發(fā)布時(shí)間：2018-01-12 20:41

  本文關(guān)鍵詞：紅細(xì)胞分布寬度對(duì)陣發(fā)性非瓣膜性房顫患者導(dǎo)管消融術(shù)后服用達(dá)比加群出血風(fēng)險(xiǎn)預(yù)測(cè)的研究　出處：《南京醫(yī)科大學(xué)》2017年博士論文　論文類型：學(xué)位論文

  更多相關(guān)文章： 紅細(xì)胞分布寬度 非瓣膜性房顫 導(dǎo)管消融 HAS-BLED評(píng)分 達(dá)比加群 安全性

【摘要】：目的:諸多研究表明紅細(xì)胞分布寬度(red cell distribution width,RDW)與心血管疾病如冠心病、心力衰竭、房顫等的發(fā)生及預(yù)后有關(guān),HAS-BLED評(píng)分系統(tǒng)是目前使用最廣泛的房顫出血風(fēng)險(xiǎn)評(píng)估體系,本研究旨在探討RDW與HAS-BLED評(píng)分之間的相關(guān)性以及對(duì)陣發(fā)性非瓣膜性房顫患者導(dǎo)管消融術(shù)后服用達(dá)比加群酯(11Omg b.i.d)過程中發(fā)生真實(shí)出血事件的預(yù)測(cè)價(jià)值。方法:1.納入2014年1月至2015年1月在江蘇省人民醫(yī)院住院行導(dǎo)管消融的陣發(fā)性非瓣膜性房顫(non-valvular atrial fibrillation,NVAF)患者172例,入院前均于門診給予達(dá)比加群酯(Dabigatranetexilate,DE)110mg,一天兩次,口服三周,所有患者入院時(shí)記錄年齡、性別、身高、體重、高血壓史、糖尿病史、腦卒中史等臨床資料,計(jì)算入選患者入院時(shí)的HAS-BLED評(píng)分,入院后次日清晨空腹?fàn)顟B(tài)DE谷濃度時(shí)采集血液樣本,主要的監(jiān)測(cè)項(xiàng)目包括血常規(guī)、活化部分凝血酶原時(shí)間(activated partial thromboplastin time,APTT)、肝腎功能等。2.根據(jù)HAS-BLED評(píng)分將受試者分為高HAS-BLED評(píng)分組(≥3分)和低HAS-BLED評(píng)分組(3分),利用Sperman相關(guān)性分析比較RDW與HAS-BLED評(píng)分的相關(guān)性,利用受試者工作特征曲線(receiver operating characteristic curve,ROC)判斷RDW對(duì)高HAS-BLED評(píng)分的預(yù)測(cè)價(jià)值。利用多因素Logistic回歸分析判斷RDW是否可以作為高HAS-BLED評(píng)分的獨(dú)立預(yù)測(cè)因素。3.所有患者導(dǎo)管消融術(shù)后隨診3個(gè)月,觀察終點(diǎn)為出血事件的發(fā)生,利用ROC曲線分析RDW對(duì)消融術(shù)后服用DE過程中發(fā)生出血事件的預(yù)測(cè)價(jià)值,多變量Cox回歸分析用于評(píng)估RDW是否可以作為發(fā)生出血事件的獨(dú)立預(yù)測(cè)因素。結(jié)果:1.高HAS-BLED評(píng)分組的RDW值明顯高于低HAS-BLED評(píng)分(13.96±0.93%比13.08±1.03%,P=0.000)。PDW值與HAS-BLED評(píng)分呈正相關(guān)(r=0.393,P0.0001)。用RDW值預(yù)測(cè)高HAS-BLED評(píng)分的ROC曲線下面積為 0.796(95%CI:0.740-0.844,P0.0001)。多因素 Logistic 回歸顯示:高RDW值可作為高HAS-BLED評(píng)分的獨(dú)立預(yù)測(cè)因素(OR:1.33,95%CI:1.10-1.56,p=0.031)。2.所有患者術(shù)后隨診3個(gè)月,共有13例出血事件,其中皮下出血4例,牙齦出血3例,泌尿道出血3例,球結(jié)膜出血3例。利用RDW值預(yù)測(cè)出血事件發(fā)生的 ROC 曲線下面積為 0.737(95%CI:0.616-0.875,P0.001),截點(diǎn)為 13.25%。多變量Cox回歸分析顯示:高RDW可作為發(fā)生出血事件的獨(dú)立預(yù)測(cè)因素(HR:1.91,95%CI:1.03-3.98,P=0.031)。結(jié)論:1.RDW值與HAS-BLED評(píng)分呈正相關(guān),對(duì)高HAS-BLED評(píng)分有一定的預(yù)測(cè)價(jià)值,且可作為高HAS-BLED評(píng)分的獨(dú)立預(yù)測(cè)因素。2.RDW值與陣發(fā)性NVAF患者消融術(shù)后服用DE(11Omg,2/日)出血事件的發(fā)生有相關(guān)性,當(dāng)RDW值≥13.25%時(shí)提示發(fā)生出血事件的風(fēng)險(xiǎn)增加。高RDW值可作為陣發(fā)性NVAF患者消融術(shù)后服用DE過程中發(fā)生出血事件的獨(dú)立預(yù)測(cè)因素。
[Abstract]:Objective: many studies have shown that red cell distribution RDWs are associated with cardiovascular diseases such as coronary heart disease and heart failure. The occurrence and prognosis of atrial fibrillation are related to the HAS-BLED scoring system, which is currently the most widely used risk assessment system for atrial fibrillation bleeding. The purpose of this study was to investigate the correlation between RDW and HAS-BLED scores and to evaluate the effect of dabiganin 11Omg b.i.dafter catheter ablation in patients with paroxysmal non-valvular atrial fibrillation (PAF). Predictive value of true haemorrhage events during the course. Methods: 1.Paroxysmal non-valvular atrial fibrillation (PAF), including catheter ablation in Jiangsu Provincial people's Hospital from January 2014 to January 2015, was included. Non-valvular atrial fibrillation. 172 NVAFs were treated with Dabigatranetexilate (Dabigatranetexilate) 110mg before admission, twice a day for three weeks. Age, sex, height, weight, history of hypertension, history of diabetes, history of stroke and other clinical data were recorded at admission in all patients. The HAS-BLED scores were calculated on admission. Blood samples were collected early in the morning after admission to the fasting state of DE. The main monitoring items included blood routine. Activated partial prothrombin time and activated partial thromboplastin (APTT). According to the HAS-BLED score, the subjects were divided into high HAS-BLED score group (鈮，

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