不同血压水平人群中血小板参数与新发脑卒中发生风险的关联性研究

Association between platelet parameters and risk for stroke in people with different blood pressure levels:Dongfeng-Tongji cohort

目的探讨在不同血压水平人群中,血小板参数与新发脑卒中发生风险的关联。方法研究人群来源于东风-同济队列第1次随访调查到的38295名东风汽车公司离、退休职工。选取基线未患冠心病、脑卒中、癌症以及未失访者,排除有抗血小板用药史以及血小板参数和血压缺失者,最终纳入21294名研究对象。纳入分析的研究对象均完成了问卷调查、体格检查、生化指标检查和血液样本采集。采用Cox比例风险回归模型分析不同血压水平人群中各血小板参数与脑卒中及其亚型发生风险的关联,并计算风险比(HR)和95%CI。结果平均随访8.0年后,1578人发生脑卒中,其中缺血性脑卒中(IS)1266例,出血性脑卒中(HS)312例。在高血压人群中,与血小板计数(PLT)<188×10^(9)/L者相比,PLT≥188×10^(9)/L者脑卒中及IS的发生风险显著增加,HR值(95%CI)分别为1.27(1.12~1.44)和1.39(1.21~1.60)。在高血压人群中,与血小板压积(PCT)<0.165%者相比,PCT≥0.165%者的脑卒中(HR=1.15,95%CI:1.01~1.30)发生风险显著增加,HS(HR=0.70,95%CI:0.53~0.93)发生风险显著降低;在非高血压和高血压人群中,PCT≥0.165%者IS的发生风险均显著增加,HR值(95%CI)分别为1.27(1.05~1.54)和1.31(1.14~1.50)。在各血压水平分类人群中均未发现平均血小板体积、血小板分布宽度水平与脑卒中发生风险之间的关联。与血小板参数水平较低的非高血压人群相比,在各血小板参数水平下高血压人群的脑卒中发生风险均明显升高。结论高水平PLT和PCT显著增加中老年高血压人群脑卒中及IS发生风险,低PCT水平显著降低高血压人群HS发生风险。

Objective To explore the associations of platelet parameters platelet count(PLT),mean platelet volume(MPV),platelet distribution width(PDW)and plateletcrit(PCT)with the risk for stroke in people with different blood pressure levels.Methods All the participants were from Dongfeng-Tongji cohort,including 38295 retired employees from Dongfeng Motor Corporation at the first follow-up survey.After excluding participants with coronary heart disease,stroke,cancer,history of platelet influential drug use and those with missed data of platelet parameters or blood pressure or lost to follow-up,finally a total of 21294 participants were included in this study.All the participants completed baseline questionnaires,physical examinations,clinical biochemical tests,and blood sample collection.Cox proportional hazard models were used to estimate the hazard ratios(HRs)and the corresponding 95%confident intervals(CIs)for the associations between platelet parameters and risk for stroke in people with different blood pressure levels.Results After a mean follow-up of 8.0 years,1578 participants developed incident stroke[1266 ischemic stroke(IS)cases and 312 hemorrhagic stroke(HS)cases].Compared with the participants with PLT<188×10^(9)/L,those with PLT≥188×10^(9)/L among hypertension cases were significantly associated with higher risks for stroke and IS(stroke:HR=1.27,95%CI:1.12-1.44;IS:HR=1.39,95%CI:1.21-1.60).Among hypertension group,compared with participants with PCT<0.165%,PCT≥0.165%were significantly associated with higher risk for stroke(HR=1.15,95%CI:1.01-1.30)and lower risk for HS(HR=0.70,95%CI:0.53-0.93);Among non-hypertension and hypertension group,PCT≥0.165%were significantly associated with higher risks of IS(HR=1.27,95%CI:1.05-1.54;HR=1.31,95%CI:1.14-1.50).MPV and PDW were not significantly associated with risk for stroke.Risk for stroke increased significantly in hypertension cases with different platelet parameters levels compared with non-hypertension cases with lower levels of each platelet parameters.Conclusion Higher levels of PLT and PCT could increase the risks for stroke and IS in middle-aged and elderly hypertension patients,and lower levels of PCT could decrease the risk for HS in hypertension patients.