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目的:评估SAMe-TT_2R_2评分预测非瓣膜性房颤患者应用华法林抗凝控制质量的能力,探索SAMe-TT_2R_2评分与缺血性卒中和严重出血的关系。方法:对某院2014年1月-2015年6月初次应用华法林治疗的非瓣膜性房颤患者进行为期1年的随访,计算患者SAMe-TT_2R_2分数及抗凝治疗范围内时间百分比[the percentage time in therapeutic International Normalised Ratio(INR)range,TTR],运用ANOVA检验,ROC曲线分析评估SAMe-TT_2R_2评分对患者TTR的预测能力。记录随访期间缺血性卒中或严重出血事件发生情况以探寻SAMe-TT_2R_2分数与缺血性卒中和严重出血的关系。结果:178例患者平均TTR为57.79%±15.53%,随着SAMe-TT_2R_2分数增加,患者TTR逐渐下降(P=0.001),SAMe-TT_2R_2预测TTR<70%准确性较高(ROC曲线下面积为0.734,P<0.001),最佳临界值为2,敏感度和特异性分别为95%和36%,Youden指数为最高值0.31,提示当SAMe-TT_2R_2>2时患者抗凝控制质量较差(TTR<70%)。随访期间共有7例患者(3.93%/年)发生缺血性卒中,3例患者(1.69%/年)发生严重出血。Kaplan-Meier生存分析提示SAMe-TT_2R_2评分与患者缺血性卒中年发生率无明显相关(Log Rank=1.653,P=0.647)。结论:在应用华法林抗凝的非瓣膜性房颤患者中,SAMe-TT_2R_2评分具有预测TTR的能力,针对抗凝控制质量较差患者,临床药师应为其制定个体化用药方案,改善抗凝质量。
PURPOSE: To evaluate the ability of SAMe-TT 2 R 2 to predict warfarin anticoagulation in patients with non-valvular atrial fibrillation and to explore the relationship between SAMe-TT 2 R 2 score and ischemic stroke and severe hemorrhage. Methods: The non-valvular atrial fibrillation patients who were treated with warfarin for the first time from January 2014 to June 2015 in our hospital were followed up for a period of one year. The percentage of patients with SAMe-TT 2 R 2 and the percentage of time percentage time in therapeutic International Normalized Ratio (INR) range, TTR]. The ANOVA test and ROC curve analysis were used to evaluate the predictive ability of SAMe-TT_2R_2 in patients with TTR. The incidence of ischemic stroke or severe bleeding during follow-up was recorded to investigate the association of SAMe-TT 2 R 2 score with ischemic stroke and severe bleeding. Results: The average TTR of 178 patients was 57.79% ± 15.53%. The TTR decreased gradually with the increase of SAMe-TT_2R_2 score (P = 0.001). The accuracy of TTR <70% was predicted by SAMe-TT_2R_2 (the area under ROC curve was 0.734, P <0.001). The best cutoff value was 2, the sensitivity and specificity were 95% and 36%, respectively, and the Youden index was 0.31, indicating that the quality of anticoagulation was poor when SAMe-TT_2R_2> 2 TTR <70%). A total of 7 patients (3.93% / year) had ischemic stroke during follow-up, and severe bleeding occurred in 3 patients (1.69% / year). Kaplan-Meier survival analysis suggested that there was no significant correlation between the SAMe-TT 2 R 2 score and the annual incidence of ischemic stroke (Log Rank = 1.653, P = 0.647). CONCLUSIONS: SAMe-TT_2R_2 score has the ability to predict TTR in non-valvular atrial fibrillation patients receiving anticoagulation with warfarin and should be tailored to individualized drug regimens and to improve anticoagulation quality in patients with poor anticoagulation control .