不同肾脏功能对非瓣膜性心房颤动患者使用口服抗凝药物临床结局的影响研究  

Effect of different renal function on clinical outcome of oral anticoagulant drugs in patients with nonvalvular atrial fibrillation

作　　者：岳云霄[1] YUE Yun-xiao(Department of Pharmacy,the First People's Hospital of Pingdingshan,Pingdingshan,Henan 467000,China)

机构地区：[1]平顶山市第一人民医院药学部,河南平顶山467000

出　　处：《医药论坛杂志》2024年第15期1621-1627,共7页Journal of Medical Forum

摘　　要：目的分析不同基线肾脏功能口服抗凝药物对非瓣膜性心房颤动(atrial fibrillation,AF)患者出院后1年内主要出血事件和缺血性卒中的影响。方法应用回顾性研究方法。选取2022年1月—2022年9月在平顶山市第一人民医院进行治疗的AF患者1893例。患者均进行口服抗凝药(oriented adaptive cross search,OACs)治疗。依据美国肾脏病基金会(NKF)肾脏病生存质量指导(KDOQI)工作组肾脏病/透析临床实践指南中对CKD的肾小球滤过率(glomeruar filtration rate,GFR)分期,根据患者的基线肾功能将其分为5组:组1,肾功能正常,GFR≥90 mL/(min·1.73 m^(2));组2,肾功能减退,GFR 60~89mL/(min·1.73 m^(2));组3,肾功能中度异常,45~59mL/(min·1.73 m^(2));组4,肾功能中重度异常,30~44mL/(min·1.73 m^(2));组5,肾功能重度异常,15~29 mL/(min·1.73 m^(2)),对比分析5组患者的基线资料和临床结局。应用logistic回归方法分析影响患者临床结局的抗凝药物因素。结果相较于组3,组1、组2是应用华法林钠患者发生缺血性卒中的保护因素;组4、组5是应用华法林钠患者发生缺血性卒中的危险因素。相较于组3,组1、组2是应用华法林钠患者发生主要出血事件的保护因素;组4、组5是应用华法林钠患者发生主要出血事件的危险因素。相较于组3,组1、组2是应用利伐沙班患者发生缺血性卒中的保护因素;组4、组5是应用利伐沙班患者发生缺血性卒中的危险因素。相较于组3,组1、组2是应用利伐沙班患者发生主要出血事件的保护因素;组4、组5是应用利伐沙班患者发生主要出血事件的危险因素。相较于组3,组1、组2是应用达比加群酯患者发生缺血性卒中的保护因素;组4、组5是应用达比加群酯患者发生缺血性卒中的危险因素。相较于组3,组1、组2是应用达比加群酯患者发生主要出血事件的保护因素;组4、组5是应用达比加群酯患者发生主要出血事件的危险因素。结�Objective To analyze the effects of oral anticoagulants on major bleeding events and ischemic stroke within 1 year after discharge under different baseline renal function.Methods The retrospective study method was applied.A total of 1893 AF patients treated in our hospital from January 2022 to September 2022 were selected.All patients were treated with OACs.Glomeruar filtration rate(GFR)staging of CKD according to the American Kidney Disease Foundation(NKF)Quality of Life Guidelines for Kidney Disease(KDOQI)Working Group Renal/Dialysis Clinical Practice Guidelines,patients were divided into 5 groups according to baseline renal function:group 1,Normal kidney function,GFR≥90 mL(min·1.73m^(2));group 2,Hyporenal function,GFR60-89 mL(min·1.73m^(2));group 3,Moderately abnormal renal function,45-59 mL(min·1.73m^(2));group 4,Moderate to severe renal dysfunction,30-44 mL(min·1.73m^(2));group 5,Severe renal dysfunction,15-29 mL(min·1.73m^(2)).Baseline data and clinical outcomes of the 5 groups were compared.Logistic regression was used to analyze the factors of anticoagulant drugs affecting the clinical outcome of patients.Results Compared with group 3,group 1 and group 2 were the protective factors of ischemic stroke in patients treated with warfarin;group 4 and group 5 were the risk factors of ischemic stroke in patients treated with warfarin.Compared with group 3,group 1 and group 2 were the protective factors of major bleeding events in patients treated with warfarin;group 4 and group 5 were the risk factors of major bleeding events in patients treated with warfarin.Compared with group 3,group 1 and group 2 were the protective factors of ischemic stroke in patients treated with apixaban;group 4 and group 5 were the risk factors of ischemic stroke in patients treated with apixaban.Compared with group 3,group 1 and group 2 were the protective factors of major bleeding events in patients treated withapixaban;group 4 and group 5 were the risk factors of major bleeding events in patients treated with apixaban.Compare

关 键 词：肾功能 非瓣膜性心房颤动 抗凝药物 安全性 

分 类 号：R541.7[医药卫生—心血管疾病]