替罗非班诱导的血小板减少症对患者预后影响的回顾性对照研究

A retrospective controlled study of the effect of tirofiban-induced thrombocytopenia on the prognosis of patients

目的:探讨经皮冠状动脉介入治疗(PCI)围手术期替罗非班诱导血小板减少症患者的预后情况。方法:选取郑州大学第一附属医院2016年1月1日—2019年12月30日收治入院的74例PCI围术期发生替罗非班诱导血小板减少的患者作为研究组;连续入选郑州大学第一附属医院2018年1月1日—2018年12月30日入院的213例PCI围术期使用替罗非班未发生血小板减少的患者作为对照组。采用倾向性评分匹配获得基线项目相似的对照组和研究组,对比2组30 d内出血事件及随访12个月时主要不良心脑血管事件(MACCE)。结果:匹配前研究组较对照组,年龄偏大[63(57,69)岁∶60(52,66)岁],有吸烟史的患者所占比例偏大[37(50.0)%∶64(30.0)%],血小板基数偏低[192(164,249)×10^(9)/L∶219(181,256)×10^(9)/L],且差异均有统计学意义(P<0.05)。匹配后获得74例研究组和74例对照组,组间的基线资料比较差异无统计学意义(P>0.05)。与对照组比较,研究组30 d内总出血事件和轻微出血发生概率显著升高(P<0.05)。随访12个月时研究组和对照组间的MACCE发生率比较差异无统计学意义(P>0.05)。结论:替罗非班诱导的血小板减少症增加30 d内出血的风险但不增加严重出血的风险,不增加随访中期MACCE发生的风险。

Objective:To investigate the prognosis of patients with thrombocytopenia induced by tirofiban during the perioperative period of PCI.Methods:The 74 patients who suffered from thrombocytopenia induced by tirofiban during the perioperative period of PCI were enrolled as a study group from January 1,2016 to December 30,2019 in the First Affiliated Hospital of Zhengzhou University.The 213 patients without thrombocytopenia who used tirofiban during the perioperative period of PCI were enrolled as a control group from January 1,2018 to December 30,2018 in the First Affiliated Hospital of Zhengzhou University.The control group and the study group with similar baseline items were selected by propensity score matching.Bleeding events within 30 days and major adverse cardiac and cerebrovascular events(MACCE)at 12 months of follow-up were compared between the two groups.Results:Compared with the control group before matching,the age was older[63(57,69)years∶60(52,66)years],and the proportion of smoking history was higher[37(50.0)%∶64(30.0)%],the platelet base was low[192(164,249)×10^(9)/L∶219(181,256)×10^(9)/L]in the study group,and the difference was statistically significant(P<0.05).After matching,74 cases in the study group and 74 cases in the control group were obtained,and there was no significant difference in baseline data between the groups(P>0.05).Compared with the control group,the probability of total bleeding events and minor bleeding within 30 days in the study group was significantly increased(P<0.05).There was no significant difference in the incidence of MACCE between the study group and the control group at 12 months of follow-up(P>0.05).Conclusion:Tirofiban-induced thrombocytopenia increased the risk of bleeding within 30 days but did not increase the risk of severe bleeding.There was no increased risk of MACCE at mid-follow-up.