【摘要】 目的 探讨血清生长分化因子15（GDF-15）及以此为基础的ABC（年龄、生物标志物和临床病史）出血风险评分在老年（年龄≥65岁）非瓣膜病心房颤动（NVAF）患者使用非维生素K拮抗剂口服抗凝药物（NOAC）治疗后，随访期间发生出血事件的预测能力，并与传统HAS-BLED出血风险评分比较。方法 选取心血管内科住院收治的、首次诊断为NVAF且接受NOAC治疗的老年患者，采集入选患者的临床资料并分析血清GDF-15水平，计算以GDF-15等心脏生物标志物为基础的ABC出血风险评分及HAS-BLED出血风险评分。对患者出院后进行随访，记录随访期间各种出血事件，按各出血事件的严重程度[重大出血事件、临床相关非重大出血的消化道出血事件（CRNM-GIB）、轻微出血事件、无出血事件]分组，分别评价及比较ABC出血风险评分与HAS-BLED出血风险评分对各种程度出血事件的预测能力。结果 142例老年NVAF患者，CHA₂DS₂-VASc卒中风险评分为（4.86±1.75）分，HAS-BLED出血风险评分为（2.92±0.99）分，经ABC出血风险评分计算预测1年出血事件发生率为（5.72%±4.11%）,平均随访（19.92±6.83）月，49例（49/142,34.5%）发生出血事件，其中脑出血3例，CRNM-GIB 19例，轻微出血27例。受试者工作特征（ROC）曲线显示，血清GDF-15水平对CRNM-GIB[曲线下面积（AUC）为0.718,95%CI为0.645～0.835,P<0.001]及全部出血事件有预测价值（AUC为0.670,95%CI为0.690～0.727,P<0.001）,ABC出血风险评分对CRNM-GIB（AUC为0.688,95%CI为0.552～0.824,P<0.001）及全部出血事件有预测价值（AUC为0.679,95%CI为0.579～0.779,P<0.001）。与HAS-BLED出血风险评分相比，ABC出血风险评分预测脑出血能力较高（ABC出血风险评分AUC为0.868,95%CI为0.752～0.985;HAS-BLED出血风险评分AUC为0.745,95%CI为0.556～0.933,重分类改善指标（NRI）为84.17%,P=0.001）,预测CRNM-GIB能力较低（ABC出血风险评分AUC为0.688,95%CI为0.552～0.824;HAS-BLED出血风险评分AUC为0.744,95%CI为0.639～0.849,NRI为-23.96%,P=0.025）。结论 血清GDF-15水平对老年NVAF患者口服NOAC的出血风险有预测价值。相比HAS-BLED评分，ABC出血风险评分能提高对脑出血事件的预测能力。更多还原

【Abstract】 Aim To explore the ability of serum growth differentiation factor-15(GDF-15) and the ABC(age, biomarkers, clinical history) bleeding risk score based on this in predicting hemorrhage events in elderly(age≥65 years) patients with non-valvular atrial fibrillation(NVAF) after oral administration of non-vitamin K antagonist oral anticoagulants(NOAC).Methods Elderly inpatients who were first diagnosed as NVAF and treated with NOAC were selected.The GDF-15 concentration in serum was analyzed and clinical data were collected in each enrolled patient.The ABC bleeding risk score was calculated, which is essential on biomarkers including GDF-15, and HAS-BLED bleeding risk score.The patients were divided into groups according to the occurrence of various bleeding events(major bleeding(MB), clinically relevant non-major gastrointestinal bleeding(CRNM-GIB),minor bleeding, and no bleeding events) during follow-up.The ABC bleeding risk score and HAS-BLED bleeding risk score were evaluated and compared for predicting various degrees of bleeding events groups.Results During the(19.92±6.83) months follow-up period, 49 cases(49/142, 34.5%) had bleeding events, including 3 cases of cerebral hemorrhage, 19 cases of CRNM-GIB, and 27 cases of minor bleeding.Receiver operating characteristic(ROC)curve showed that serum GDF-15 concentration had predictive value in predicting CRNM-GIB(AUC 0.718, 95%CI: 0.645～0.835, P<0.001) and all bleeding events(AUC 0.670, 95%CI: 0.690～0.727, P<0.001), and ABC bleeding risk score had predictive value in predicting CRNM-GIB(AUC 0.688, 95%CI: 0.552～0.824, P<0.001) and all bleeding events(AUC 0.679, 95%CI: 0.579～0.779, P<0.001).Compared with the HAS-BLED bleeding risk score, the ABC bleeding risk score had a higher ability to predict cerebral hemorrhage(AUC 0.868, 95% CI: 0.752～0.985 for ABC scorevs.AUC 0.745, 95% CI: 0.556～0.933 for HASBLED score, net reclassification improvement(NRI) 84.17%,P=0.001), less ability to predict CRNM-GIB(AUC0.688, 95% CI: 0.552～0.824 for ABC scorevs.AUC 0.744, 95% CI: 0.639～0.849 for HAS-BLED score, NRI-23.96%,P=0.025).Conclusion GDF-15 concentration in blood has predictive value for the bleeding risk of oral NOAC in elderly NVAF patients.Compared with HAS-BLED, ABC bleeding risk score can improve the ability to predict cerebral hemorrhage.更多还原