非瓣膜性心房颤动患者血小板指数与国际标准化比值关系的研究

The study of the platelet indices and its relationship with international normalized ratio in patients with non valvular atrial fibrillation

目的探讨非瓣膜性心房颤动患者血小板指数与国际标准化比值（INR）的关系。方法选择2013年8月——2015年8月湖北省黄石市中心医院心内科住院诊治的非瓣膜性心房颤动患者233例,均行华法林抗凝治疗。根据患者INR水平分为达标组（INR 2.0-3.0）84例及未达标组（INR〈2.0）149例。收集患者的基本临床资料、入院24h内实验室检测结果及超声心动图变化,并进行统计学分析。结果未达标组患者吸烟率高于达标组（14.8%vs.4.8%,t=6.730,P〈0.05）。2组血小板（PLT）、血小板平均容积（MPV）、血小板分布宽度（PDW）及大小血板比率（P-LCR）等血小板指数及低密度脂蛋白胆固醇（LDL-C）水平比较差异有统计学意义（均P〈0.05）。多变量Logistic回归分析发现P-LCR是INR不达标的预测因子（OR=0.860,95%CI 0.749-0.988,P=0.029）。MPV、PDW及PLCR预测INR未达标的ROC曲线下面积分别为0.847（95%CI 0.783-0.910）、0.876（95%CI 0.815-0.938）及0.874（95%CI 0.816-0.931）。结论血小板指数与心房颤动患者INR是否达标相关,可能有助于华法林治疗疗效的判断。

Objective To evaluate the relationship between platelet indices and the international normalized ratio（INR） in patients undergoing warfarin treatment.Methods Selected from August 2013 to August 2015,in Hubei Huangshi Center Hospital,233 cases of non valvular atrial fibrillation patients who underwent anticoagulation therapy with warfarin.According to the patient＇s INR level,they were divided into the standard group（INR 2.0-3.0） with 84 cases and the standard group（INR 2.0） with 149 cases.The basic clinical data ol patients were collected,the results of laboratory test and the changes of echocardiography in 24 h were analyzed statistically.Results The smoking rate of patients in the non-reached standard group was higher than that in the reached standard group（14.8%vs.4.8%,t =6.730,P〈0.05）.Two groups＇ platelet（PLT）,mean platelet volume（MPV）,platelet distribution of platelet index ratio of width（PDW） and size of blood plate（P-LCR） and low density lipoprotein cholesterol（LDL-C） levels＇ difference had statistical significance（P〈0.05）.Multivariate Logistic regression analysis showed that P-LCR are predictors of INR standards（OR =0.860,95%CI 0.749-0.988,P =0.029）.MPV,PDW and LCR predicted the INR＇ s ROC area under curve were 0.847（95%CI 0.783-0.910）,0.876（95%CI 0.815-0.938） and 0.874（95%CI 0.816-0.931）.Conclusion The platelet index is related to INR in patients with atrial fibrillation,it may help determine the therapeutic effect of warfarin.