不稳定心绞痛和非Q波心肌梗死抗凝治疗中血小板减低的临床意义

Clinical Significance of Thrombocytopenia During Anticoagutation Therapy in Unstable Angina Pectoris and No Q Myocardical Infarction

目的 本文旨在探讨肝素在治疗不伴有 ST段抬高的不稳定性心绞痛 (U AP)和非 Q波心肌梗死 (NQMI)患者中血小板减低的临床意义。方法 冠心病监护病房收治的 84 0例不伴有 ST段抬高的 U AP及 NQMI患者 ,给予肝素抗凝治疗 ,治疗后的 2 4小时测定患者的血小板计数 ,根据血小板测定结果 ,分成血小板减低组 (<10 0× 10 9/ L,n=2 4 )及非血小板减低组 (>10 0× 10 9/ L,n=816 )。结果 血小板减少的发生率为 2 .85 % ,血小板减少组住院病死率、顽固性心绞痛及出血合并症显著高于非血小板减低组 (分别为 18.31%比 5 .14 % ,P<0 .0 5 ;2 5 .0 0 %比 11.4 2 % ,P<0 .0 5和 33.33比 11.6 4 % ,<0 .0 1) ;急性心肌梗死发生率有高于非血小板减低组的趋势 (16 .6 7%比 11.0 3% ,但 P >0 .0 5 )。结论 在肝素治疗不伴有 ST段抬高的 U AP及 NQMI中 。

Objective This study was designed to investigate the clinical significance of thrombocytopenia during anticoagutation therapy in unstable angina pectoris and no Q myocardical infarction without ST segment elevation. Methods In the coronary care unit (CCU) at our hospital,840 caseo of the patients with unstable angina pectoris and no Q myocardical infarction without ST segment elevation receive heparin therapy and platelet counts were measured within 24 hours of therapy.Thty were divided into thrombocytopenia group( >100×10 9/L, n =24) and no thrombocytopenia (>100×10 9/L, n =816).Results The incidence of thrombocytopenia was 2.85% .Hospital mortality,the complication of recurrent ischemia and bleeding in thrombocytopenia group was significantly higher than no thrombocytopenia group (18.31% vs 5.14%, P <0.05;25.00% vs 10.42%, P <0.05;33.33%vs 11.64 %, P <0.01). The incldence of myocardical infarction in thrombocytopenia group coald be higher than no thrombocytopenia group (16.67% vs 11.03%, but P >0.05).Conclusion This study show that the patients with unstable angina pectoris and no Q myocardical infarction without ST segment elevation who receive heparin therapy in that there was elderly, onset thrombocytopania were associated with adverse clinical outcomes.