房颤论文

彭雪梅 13651072675

北京市房山区第一医院心内科（102400）

龙德勇 马长生

北京市首都医科大学附属安贞医院

北京市房山区65岁以上老年非瓣膜性房颤

华法林抗凝的临床研究

彭雪梅 龙德勇 马长生

【摘要】

目的：研究适宜剂量的华法林对北京市房山区65岁以上老年无其他危险因素的非瓣膜性房颤患者的影响及抗凝治疗情况。 方法：对北京市房山区65岁以上老年无其他危险因素的非瓣膜性房颤患者的抗凝治疗情况的临床资料进行分析。分为阿司匹林组和调整剂量华法林组。常规门诊随访，记录患者的终点事件和不良反应发生情况。主要终点事件是缺血性脑卒中和死亡。次要终点事件包括短暂性脑缺血发作， 腔隙性脑梗死、外周动脉栓塞、急性心肌梗死和严重出血。

结果：入选病例共937例，有效病例870例，失访67例, 脱落率为7.1%。男592例，女278例;年龄77. 9士5. 87 岁; 随访时间 19. 2士2.1个月(最短随访时间8个月).所有患者均为

持续性房颤，合并高血压的患者563例,占64.7%,冠心病患者446例，占51.3%，孤立性房颤180例，占20.69%。阿司匹林组399例，年龄 76.8士7.92岁;华法林组471例，年龄77. 6士6.33岁。两组在年龄、性别、合并高血压、冠心病和合并心血管用药等方面差异无统计学意义。华法林组较阿司匹林组危险率降低62% [ 1.06 %比 6.52 % , P = 0. 04 ， OR 0. 4， 95%可信区间(CI)为0. 196-- 0. 980 ]。 缺血性脑卒中的相对危险下降68%(0.42%比4.76% , P=0. 04， OR 0. 39， 95% CI为0. 144~ 0.963);华法林组总死亡率低于阿司匹林组（2例比12例，P=0.02），两组之间差异有统计学意义 。包括主要和次要终点的联合终点事件华法林组低于阿司匹林组(2.97%比13·03%,P=0·04 )。

结论：北京市房山区老年患者是房颤的主要患病人群，这些患者绝大多数同时合并卒中危险因素。对于老年房颤患者，华发林的保护作用与既往研究相似。但是，中度强度的抗凝治疗保护作用最大，出血并发症的发生比例最小。本研究表明，至少对于老年患者，即使无任何其它危险因素，给予华发林治疗也是合理的。因为华发林可以在一定范围内更大程度的降低卒中并发症发生率。这为进一步的随机对照研究提供了证据。

【关键词】 心房颤动; 华法林; 阿司匹林； 抗凝治疗

The study of anticoagulation in patients over 65 years

old in Beijing with nonvalvular

atrial fibrillation

【Abstract】

Objective: to study the optimal intensity of

warfarin therapy for prevention of thromboembolism in patients over 65 years old in Beijing have no other dangerous factors with nonvalvular atrial fibrillation .

Methods：The clinic data of patients over 65 years old in

Beijing with nonvalvular atrial fibrillation were analyzed. Those diagnosed as having nonvalvular atrial fibrillation received aspirin 150 mg-160 mg once daily or adjusted-dose warfarin ( international normalized ratio, 2. 0-3. 0). We compared the effect of the two therapies on the primary end point of ischemic stroke or death from any cause and on the combined end-point ( stroke,

death, peripheral arteries embolism, TIA, acute myocardial infarction, serious bleeding) during a median follow-up period of 19.2士2.1 months. All patients were permanent AF ,563 patients with hypertension (64.7%) and 446 patients with coronary artery disease (51.3%).399 patients in aspirin group,the average patient age was 76.8士7.92 years and 471 patients in warfarin groups , the average patient age was 77. 6士6.33 years .There was no significant differences between the two groups in age ,sex and medicine.

Results：Of the 870 patients, 278 ( 31. 9% ) were female.

The average age was ( 77.9±5.87) years. The follow-up period was 19.2士2.1 months. The mean dose of warfarin was (3. 0±0. 3) mg. Compared with aspirin, the primary end point of death or ischemic stroke was reduced by warfarin (1.06% vs 6.52% ,P=0. 04,OR0. 4, 95%CI0. 196-0. 980) and the relative risk decreased by 68%. There was significant difference of the mortality rate between the two groups ( 2 vs 12 ，P=0.02）.The secondary end point was nonsignificantly reduced in the warfarin group than that in the aspirin group, while the combined end point statistically decreased by adjusted-dose warfarin(2.97% vs 13.03%,P=0.04).

Conclusions: The patients over 65 years old of

Fangshan,Beijing, were highly vulnerable to nonvalvular