性房颤患者的效果观察  

Effect observation on elderly patients with non-valvular atrial fibrillation treated with dabigatran etexilate

作　　者：王学文[1] 李广平[1] 毕晓雪 张子钊 徐延敏[1] 刘彤[1] Wang Xuewen;Li Guangping;Bi Xiaoxue;Zhang Zizhao;Xu Yanmin;Liu Tong(Tianjin Key Laboratory of Ion and Molecular Function of Cardiovascular Diseases,Cardiology Department,The Second Hospital of Tianjin Medical University,Tianjin Institute of Cardiology,Tianjin 300211,China)

机构地区：[1]天津市心血管病离子与分子机能重点实验室、天津医科大学第二医院心脏科天津心脏病学研究所,天津300211

出　　处：《国际医药卫生导报》2024年第10期1604-1608,共5页International Medicine and Health Guidance News

基　　金：国家自然科学基金(82370320)。

摘　　要：目的探讨达比加群酯治疗老年非瓣膜性房颤患者对凝血功能、心功能的影响及不良反应和预后。方法本研究为随机对照试验,共纳入2020年1月至2023年9月期间天津医科大学第二医院130例老年非瓣膜性房颤患者。通过随机数字表法将患者分为A组(华法林治疗,43例)、B组(利伐沙班治疗,43例)和C组(达比加群酯治疗,44例)。A组男性22例,女性21例,年龄为(74.56±6.43)岁;心功能分级Ⅰ级23例、Ⅱ级20例。B组男性24例,女性19例,年龄为(73.89±6.21)岁;心功能分级Ⅰ级22例、Ⅱ级21例。C组男性20例,女性24例,年龄为(74.12±6.38)岁;心功能分级Ⅰ级23例、Ⅱ级21例。A组接受华法林钠片治疗,每日一次,起始剂量为2.5 mg,后根据国际标准化比值(INR)调整剂量,每次调整0.5mg,保持INR在2.0~3.0之间;B组接受利伐沙班片治疗,每次15mg,每日一次;C组接受达比加群酯胶囊治疗,每次110 mg,每日两次。疗程为2个月。对比3组患者肝肾功能指标[肌酐(Cr)、尿素氮(BUN)、丙氨酸氨基转移酶(ALT)、天门冬氨酸氨基转移酶(AST)]的水平、凝血功能[凝血酶时间(TT)、纤维蛋白原(FIB)、活化部分凝血活酶时间(APTT)、血浆凝血酶原时间(PT)]、心房颤动栓塞风险CHA2DS2-VASc评分、心房颤动抗凝出血风险HAS-BLED评分和不良反应(皮肤瘀斑、恶心呕吐、脑卒中、血尿)的发生情况,并随访3个月,统计3组的血栓栓塞形成率和出血情况。采用重复测量方差分析、χ^(2)检验、Fisher确切概率法。结果治疗2个月后,B组和C组Cr、BUN、ALT和AST水平低于A组,差异均有统计学意义(均P<0.05)。B组和C组TT、APTT、PT高于A组,FIB低于A组,差异均有统计学意义(均P<0.05)。A组、B组和C组CHA2DS2-VASc和HAS-BLED评分较治疗前略升高,但差异均无统计学意义(均P>0.05)。A组、B组和C组的不良反应发生率为16.28%(7/43)、4.65%(2/43)、2.27%(1/44);C组的不良反应发生率低于A组,差异有统计学意Objective To investigate the effects of dabigatran etexilate treatment on the coagulation function, cardiac function, adverse reactions, and prognosis in elderly patients with non-valvular atrial fibrillation. Methods This study was a randomized controlled trial. A total of 130 elderly patients with non-valvular atrial fibrillation admitted to the Second Hospital of Tianjin Medical University from January 2020 to September 2023 were included. The patients were divided into group A (warfarin treatment, 43 cases), group B (rivaroxaban treatment, 43 cases), and group C (dabigatran etexilate treatment, 44 cases) by the random number table method. Group A included 22 males and 21 females, aged (74.56±6.43) years;there were 23 cases of grade I and 20 cases of grade II cardiac function. Group B included 24 males and 19 females, aged (73.89±6.21) years;there were 22 cases of grade I and 21 cases of grade II cardiac function. Group C included 20 males and 24 females, aged (74.12±6.38) years;there were 23 cases of grade I and 21 cases of grade II cardiac function. Group A was treated with warfarin sodium tablets, once a day, starting at 2.5 mg and then adjusting the dose according to the international normalized ratio (INR) by 0.5 mg each time, keeping the INR between 2.0 and 3.0. Group B was treated with rivaroxaban tablets, 15 mg each time, once a day. Group C was treated with dabigatran etexilate capsules, 110 mg each time, twice a day. The course of treatment was 2 months. The levels of liver and kidney function indicators [creatinine (Cr), urea nitrogen (BUN), alanine aminotransferase (ALT), and aspartate aminotransferase (AST)], coagulation function indicators [thrombin time (TT), fibrinogen (FIB), activated partial thromboplastin time (APTT), and plasma prothrombin time (PT)], CHA2DS2-VASc scores of atrial fibrillation thromboembolic risk, HAS-BLED scores of atrial fibrillation anticoagulant bleeding risk, and adverse reactions (skin ecchymosis, nausea and vomiting, stroke, and hematuria) of the three groups were

关 键 词：达比加群酯 利伐沙班 华法林 非瓣膜性房颤 老年 预后 

分 类 号：R541.75[医药卫生—心血管疾病]