2024 年第 1 期 第 19 卷

非瓣膜性心房颤动患者服用新型口服抗凝药发生消化道出血的危险因素分析

Risk factors of gastrointestinal bleeding in patients with non-valvular atrial fibrillation taking new oral anticoagulants

作者：魏梦珂 孙亚梅 陈雪 张杰

英文作者：Wei Mengke Sun Yamei Chen Xue Zhang Jie

单位：首都医科大学附属北京安贞医院消化内科，北京100029

英文单位：Department of Gastroenterology Beijing Anzhen Hospital Capital Medical University Beijing 100029 China

关键词：非瓣膜性心房颤动；新型口服抗凝药；消化道出血；危险因素

英文关键词：Non-valvularatrialfibrillation;Neworalanticoagulants;Gastrointestinalbleeding;Riskfactors

• 摘要：

• 目的  探讨非瓣膜性心房颤动患者服用新型口服抗凝药发生消化道出血的危险因素。方法  选取2016年1月至2023年5月在首都医科大学附属北京安贞医院住院的因非瓣膜性心房颤动服用新型口服抗凝药的患者，纳入在住院期间发生消化道出血的患者作为出血组，根据年龄、性别及新型口服抗凝药的类型和剂量进行1∶2随机匹配，纳入在住院期间未发生消化道出血的患者作为未出血组。收集2组患者一般资料、合并症、药物使用、化验指标等信息。采用Logistic回归分析探讨非瓣膜性心房颤动患者服用新型口服抗凝药发生消化道出血的危险因素，绘制受试者工作特征(ROC)曲线并计算曲线下面积(AUC)以评估危险因素对非瓣膜性心房颤动患者服用新型口服抗凝药发生消化道出血的预测价值。结果  共纳入服用新型口服抗凝药的患者153例，其中出血组患者51例，未出血组患者102例。出血组患者合并冠心病（冠状动脉粥样硬化性心脏病）、心功能不全、既往消化道出血史、消化性溃疡、贫血、慢性肾功能不全、静脉血栓栓塞症、周围血管病比例均高于未出血组（均P＜0.05）。出血组患者的基线血红蛋白水平低于未出血组，中性粒细胞百分比、血尿素氮、D-二聚体水平高于未出血组（均P＜0.05）。多因素Logistic回归分析结果显示，冠心病(比值比=4.678,95%置信区间：1.600～13.677)、既往消化道出血史(比值比=9.906,95%置信区间：1.449～67.742)、慢性肾功能不全(比值比=4.893,95%置信区间：1.122～21.330)、贫血(比值比=13.487,95%置信区间：1.847～98.496)、D-二聚体(比值比=1.001,95%置信区间：1.000～1.003)是新型口服抗凝药治疗非瓣膜性心房颤动时发生消化道出血的独立危险因素。联合上述指标绘制ROC曲线，曲线下面积（AUC）为0.905（95%置信区间：0.854～0.955,P＜0.001）。结论  冠心病、既往消化道出血史、慢性肾功能不全、贫血、D-二聚体是非瓣膜性心房颤动患者服用新型口服抗凝药发生消化道出血的独立危险因素。

• Objective  To investigate risk factors of gastrointestinal bleeding in patients with non-valvular atrial fibrillation taking new oral anticoagulants. Methods  Patients with non-valvular atrial fibrillation taking new oral anticoagulants who were hospitalized in Beijing Anzhen Hospital, Capital Medical University from January 2016 to May 2023 were enrolled. Patients with gastrointestinal bleeding during hospitalization were enrolled as the bleeding group, and were randomly matched 1∶2 according to age, sex, and type and dose of new oral anticoagulants. Patients without gastrointestinal bleeding during hospitalization were included as the non-bleeding group. The general information, comorbidities, drug use, laboratory indicators and other information of patients in the two groups were collected. Logistic regression analysis was used to explore the risk factors of gastrointestinal bleeding in patients with non-valvular atrial fibrillation taking new oral anticoagulants. The receiver operating characteristic (ROC) curve was drawn and the area under the curve (AUC) was calculated to evaluate the predictive value of risk factors for gastrointestinal bleeding in patients with non-valvular atrial fibrillation taking new oral anticoagulants. Results  A total of 153 patients taking new oral anticoagulants were enrolled, including 51 patients in bleeding group and 102 patients in non-bleeding group. The proportions of patients with coronary atherosclerotic heart disease, cardiac insufficiency, previous gastrointestinal bleeding history, peptic ulcer, anemia, chronic renal insufficiency, venous thromboembolism and peripheral vascular disease in the bleeding group were higher than those in the non-bleeding group (all P<0.05). The level of hemoglobin in bleeding group was lower than that in non-bleeding group, and the levels of neutrophil percentage, blood urea nitrogen and D-dimer were higher than those in non-bleeding group (all P<0.05). Multivariate Logistic regression analysis showed that coronary atherosclerotic heart disease ［odds ratio (OR)=4.678, 95% confidence interval (CI): 1.600-13.677］, history of gastrointestinal bleeding (OR=9.906, 95%CI:1.449-67.742), chronic renal insufficiency (OR=4.893, 95%CI:1.122-21.330), anemia (OR=13.487, 95%CI:1.847-98.496), and D-dimer (OR=1.001, 95%CI:1.000-1.003) were independent risk factors for gastrointestinal bleeding in the treatment of non-valvular atrial fibrillation with new oral anticoagulants. ROC curve was drawn by combining the above indicators, and the AUC was 0.905 (95%CI:0.854-0.955, P＜0.001). Conclusion  Coronary atherosclerotic heart disease, history of gastrointestinal bleeding, chronic renal insufficiency, anemia and D-dimer are independent risk factors for gastrointestinal bleeding in patients with non-valvular atrial fibrillation treated with new oral anticoagulants.