经皮二尖瓣球囊扩张术后疗效及血小板指数的变化分析

Curative effect and change of platelet indices after percutaneous balloon mitral valvuloplasty

目的研究风湿性二尖瓣狭窄(RMS)经皮二尖瓣球囊扩张术(PBMV)后疗效及血小板指数的变化,初步探讨PBMV在降低血栓形成风险中的作用。方法选择69例风湿性二尖瓣狭窄的患者[平均年龄(46.3±9.2)岁]及27例健康体检者[平均年龄(42.1±6.7)岁]为研究对象。所有研究对象于入院时、病例组术后4周采集患者外周静脉全血,测定血小板计数(PLT)、平均血小板体积(MPV)、血小板压积(PCT)、血小板体积分布宽度(PDW)等指标的变化。经超声心动图检查,记录术前及术后4周二尖瓣口面积(MVA)、左心室舒张末期内径(LVEDd)、左心室收缩末期内径(LVEDs)、左心房内径(LAD)、右心室舒张末期内径(RVEDd)、右心房内径(RAD)等数据。统计分析结果,比较手术前后各指标的变化。结果 (1)风湿性二尖瓣狭窄患者MPV、PDW较正常对照组明显升高,差别有统计学意义(P<0.05,P<0.01);(2)病例组PBMV术后MPV较术前下降,差别有统计学意义(P<0.05);(3)MVA在术后明显增大,LVEDd、LAD术后明显回缩,差别均有统计学意义(P<0.05);(4)MPV与MVA成负相关,相关系数r=-0.45,相关系数检验有统计学意义(P<0.05);与其余指标无明显相关性。结论 PBMV可明显增大二尖瓣口面积,改善风湿性二尖瓣狭窄血流动力学指标;PBMV可降低MPV水平,对降低血栓形成的风险可能有益。

ObjectiveBy studying the efficacy of PBMV in rheumatic mitral stenosis, and the impact of PBMV on MPV, to explore the role of PBMV in reducing thromboembolic events.MethodsIn the present study, MPV, PLT, PCT, PDW were measured in 69 （46.3±9.2 years） patients with RMS planned for PMBV just before and 4 weeks after the procedure. 27 （42.1±6.7 years） healthy controls were used for comparison. Mitral valve area （MVA）, left ventricular end diastolic dimension （LVEDd）, left ventricular end systolic diameter （LVEDs）, left atrial diameter （LAD）, right ventricular end diastolic diameter （RVEDd）, left atrial diameter （RAD） were measured using transthoracic echocardiography.Results（1）Compared to apparently healthy controls, patients with RMS had higher MPV and PDW （P〈0.05,P〈0.01）. （2）Compared to values obtained before the procedure, PLT, PCT, PDW remained unchanged. However, MPV decreased significantly （P〈0.05）. （3）All patients with RMS underwent successful PMBV 4 weeks after the procedure, MVA increased significantly （P〈0.05）. （4）MPV had negative correlation with MVA （r=-0.45,P〈0.05）. Conclusions PBMV could enlarge MVA, improve the heart function. As compared to apparently healthy controls, patients with RMS had higher MPV reflecting increased platelet activity and high risk of thromboembolic events, and PMBV was associated with a significant decrease in MPV 4 weeks after the procedure.