急性肺栓塞患者血小板动态变化与预后的相关性分析

Correlation analysis between dynamic platelet variation and prognosis in patients with acute pulmonary embolism

目的急性肺栓塞患者血小板动态变化与预后的相关性分析。方法连续性纳入2010年1月至2015年6月于我院住院治疗的60例急性肺栓塞(acute pulmonary embolism,APE)患者。根据APE患者的预后分为存活组(n=36)和死亡组(n=24)。综合分析治疗前和治疗后7天APE患者血小板数量和形态(血小板分布宽度platelet distribution width,PDW和平均血小板体积mean platelet volume,MPV)方面的改变。结果存活组患者Qanadli栓塞指数明显低于死亡组患者(P<0.05)。存活组和死亡组患者MPV水平均明显高于对照组(P<0.05),经过治疗后两组患者MPV水平均有所下降,其中存活组下降最为明显(P<0.05)。MPV治疗前后改变(△MPV)水平和Qanadli栓塞指数具有一定的预测APE患者临床转归的价值。治疗前MPV水平与APE患者死亡成正相关(r=0.601,P=0.03),而△MPV与APE患者死亡成负相关(r=-0.629,P=0.03)。△MPV(>4.5fl)(OR=0.49,95%CI 0.20-1.02,P<0.05)和Qanadli栓塞指数(>35.1)(OR=1.56,95%CI 0.45-2.12,P<0.05)为APE患者发生死亡的独立危险因素。结论 MPV和△MPV是评估APE死亡风险的潜在预测因子。

Objective To evaluate the correlation between dynamic platelet variation and prognosis in patients with acute pulmonary embolism （APE）. Methods 60 APE patients were enrolled in this study and divided into two group ： the survival group （ n = 36） and the dead group （ n = 24） based on clinical prognosis. The number and morphological index of platelet was recorded and analyzed before treatment and 7days after treatment. Results The Qanadli index in the survival group was significantly lower than that in the dead group （ P 〈 0. 05 ）. MPV level in APE patients were higher than that in control cases （P 〈 0. 05 ）. After treatment, the level of MPV decreased in the two groups, and the decrease was more pronounced in the survival group than in the death group （ P 〈 0. 05 ）. ROC analysis showed that A MPV and Qanadli index had predictive value of prognosis. The level of MPV before treatment was positively associated with clinical prognosis in APE patients while level of A MPV was negatively related with mortality in APE patients. Conclusion The levels of MPV and A MPV may be the potential factors for estimating the clinical prognosis.