不同强度华法林抗凝治疗高龄稳定性冠心病合并非瓣膜性心房颤动患者的临床研究

周冰洁 李玉梅 罗向卫

【摘要】 目的：探究不同強度华法林抗凝治疗高龄稳定性冠心病（coronary heart disease，CHD合并非瓣膜性心房颤动（nonvalvular atrial fibrillation，NVAF）的临床价值。方法：选取2016年10月-2017年10月在本院治疗的稳定性CHD合并NVAF的高龄患者143例为研究对象，根据随机数字法将研究对象分为S组72例和L组71例。S组采用标准计量的华法林治疗，L组采用低剂量华法林治疗，并对患者进行为期1年的随访观察。分析并比较两组的临床复合终点以及安全终点情况，并比较两组的平均华法林用量和INR水平。结果：两组的肺栓塞、缺血性脑卒中、无症状脑卒中、全因死亡、脑出血、胃出血的发生率比较，差异均无统计学意义（P>0.05）。L组和S组的外周血管栓塞率分别为10.14%和1.45%，L组高于S组（字2=4.777，P=0.029）;L组和S组的腔隙性脑梗死率分别为14.49%和4.35%，L组高于S组（字2=4.161，P=0.041）;L组和S组的皮肤黏膜出血率分别为4.35%和15.94%，L组低于S组（字2=5.088，P=0.024）;L组和S组的牙龈出血率分别为2.90%和14.49%，L组低于S组（字2=5.841，P=0.016）;L组和S组的肾出血率分别为1.45%和10.14%，L组低于S组（字2=4.777，P=0.029）。结论：对高龄稳定性冠心病合并非瓣膜AF患者采用不同浓度的华法林治疗，临床复合终点及安全终点相似，但低剂量的华法林安全性更好。

【关键词】 华法林; 稳定性冠心病; 房颤

【Abstract】 Objective：To explore the different intensity Warfarin anticoagulant therapy-stability of coronary heart disease（coronary heart diseases，CHD nonvalvular atrial fibrillation（nonvalvular atrial fibrillation，NVAF）clinical value.Method：143 elderly patients with stable CHD combined with NVAF who were treated in our hospital from October 2016 to October 2017 were selected as study subjects.The subjects were divided into S group and L group according to the random number method.The S group was treated with standard Warfarin，while the L group was treated with low-dose Warfarin.Patients were followed up for one year.The clinical composite endpoints and safety endpoints of the two groups were analyzed and compared，the mean warfarin dosage and INR levels of the two groups were compared.Result：There was no significant difference in the incidence of pulmonary embolism，ischemic stroke，asymptomatic stroke，all-cause death，cerebral hemorrhage and gastric hemorrhage between the two groups（P>0.05）.The rates of peripheral vascular embolism in group L were 10.14% higher than group S of 1.45%（字2=4.777，P=0.029）.The lacunar infarction rate of group L was 14.49% higher than group S of 4.35%（字2=4.161，P=0.041）.The rate of cutaneous mucosal hemorrhage in group L was 4.35% lower than group S of 15.94%（字2=5.088，P=0.024）.The gingival bleeding rate of group L was 2.90% lower than group S of 14.49%（字2=5.841，P=0.016）.The renal bleeding rate of group L was 1.45% lower than group S of 10.14%（字2=4.777，P=0.029）.Conclusion：warfarin of different concentrations was used in elderly patients with stable coronary heart disease complicated with non-valvular AF.The clinical composite endpoint and safety endpoint were similar，but the safety of low-dose warfarin was better.

可见，不同剂量的华法林均可有效的治疗高龄稳定性CHD合并非瓣膜性AF，但是低剂量时的安全性相对更好。但是由于个体差异、地域差异等原因，本研究还需要增加样本量进一步研究。

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