CAJ | 학술논문

目的:探讨不同国际标准化比率(INR)对伴有慢性肾功能衰竭(CRF)的心房颤动患者缺血性脑卒中(CIS)及出血风险的影响.方法:将伴有CRF的心房颤动患者随机分成观察组46例和对照组46例,两组均给予华法林抗凝治疗,但观察组INR控制目标1.5~2.5,对照组INR控制目标2.0~3.0,对其进行随访,比较两组随访期间出血风险和CIS风险比例.结果:观察组和对照组随访时间分别为15.83(7.32~28.53)月和16.12(7.41~29.42)月,两组比较差异无统计学意义(P>0.05);观察组随访期间INR实际控制值为(2.12±0.31)高于对照组(2.58±0.40),差异有统计学意义(P<0.05).随访期间观察组和对照组CIS发生率分别为2.19/100患者年和4.36/100患者年,两组比较差异无统计学意义(HR=0.79,P<0.05);随访期间观察组出血发生率(6.49/100患者年)显著低于对照组(21.38/100患者年),两组比较差异有统计学意义(HR=2.12,P<0.05).结论:适当下调伴有CRF的心房颤动患者华法林抗凝的INR可大大降低出血风险,且不增加CIS发生率.
목적:탐토불동국제표준화비솔(INR)대반유만성신공능쇠갈(CRF)적심방전동환자결혈성뇌졸중(CIS)급출혈풍험적영향.방법:장반유CRF적심방전동환자수궤분성관찰조46례화대조조46례,량조균급여화법림항응치료,단관찰조INR공제목표1.5~2.5,대조조INR공제목표2.0~3.0,대기진행수방,비교량조수방기간출혈풍험화CIS풍험비례.결과:관찰조화대조조수방시간분별위15.83(7.32~28.53)월화16.12(7.41~29.42)월,량조비교차이무통계학의의(P>0.05);관찰조수방기간INR실제공제치위(2.12±0.31)고우대조조(2.58±0.40),차이유통계학의의(P<0.05).수방기간관찰조화대조조CIS발생솔분별위2.19/100환자년화4.36/100환자년,량조비교차이무통계학의의(HR=0.79,P<0.05);수방기간관찰조출혈발생솔(6.49/100환자년)현저저우대조조(21.38/100환자년),량조비교차이유통계학의의(HR=2.12,P<0.05).결론:괄당하조반유CRF적심방전동환자화법림항응적INR가대대강저출혈풍험,차불증가CIS발생솔.
Objective:To explore the effect of different international normalized ratio(INR) on the risk of cerebral ischemic stroke (CIS) and bleeding in atrial ifbrillation (AF) patients with chronic renal failure (CRF).Methods: 92 AF patients with CRF were randomly divided into the observation group (n=46) and the control group (n=46). They all received the treatment of warfarin, but the control target of INR in the observation group was 1.5-2.5, and the control target of INR in the control group was 2.0-3.0. The incidence rates of CIS and bleeding were compared between the two groups during the follow-up.Results:There was no significant difference in follow-up period between the observe group [15.83 (7.32-28.53) m] and the control group[16.12 (7.41-29.42) m] (P>0.05). There was no signiifcant difference inthe incidence rate between the observation group (2.19/100 patient year) and the control group (4.36/100 patient year) (P>0.05). The in cidence rate of bleeding in the observation group (6.49/100 patient year) was significantly lower than that in the control group (21.38/100 patient year) (HR=2.12,P<0.05).Conclusion:Appropriate reduction the INR could reduce the risk of bleeding, but did not increase the incidence of CIS in the AF patients with CRF.