吸烟对慢性阻塞性肺疾病急性加重期患者血小板活化及预后的影响

Effect of smoking on platelet activation and prognosis in patients with acute exacerbation of chronic obstructive pulmonary disease

目的探讨吸烟对慢性阻塞性肺疾病急性加重(AECOPD)患者血小板活化及预后的影响。方法收集某医院呼吸科所收治的80例AECOPD患者,根据其吸烟情况分为非吸烟组(32例)和吸烟组(48例)。记录2组患者性别、年龄、病程、住院时间及病死率;检测血常规和膜糖蛋白的阳性表达率。比较吸烟对患者血小板活化指标、住院时间及生存率的影响;分析血小板活化与患者预后的相关性。结果与非吸烟组相比,吸烟组患者的平均血小板体积(MPV)、GPⅡbⅢa阳性表达率、P选择素阳性表达率、总住院时间和死亡率均有不同程度增加。吸烟指数≥200年×支的AECOPD患者血小板MPV值、GPⅡbⅢa阳性表达率、P选择素阳性表达率、总住院时间和死亡率均高于吸烟指数<200年×支的患者。死亡组患者血小板MPV值、GPⅡbⅢa阳性表达率、P选择素阳性表达率均高于存活组。吸烟指数与血小板MPV值、GPⅡbⅢa和P选择素阳性表达率均成正强相关(r=0.340,0.343,0.333;P均<0.05);与AECOPD患者住院时间及病死率成正强相关(r=0.628,0.510;P均<0.01)。AECOPD患者死亡率与血小板MPV值、GPⅡbⅢa和P选择素阳性表达率均成正强相关(r=0.539,0.581,0.526;P均<0.01);住院时间与血小板MPV值、GPⅡbⅢa和P选择素阳性表达率均成正强相关(r=0.523,0.512,0.572;P均<0.01)。结论吸烟能够促进血小板的活化,增加AECOPD患者的住院时间,降低患者的生存率。

Objective To investigate the effect of smoking on platelet activation and prognosis in patients with acute exacerbation of chronic obstructive pulmonary disease(AECOPD). Methods Eighty patients with AECOPD admitted to the respiratory department of the hospital were selected and divided into a non-smoking group(32 cases) and a smoking group(48 cases) according to their smoking status. The gender, age, course of disease, length of hospital stay and mortality were investigated and recorded. The blood routine and positive expression rate of membrane glycoprotein were detected. The effects of smoking on platelet activation index, hospitalization time and survival rate were compared between two groups. The correlation between platelet activation and prognosis of the patients was analyzed. Results Compared with the non-smoking group, the patients in the smoking group had a higher mean platelet volume(MPV) value [(9.83±1.04)fl vs.(12.17±2.66)fl],positive rate of GPⅡbⅢa [(69.71±6.43)% vs.(75.63±7.62)%], positive rate of P selectin [(7.57±2.03)% vs.(9.99±3.93)%],length of hospital stay [(8.72±2.55) days vs.(11.06±3.86) days], and mortality rate(9.37% vs. 29.17%). Compared with the patients whose smoking index <200, the patients whose smoking index ≥200 had a higher MPV value [(13.43±3.33)fl vs.(11.35±1.73)fl], positive rate of GPⅡbⅢa [(78.88±5.51)% vs.(73.50±8.13)%], positive rate of P selectin [(11.50±4.10)% vs.(9.00±3.54)%], length of hospital stay [(13.89±3.09) days vs.(9.21±3.14) days], and mortality rate(47.37% vs. 17.24%).Compared with the survival patients, the death patients hada higher MPV value [(14.40±3.14)flvs.(10.38±1.26) fl], positive rate of GPⅡbⅢa [(81.16 ±4.59)%vs.(71.13± 6.96)%], and positive rate of P selectin [(12.84±3.60)%vs.(7.99 ± 2.68)%].The correlation analysis showed that the smoking index was positively correlated with the MPV value, GPⅡbⅢa and P selectin positive rate(r= 0.340, 0.343, 0.333, respectively, allP<0.05);the smoking index was also strongly correlated with the length of hospital stay and mortality rate(r=0.628,0.510 respectively, bothP<0.01). The mortality of AECOPD patients was strongly correlated with the MPV value, GPⅡbⅢa and P selectin positive rate(r=0.539, 0.581, 0.526, respectively,allP<0.01). The length of hospital stay of AECOPD patients was strongly correlated with the MPV value, GPⅡbⅢa and P selectin positive rate(r= 0.523, 0.512, 0.572, respectively, all P<0.01). Conclusion Smoking can promote the activation of platelets,increase the length of hospital stay, and reduce the survival rate of patients with AECOPD.