Clinical study on influencing factors to stability of warfarin anticoagulant therapy in patients with persistent atrial fibrillation
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摘要: 目的 探索影响心房颤动(房颤)患者在使用华法林抗凝治疗过程中稳定性达标的因素，以期为改善华法林的抗凝质量提供参考。方法 选取2019年1月—2019年12月就诊于南昌大学附属九江医院(九江市第一人民医院)的337例使用华法林抗凝治疗的持续性房颤患者，计算分析华法林真实抗凝世界的稳定性达标率等参数，并分析包括年龄、性别、合并疾病、吸烟、饮酒、饮绿茶、血小板分布宽度是否升高等和华法林抗凝治疗稳定性的相关性。结果 华法林的抗凝治疗稳定性达标率为18.69%，影响华法林抗凝治疗稳定性达标的相关因素包括年龄、饮酒、饮绿茶以及血小板分布宽度升高，其中血小板分布宽度升高的心房颤动患者在随访过程中具有更低的华法林抗凝治疗稳定性达标率。结论 华法林抗凝治疗的稳定性达标率较低，年龄、饮酒、饮绿茶、血小板分布宽度升高会影响华法林抗凝治疗的稳定性。
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关键词:
- 华法林 /
- 心房颤动 /
- 抗凝治疗 /
- 稳定性 /
- 治疗范围内时间百分比
Abstract: Objective To explore the factors affectin g the stability of patients with atrial fibrillation during warfarin anticoagulant therapy, in order to provide reference for improving the anticoagulant quality of warfarin.Methods The 337 patients with persistent atrial fibrillation treated with warfarin were selected in Jiujiang Hospital Affiliated to Nanchang University(Jiujiang first people's Hospital) from January 2019 to December 2019. The stability compliance rate of warfarin in the real anticoagulant world was calculated and analyzed. Some factors including age, gender, combined diseases, smoking, drinking, drinking green tea and increased platelet distribution width were studied in study of stability of warfarin anticoagulant therapy.Results The compliance rate of anticoagulant stability of warfarin was 18.69%. The relevant factors affecting the compliance rate of anticoagulant stability of warfarin included age, drinking alcohol, drinking green tea, with the increase of platelet distribution width. Patients with atrial fibrillation with increased platelet distribution width had a lower compliance rate of anticoagulant stability of warfarin during follow-up.Conclusion The stability compliance rate of warfarin anticoagulant therapy is low. Age, drinking, drinking green tea and the increase of platelet distribution width will affect the stability of warfarin anticoagulant therapy.-
Key words:
- warfarin /
- atrial fibrillation /
- anticoagulant therapy /
- stability /
- time within therapeutic range
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表 1 华法林抗凝稳定性的单因素分析
Table 1. Single factor analysis of warfarin anticoagulation stability
例(%) 观察因素 高质量抗凝组(TTR≥65%)(63例) 非高质量抗凝组(TTR < 65%)(274例) χ2值 P 性别 0.183 0.669 男(174例) 31(49.2) 143(52.2) 女(163例) 32(50.8) 131(47.8) 年龄 8.291 0.016 < 65岁(126例) 16(25.4) 110(40.1) 65~74岁(120例) 32(50.8) 88(32.1) ≥75岁(91例) 15(23.8) 76(27.8) 合并疾病 高血压(146例) 27(42.9) 119(43.4) 0.007 0.934 糖尿病(103例) 13(20.6) 90(32.8) 3.599 0.058 冠心病(77例) 11(17.5) 66(24.1) 1.276 0.259 心力衰竭(122例) 29(46.0) 93(33.9) 3.242 0.072 脑卒中(94例) 15(23.8) 79(28.8) 0.642 0.423 血管疾病(39例) 10(15.9) 29(10.6) 1.400 0.237 生活习惯 吸烟(194例) 37(58.7) 157(57.3) 0.043 0.836 饮酒(155例) 19(30.2) 136(49.6) 7.822 0.005 饮绿茶(181例) 22(34.9) 159(58.0) 11.002 0.001 血液学指标 PDW升高(138例) 16(25.4) 122(44.5) 7.751 0.005 
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表 2 影响华法林抗凝稳定性的相关因素二元logistic回归分析结果
Table 2. Binary logistic regression analysis of related factors
影响因素 B SE Wals P OR(95%CI) 饮酒 0.891 0.314 8.061 0.005 2.438(1.318~4.510) 饮绿茶 0.953 0.303 9.872 0.002 2.594(1.431~4.701) PDW升高 1.011 0.331 9.299 0.002 2.747(1.435~5.259) 年龄 < 65岁 - - 9.023 0.011 - 65~74岁 0.087 0.406 0.046 0.831 1.091(0.492~2.418) ≥75岁 0.855 0.377 5.142 0.023 0.425(0.203~0.890)
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表 3 PDW比较
Table 3. Platelet distribution width comparison
X±S 组别 例数 男/例(%) 年龄/岁 平均随访/次 PDW/% TTR/% 高质量抗凝组 63 31(49.21) 68.06±9.59 9.22±3.41 15.83±2.68 77.67±10.63 非高质量抗凝组 274 132(53.44) 65.44±12.67 10.03±4.10 18.48±2.38 49.20±23.68
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