替罗非班相关血小板减少的危险因素分析

Analysis for risk factors of thrombocytopenia associated with tirofiban

目的探讨替罗非班引起血小板减少的危险因素。方法收集2013年1月至2014年6月734例接受替罗非班抗栓治疗的冠状动脉粥样硬化患者的临床资料,根据用药后血小板计数分为血小板减少组和血小板未减少组,收集相关临床危险因素,并进行Logistic逐步分析,计算各危险因素的比值比及其95%置信区间。结果入组患者中69例患者发生了血小板减少。Logistic多因素逐步回归分析显示,年龄>65岁(OR=2.58,95%CI:1.54-4.33,P<0.05),用药前丙氨酸转氨酶>75 U·L^(-1)(OR=2.39,95%CI:1.26-4.58,P<0.05)和用药前肾小球滤过率<60 mL·min^(-1)·1.73 m^(-2)(OR=3.34,95%CI:1.89-5.88,P<0.05)为独立危险因素。出现血小板减少的中位时间和停药后血小板恢复的中位时间均为1 d。结论高龄、丙氨酸转氨酶升高和肾功能不全为替罗非班相关血小板减少的主要危险因素,因此对于此类患者需密切监测血小板计数,降低出血风险。

AIM To investigate the risk factors of thrombocytopenia associated with tirofiban. METHODS The clinical data of 734 patients receiving tirofiban with coronary atherosclerosis disease in our hospital from January 2013 to June 2014 were collected and retrospectively analyzed. The patients were divided into the thrombocytopenia group and normal platelet group according to the platelet count. Logistic regression analysis was performed to screen the related risk factors from the clinical data, and to calculate the odds ratio and 9.5 % confidence interval. RESULTS Totally 734 pa- tients were comprised of 588 male （80.1% ） and 146 female （19.9 % ） with mean age of （62.2 ± 11.2） years and mean weight of （69.6 ± 7.9） kg. Among them, thrombocytopenia occurred in 69 patients, multiple factors stepwise logistic re- gression analysis revealed the following results： the incidence of thrombocytopenia with a higher prevalence in the elder （age 〉 65 years） （OR = 2.58,95 % CI ： 1.54 - 4.33, P 〈 0.05）, serum alanine aminotransferase 〉 75 U· L- 1 （OR = 2.39,95 % CI ： 1.26 - 4.58, P 〈 0.05）, estimated glomerular filtration rate 〈 60 mL· min- 1.1.73 m- 2 （OR = 3.34, 95 % CI ： 1.89 - 5.88, P 〈 0.05） before medication. The median time of the occurrence and recovery after drug discon- tinuance of thrombocytopenia was 1 day. CONCLUSION The elder, elevated alanine aminotransferase and renal dys- function before medication may be the major risk factors of tirofiban associated thrombocytopenia. Closely monitoring the platelet count for the patients who are prescribed with tirofiban are highly recommended so as to reduce the risk of bleed-ing.