老年非瓣膜性心房颤动患者多重用药影响因素及对抗凝治疗的影响

摘要

目的 探讨老年非瓣膜性心房颤动患者多重用药影响因素及对抗凝治疗的影响.方法 从中国心房颤动注册研究数据库中随机抽取500例65岁及以上的老年非瓣膜性心房颤动患者,收集人口学资料、共患疾病及长期用药情况,根据多重用药(≥5种用药)进行分组,统计患者心血管系统用药和抗凝药物应用情况,使用多元Logistic回归模型分析多重用药的影响因素,并确定多重用药与抗凝药物应用的关系.结果 研究共纳入500例患者,其中多重用药组247例,非多重用药组253例.女性、高血压、糖尿病、冠状动脉粥样硬化性心脏病及高脂血症是多重用药的独立危险因素(比值比=1.64、2.17、2.81、2.98、1.59,95％置信区间:1.10～2.43、1.36 ～3.47、1.81 ～4.37、1.90～4.67、1.07 ～2.37,均P＜0.05).经多因素校正后,多重用药患者不增加抗凝药物应用比例(P=0.10).结论 老年心房颤动患者多重用药现象普遍,女性及多种合并疾病是多重用药的影响因素,但多重用药本身并不改善患者抗凝药物的使用比例.%Objective To investigate the influence factors of polypharmacy and its effect on anticoagulant therapy among elderly patients with non-valvular atrial fibrillation.Methods A cross-sectional analysis was performed among 500 patients who were 65 years or older with non-valvular atrial fibrillation from the China Atrial Fibrillation Registry.Demographic data,comorbidities and concomitant medication regimens were collected.Polypharmacy was defined as no less than 5 kinds of long-term prescribed drugs.Risk factors of polypharmacy and anticoagulant therapy were analyzed using multivariate Logistic regression.Results There were 247 cases in the polypharmacy group and 253 cases in the non-polypharmacy group.Polypharmacy was found to be independently associated with female gender,hypertension,diabetes,coronary heart disease and hyperlipidemia(odds ratio =1.64,2.17,2.81,2.98,1.59;95％ confidence interval:1.10-2.43,1.36-3.47,1.81-4.37,1.90-4.67,1.07-2.37;all P ＜ 0.05).Polypharmacy was not an indicator of anticoagulant use (P =0.10).Conclusions Polypharmacy is a major burden on the management of atrial fibrillation in the elderly.Female gender and many comorbidities are risk factors of polypharmacy.Polypharmacy does not increase the use of anticoagulants.