口服抗凝药物治疗的心房颤动患者出血与血小板计数之间的相关性分析

Analysis of the relationship between bleeding and platelet count in atrial fibrillation patients with treatment of oral anticoagulants

目的探讨口服抗凝药物治疗的心房颤动患者出血与血小板计数之间相关性以及对出血的影响因素进行分析。方法采用病例对照研究的方法,收集从2010-2019年9月期间在新疆医科大学第一附属医院住院治疗的心房颤动患者共2226名,根据患者有无出血症状分为出血组(n=301)和无出血组(n=1925)。收集基本信息、合并症、血液指标等,分析两组患者的基线数据特征,采用Logistic回归分析研究出血与血小板计数之间的关系及影响因素。结果两组患者在性别构成、年龄分布及合并症、血液指标等方面的差异无统计学意义(P均>0.05),两组的HAS-BLED评分差异有统计学意义(P<0.05)。心房颤动患者服用拜阿司匹灵、华法林、达比加群酯、利伐沙班等不同药物,在皮下出血、呕血、咯血、黑便及其他出血等方面的差异无统计学意义(P均>0.05)。性别、年龄分组、合并高血压、心力衰竭、糖尿病、血栓性疾病、肝功能异常、肾功能异常、CHA2DS2-VASc及HAS-BLED评分与出血事件有相关关系(P<0.05)。结论基于目前现有的资料,不能得出口服抗凝药物治疗的房颤患者出血与血小板计数之间有相关关系。性别、年龄分组、合并症、CHA2DS2-VASc及HAS-BLED评分是出血事件发生的影响因素。

Objective To explore the correlation between bleeding and platelet count in patients with atrial fibrillation treated by oral anticoagulants and analyze the influencing factors of bleeding.Methods A case-control study was used to collect 2226 patients with atrial fibrillation who were hospitalized in the First Affiliated Hospital of Xinjiang Medical University from September 2010 to September 2019.The patients were divided into bleeding group(n=301)and non bleeding group(n=1925)according to whether they had bleeding symptoms.The basic information,complications and blood indexes were collected,the baseline data characteristics of the two groups were analyzed,and the relationship between bleeding and platelet count and the influencing factors were studied by logistic regression analysis.Results There was no significant difference between the two groups in gender composition,age distribution,comorbidities and blood index(P>0.05),and there was significant difference in HAS-BLED score between the two groups(P<0.05).There was no significant difference in subcutaneous hemorrhage,hematemesis,hemoptysis,black stool and other bleeding in patients with atrial fibrillation(P>0.05).Gender,age group,hypertension,heart failure,diabetes,thrombotic disease,liver function abnormality,renal function abnormality,CHA2DS2-VASc and HAS-BLED scores were correlated with bleeding events(P<0.05).Conclusion Based on the current data,it is not possible to conclude that there is a correlation between blood loss and platelet count in patients with AF treated with oral anticoagulants.Sex,age group,comorbidity,CHA2DS2-VASc and HAS-BLED scores were the influencing factors of bleeding events.