目的 评价SAMe-TT₂R₂评分对非瓣膜性房颤使用华法林的患者中的抗凝疗效的评估作用,探讨SAMe-TT₂R₂评分与缺血性卒中事件、出血事件的相关性。方法 以石河子大学医学院第一附属医院2018年1月—2019年1月住院治疗,确诊为非瓣膜性房颤并口服华法林抗凝的患者作为观察对象,进行为期10月的随访。通过患者的国际标准化比值(INR),计算患者的抗凝治疗范围内时间百分比(Time in Therapeutic Range, TTR),并对所有患者进行SAMe-TT₂R₂评分。运用χ²检验、Spearman秩相关、ROC曲线分析评估SAMe-TT₂R₂评分对患者抗凝疗效的预测能力。随访期内收集缺血性卒中和出血事件的发生情况,分析上述事件与SAMe-TT₂R₂评分的相关性。结果 190例患者平均TTR为(46.76±21.99)％,SAMe-TT₂R₂分数与患者的TTR呈负相关(P=0.001),ROC曲线下面积为0.661,P=0.001,约登指数0.203对应的临界值取整数为4分,敏感度和特异度分别为72.6％和47.7％,提示SAMe-TT₂R₂对预测TTR<65％有一定的价值。随访期间共有5例患者发生缺血性卒中事件,25例患者发生不同程度出血事件,11例患者发生全因死亡事件,上述事件在各个SAMe-TT₂R₂分值的发生分布差异无统计学意义(P＞0.05)。结论 在非瓣膜性房颤并使用华法林抗凝治疗的患者中,SAMe-TT₂R₂评分对使用华法林抗凝治疗患者的抗凝有效性具有一定的预测能力,可将SAMe-TT₂R₂评分作为预测华法林抗凝疗效的预测的指标。

Objective To evaluate the anticoagulant effect of SAMe-TT₂R₂ in patients with non-valvular atrial fibrillation treated with warfarin, and to explore the correlation between SAMe-TT₂R₂ and ischemic stroke events and bleeding events. Methods Patients who were diagnosed as non-valvular atrial fibrillation and with oral warfarin were enrolled in the First Affiliated Hospital of Shihezi University School of Medical College in January 2018-January 2019, and for 10 months of follow-up. Collecting patients' International normalization ratio(INR), calculating the Time in therapeutic range(TTR), and the SAMe-TT2 R2 score. And χ² test, Spearman rank correlation and ROC curve analysis were used to evaluate the predictive ability of SAMe-TT2 R2 score on anticoagulant efficacy in patients. Follow-up was conducted to investigate the incidence of ischemic stroke or hemorrhagic events and explore the relationship with the SAMe-TT2 R2 score. Results The mean TTR of 190 patients was 46.76%±21.99%, and the score of SAMe-TT_{2 R2} was negatively correlated with the TTR of the patients(P=0.001), the area under the ROC curve was 0.661, P=0.001, The critical value corresponding was 4 points, and the sensitivity and specificity were 72.6% and 47.7%, respectively suggesting that SAMe-TT₂R₂ had certain value in predicting TTR< 65%. During follow-up, a total of 5 patients had ischemic stroke, 25 patients had different degrees of bleeding, and 11 patients had all-cause death, different SAMe-TT₂R₂ scores showed no statistical significance(P>0.05). Conclusion In patients with non-valvular atrial fibrillation treated with warfarin anticoagulant, the SAMe-TT₂R₂ score has a certain predictive ability for the anticoagulant efficacy of patients treated with warfarin anticoagulant, and the SAMe-TT₂R₂ score could be used as an indicator for predicting the anticoagulant efficacy of warfarin.

目的 研讨阿司匹林广泛用于高危血栓、栓塞抗凝的预防治疗应用。方法 查阅参考文献,结合临床实践,新口服抗凝药疗效终点卒中和体循环栓塞方面为基准。结果 界於CHADS2和CHA2DS2-VASc 评分所涵盖的风险和差异因素,后期华法林与新口服抗凝药可能取舍或并存。结论 在危险分层,卒中抗拴防凝治疗中,我国房颤患者不建议继续服用阿司匹林。

Objective To Study and discuss the applications for prevention and treatment of high risky thrombosis and embolism anticoagulation of Aspirin. Methods Combining literature consultation and clinical practice,making stroke and general circulation embolism of oral anticoagulant curative effect terminal point as the base. Results According to the risky and different factors covered by CHADS2 and CHA2DS2-VASc in the later stage, warfarin and the new oral anticoagulant can be taken together or abandon one of them. Conclusion In the risky factors classification and stroke anticoagulant therapy, we suggest that the atrial fibrillation patients should not take Aspirin.