КЛИНИЧЕСКИЕ ФАКТОРЫ И УРОВЕНЬ АНТИКОАГУЛЯЦИИ, ОПРЕДЕЛЯЮЩИЕ РАЗВИТИЕ БЫСТРОЙ ПОТЕРИ ПОЧЕЧНОЙ ФУНКЦИИ У ПАЦИЕНТОВ, ДЛИТЕЛЬНО ПРИНИМАЮЩИХ ВАРФАРИН (5-ЛЕТНЕЕ ПРОСПЕКТИВНОЕ НАБЛЮДЕНИЕ)

Оценка функции почек обязательна у всех кардиологических больных, а больные с фибрилляцией предсердий представляют собой категорию пациентов высокого тромботического риска, что увеличивает риск снижения функции почек на протяжении наблюдения. Проблема варфарин-ассоциированной нефропатии в настоящее время является актуальной и дискутабельной. По данным проспективного 5-летнего наблюдения за 172 больными, получающими терапию варфарином, выявлено, что у 26,7 % отмечалась быстрая потеря почечной функции (БППФ) (определяемая как ежегодное снижение скорости клубочковой фильтрации (СКФ) ≥ 3 мл / мин / 1,73 см2). По результатам ROC-анализа было определено, что значение максимального МНО > 3,97 ассоциировалось с БППФ (площадь под кривой – 0,649, чувствительность – 56,5 %, специфичность – 74,6 %, р = 0,003), а значение максимального МНО > 6,0 повышало специфичность анализа до 96 %. Результаты исследования демонстрируют, что для пациентов, имевших значение максимального МНО ≥ 3,97, средняя дельта изменений СКФ имеет отрицательное значение, а наибольшая отрицательная динамика характерна для больных, имевших максимальное МНО ≥ 6,0. Рассчитанное отношение шансов развития БППФ подтверждает высокую прогностическую значимость величины максимального МНО. Максимальное МНО 3,97–5,9 повышало риск развития БППФ в 3,07 раза (95 % ДИ 1,5241–6,2017, р = 0,0017), так же как и значение МНО ≥ 6,0 (ОШ 3,05, 95 % ДИ 1,0073–9,2433, р = 0,0485). По результатам многофакторного дискриминантного анализа, предикторами БППФ на фоне 5-летней терапии варфарином были значение максимального МНО ≥ 3,97 (F = 10,45, p = 0,0014), ИБС (F = 8,7, p = 0,0036), диабетическая нефропатия (F = 5,29, p = 0,0226) и количество баллов по шкале CHA2DS2-VASc ≥ 4 (F = 5,05, p = 0,0258).

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