老年共病NVAF血栓形成高危患者出血评分相关因子分析

成海娟; 邓捷; 张倩榕; 周潇; 刘双玉; 金爱萍

doi:10.12125/j.chj.202103081

老年共病NVAF血栓形成高危患者出血评分相关因子分析

Analysis of related factors of bleeding score in elderly patients with high risk of thrombosis of comorbid non valvular atrial fibrillation

摘要

摘要:
目的通过对老年共病非瓣膜性房颤（nonvalvular atrial fibrillation, NVAF）患者血低密度脂蛋白胆固醇(LDL-C)与HAS-BLED出血评分的相关性分析，进而为该类患者的调脂及抗凝治疗提供理论依据。
方法根据纳入及排除标准，入选西安交通大学第二附属医院在2018.01~2020.06期间干二病区及心血管内科住院CHA2DS2-VASc≥2 分的老年共病NVAF患者260例(女，156)，根据HAS-BLED评分将其分为出血低危组(HAS-BLED<3分，n = 156)和出血高危组(HAS-BLED≥3分，n = 104)，采用Logistic回归及Pearson相关分析LDL-C与HAS-BLED评分的相关关系。
结果出血低危组LDL-C(2.3 ± 0.8) mmol/L水平显著高于高危组(2.0 ± 0.6)mmol/L (P<0.01)。Pearson相关分析显示，LDL-C(r = −0.197)与HAS-BLED呈显著负相关（P<0.01）。Logistic回归分析显示，LDL-C<1.8 mmol/L与HAS-BLED评分显著正相关，校正混杂因素后，该相关性仍然独立存在(OR = 0.310，95%CI：0.117-0.820，P=0.018)，而LDL-C<2.6 mmol/L与HAS-BLED出血风险无明显相关。
结论血栓形成高危(CHA2DS2-VAS≥2分)的老年共病NVAF患者抗凝治疗中，LDL-C<1.80 mmol/L可能是其出血风险增加的危险因素之一，建议此类人群抗凝治疗中，如果LDL-C水平控制在1.8 mmol/L以下，需要慎重。

Abstract:
AIM To study the correlation between low density lipoprotein cholesterol (LDL-C) and HAS-BLED bleeding score in elderly patients with comorbid nonvalvular atrial fibrillation for lipid-lowering and anticoagulant therapy.
METHODS According to the criterion, 260 elderly patients of our hospital from January 2018 to June 2020 with comorbid nonvalvular atrial fibrillation (NVAF) and CHA2DS2-VASc≥2 were recruited. According to the HAS-BLED score, they were divided into low-risk group (HAS-BLED < 3, n = 156) and high-risk group (HAS-BLED ≥ 3, n = 104), Binary logistic regression and Pearson correlation were used to analyze the correlation between the LDL-C and the HAS-BLED score.
RESULTS The LDL-C level of low-bleed-risk group (2.3 ± 0.8) mmol/L was significantly higher than that in high-bleeding-risk group (2.0 ± 0.6 mmol/L). Pearson correlation analysis showed that there was a significant correlation between HAS-BLED and LDL-C (r = −0.197, P<0.01). Binary logistic regression analysis showed that LDL-C<1.8 mmol/l was positively correlated with the increased risk of bleeding. After adjusting for confounding variables, the correlation still existed independently (OR = 0.310, 95%CI: 0.117-0.820, P = 0.018). No significant association was found between lower LDL-C level (<2.6 mmol/L) and HAS-BLED groups.
CONCLUSION LDL-C<1.8 mmol/L may be one of the risk factors of increased risk of bleeding in elderly patients with comorbidity non-valvular atrial fibrillation and high risk of thrombosis (CHA2DS2-VASC≥2). It is suggested that the level of LDL-C of patients with this disease should be carefully controlled less than 1.8 mmol/L.

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