《美国心血管药物杂志》：中国学者最新研究——地高辛显著增加房颤患者不良结局，临床上应谨慎使用！

房颤是最常见的心律不齐疾病，但危险性不容小觑。由于心房的收缩功能丧失，引起心脏节律紊乱，同时会形成血栓，诱发室颤，对患者的健康有极大影响，严重时可危及生命。房颤的治疗主要有两大方面：控制心室率和预防血栓形成。作为心血管内科应用最久的药物之一，地高辛一直作为控制房颤心室率的一线用药，在临床上应用广泛。

但是，中国学者2019年5月11日发表在《美国心血管药物杂志》（American Journal of Cardiovascular Drugs）上的一项旨在评估地高辛与中国房颤患者不良结局之间关系的研究，结果却令人瞠目结舌：在未接受消融治疗的房颤患者中，地高辛的使用与不良结局的显著增加相关，临床上应谨慎使用地高辛！

Association Between Digoxin Use and Adverse Outcomes Among Patients in the Chinese Atrial Fibrillation Registry

Am J Cardiovasc DrugsOriginal Research Article

Early Recent, May 11, 2019

10.1007/s40256-019-00350-8

Introduction

地高辛广泛应用于房颤（AF）患者，但其与不良结局的关系仍有争议。

研究目的

我们旨在评估地高辛与中国房颤患者不良结局之间的关系。

研究方法

我们使用来自中国房颤登记处的数据，进行了一项涉及31家医院的前瞻性、多中心、基于医院的登记研究。从2011年8月到2016年12月，共有10472名符合条件的房颤患者被纳入本研究。使用Cox比例风险模型研究地高辛的使用与全因死亡率、心血管死亡和心血管住院的关系。

研究结果

总共1152（11%）名患者在基线时接受地高辛治疗。接受地高辛治疗的患者年龄较大（平均年龄69.7岁vs.66.5岁），心率较快（92.4 vs.79.7次/min）。接受地高辛治疗的患者有心力衰竭（62.5 vs.15.6%）、糖尿病（34.4 vs.24.4%）和持续性房颤（67.9 vs.38.4%）病史的比例较高。地高辛的使用与全因死亡率（校正危险比（aHR）1.21；95%CI 1.02-1.43； P＝0.031）、心血管死亡（aHR 1.25；95%CI 1.01-1.55； P＝0.043）和心血管住院（aHR 1.21；95%CI 1.05-1.39； P＝0.007）的增加独立相关。除肾功能不全和无肾功能不全的患者外，不同亚组间的相关性也相同（相互作用 P=0.029）。

讨论

在这组中国房颤患者中，未接受消融治疗的患者，地高辛的使用与不良结局的显著增加相关。虽然可能存在残余混杂因素，也没有地高辛的血清浓度，但地高辛在临床实践中应谨慎使用，其疗效需要在随机试验中进行严格评价。

引用文献

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