脉搏短绌与华法林抗凝治疗稳定性的相关性  

The correlation between Short pulse of light and the stability of warfarin anticoagulation

作　　者：丁斌俊 刘松涛 熊建华 罗潇 DING Bin-Jun;LIU Song-Tao;XIONG Jian-Hua(Department of geriatrics medicine,Fuzhou NO.1 People's Hospital,Fuzhou 344000,Jiangxi,China)

机构地区：[1]抚州市第一人民医院老年医学科,江西抚州344000 [2]江西省人民医院心血管内科 [3]九江市第一人民医院心血管内科

出　　处：《吉林医学》2025年第2期270-276,共7页Jilin Medical Journal

基　　金：2022年江西省卫生健康委员会科技计划项目[项目编号:202211818]。

摘　　要：目的:探索脉搏短绌对华法林抗凝稳定性的诊断预测价值。方法:选取2022~2023年113例使用华法林抗凝治疗且随访数据完整的持续性心房颤动患者作为研究对象,首先根据治疗窗内时间(TTR)是否≥70%将所有研究对象分为抗凝稳定性高质量组和抗凝稳定性非高质量组,比较两组研究对象在性别、年龄、合并疾病、脉搏短绌情况、血液学检查等方面的异同,并就相关指标进行二元Logistic回归分析,探索比较两组间存在差异且可能是TTR影响因素的相关参数,进而分析不同指标单独及联合使用对TTR的预测价值。结果:华法林抗凝稳定性高质量组与非高质量组之间在脉搏短绌、血小板(PLT)、血小板分布宽度(PDW)、红细胞体积分布宽度(RDW)、脂蛋白a[Lp(a)]比较,差异均有统计学意义(P<0.05),其中华法林抗凝高质量组脉搏短绌的发生程度较之于非高质量组呈现偏低趋势。二元Logistic回归分析显示脉搏短绌、年龄、PLT、RDW、平均红细胞体积(MCV)是华法林抗凝高质量与否的影响因素。脉搏短绌诊断华法林抗凝高质量的受试者工作特征(ROC)曲线下面积(AUC)为0.982(95%CI:0.964,1.000),灵敏度和特异度分别为0.933和0.941,约登指数为0.874,对应的最佳截断值为16.5。PLT诊断华法林抗凝高质量的AUC为0.626(95%CI:0.523,0.729),灵敏度和特异度分别为0.600和0.632,约登指数为0.232,对应的最佳截断值为189.5。RDW诊断华法林抗凝高质量的AUC为0.608(95%CI:0.499,0.717),灵敏度和特异度分别为0.489和0.735,约登指数为0.224,对应的最佳截断值为14.05%。PLT联合RDW诊断华法林抗凝高质量的AUC为0.651(95%CI:0.544,0.759),灵敏度和特异度分别为0.711和0.618,约登指数为0.329,对应的最佳截断值为0.352。结论:脉搏短绌对华法林抗凝稳定性的预测诊断价值良好。Objective To explore the predictive value of short pulse for the stability of warfarin anticoagulation.Method 113 patients with persistent atrial fibrillation who received warfarin anticoagulation therapy and had complete follow-up data from 2022 to 2023 were selected as the study subjects,first of all,according to the TTR event whether 70%or higher will all the research object was divided into anticoagulation stability high quality group and anticoagulation stability of high quality,The similarities and differences in gender,age,comorbidities,short pulse and hematological examination between the two groups were compared,and binary Logistic regression analysis was performed on related indicators to explore and compare the related parameters that were different between the two groups and may be the influencing factors of TTR,and then the predictive value of different indicators alone or in combination for TTR was analyzed.Results Warfarin anticoagulation stability between high quality group and the high quality in short light pulse,PLT,PDW,RDW,Lp(a)the comparison of the differences statistically significant(P<0.05),including warfarin anticoagulation quality set of short pulse of light compared to the high levels of group showed a trend of low quality.Binary Logistic regression analysis revealed that short pulse of light,age,PLT,RDW,the MCV was the influence factors of warfarin anticoagulation quality or not.Short light pulse diagnosis of warfarin anticoagulation quality AUC 0.982(95%CI:0.964,1.000),the sensitivity and specific degree were 0.933 and 0.941 respectively,about an indexwas 0.874,the corresponding optimal cutoff value of 16.5.The AUC of PLT for diagnosing high-quality warfarin anticoagulation was 0.626(95%CI:0.523,0.729),the sensitivity and specificity were 0.600 and 0.632,respectively,the Youden index was 0.232,and the corresponding best cut-off value was 189.5.The AUC of RDW for diagnosing high-quality warfarin anticoagulation was 0.608(95%CI:0.499,0.717),the sensitivity and specificity were 0.489 and

关 键 词：脉搏短绌 华法林 抗凝稳定性 诊断预测价值 

分 类 号：R541.7[医药卫生—心血管疾病]