血液参数和胃肠道出血之间的关系 在接受口服抗凝剂的心房患者中
Hayrullah Yurdakul1, Muhammet Cakas2, Seda Elcim Yildirim3
1Nizip City Hospital, 27300 Gaziantep, Turkey.
Journal of clinical medicine
|November 13, 2025
概括
系统性炎症标志物预测口服抗凝剂 (OAC) 的心房动 (AF) 患者的胃肠道出血风险. 这些标记物,特别是在非维生素K抗剂口服抗凝剂 (NOAC) 用户中,可以改善风险分层和个性化OAC治疗.
科学领域:
- 心脏病学 心脏病学
- 内部医学 内部医学
- 紧急医疗 紧急医疗
背景情况:
- 心房动 (AF) 需要口服抗凝剂 (OAC) 治疗以预防中风,但会增加胃肠道 (GI) 出血的风险.
- 准确的胃肠道出血风险分层在OAC的AF患者中至关重要,特别是在急诊室 (ED).
- 现有的风险评分可能无法完全捕捉在接受华法林或非维生素K对抗剂口服抗凝剂 (NOACs) 的患者的出血风险.
研究的目的:
- 为了评估系统性炎症标志物作为预测器的胃肠道出血在AF患者治疗OACs.
- 为了比较NOAC和华法林用户之间的炎症指数的预测值.
- 探索炎症标志物的实用性,以提升消化道出血的风险分层,以实现个性化的抗凝策略.
主要方法:
- 在ED环境中对155名AF患者进行回顾性队列研究 (2019-2023年).
- 患者分为胃肠道出血 (病例) 和没有胃肠道出血 (对照) 组.
- 分析包括人口统计,并发症,CHA2DS2-VASc,HAS-BLED分数和炎症指数 (尿酸/白蛋白比率,NLR,PLR,SII).
主要成果:
- 在NOAC使用者中,更高的尿酸/蛋白比率,NLR,PLR和SII与肠道出血有显著的关联 (p <0.05).
- 在华法林使用者中,只有尿酸/白蛋白比在出血组显著升高 (p < 0.001).
- 在出血组中,HAS-BLED分数更高;在NOAC使用者中,特定因素如低脂血症预测出血,而在华法林使用者中,低白蛋白血症预测出血.
结论:
- 系统性炎症指数,特别是NOAC使用者的系统性炎症指数,显示出AF患者胃肠道出血风险分层的前景.
- 这些生物标志物可以增强个性化的抗凝策略,潜在地降低发病率和死亡率.
- 进一步将炎症标志物纳入临床实践是有必要的,以改善患者管理.
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