急性冠脉综合征患者发生血小板减少的危险因素及其对临床不良事件的影响

Risk Factors for Thrombocytopenia in Patients with Acute Coronary Syndrome and Its Impact on Clinical Adverse Events

目的 分析急性冠脉综合征(ACS)患者发生血小板减少的危险因素及其对临床不良事件的影响。方法 回顾性选取2019—2020年于中国人民解放军联勤保障部队第九〇九医院行PCI的ACS患者955例为研究对象。根据入院48 h内患者血小板计数将其分为血小板正常组(血小板计数≥100×10^(9)/L,861例)和血小板减少组(血小板计数<100×10^(9)/L,94例)。收集患者一般资料,采用多因素Logistic回归分析探讨ACS患者发生血小板减少的影响因素;比较两组住院期间临床不良事件发生率。结果 血小板减少组男性、有慢性肾脏病者、有慢性肝病者占比和围术期氯吡格雷使用率及肌酐、总胆红素高于血小板正常组(P<0.05)。多因素Logistic回归分析结果显示,慢性肾脏病[OR=1.901,95%CI(1.481,2.437)]、围术期氯吡格雷使用情况[OR=2.153,95%CI(1.242,3.722)]、肌酐[OR=2.299,95%CI(1.451,3.646)]是ACS患者发生血小板减少的影响因素(P<0.05)。血小板减少组出血事件发生率、输血率高于血小板正常组(P<0.05)。结论 合并慢性肾脏病、围术期使用氯吡格雷、肌酐升高是ACS患者发生血小板减少的独立危险因素;且合并血小板减少的ACS患者住院期间出血事件发生风险、输血风险更高。

Objective To investigate the risk factors for thrombocytopenia in patients with acute coronary syndrome(ACS)and its impact on clinical adverse events.Methods A total of 955 ACS patients who underwent PCI in No.909 Hospital of the Joint Logistics Support Force of the PLA from 2019 to 2020 were retrospectively selected as the research subjects.According to the platelet count within 48 h of admission,the patients were divided into normal platelet group(platelet count≥100×10^(9)/L,861 cases)and thrombocytopenia group(platelet count<100×10^(9)/L,94 cases).The general data of the patients were collected,and multivariate Logistic regression analysis was used to explore the influencing factors of thrombocytopenia in patients with ACS;the incidence of clinical adverse events during hospitalization was compared between the two groups.Results In the thrombocytopenia group,the proportion of males,patients with chronic kidney disease and patients with chronic liver disease,perioperative clopidogrel usage,creatinine and total bilirubin were higher than those in the normal platelet group(P<0.05).Multivariate Logistic regression analysis showed that chronic kidney disease[OR=1.901,95%CI(1.481,2.437)],perioperative clopidogrel use[OR=2.153,95%CI(1.242,3.722)],and creatinine[OR=2.299,95%CI(1.451,3.646)]were the influencing factors of thrombocytopenia in patients with ACS(P<0.05).The incidence of bleeding events and blood transfusion in the thrombocytopenia group was higher than that in the normal platelet group(P<0.05).Conclusion Chronic kidney disease,perioperative use of clopidogrel,and elevated creatinine are independent risk factors for thrombocytopenia in patients with ACS;and ACS patients with thrombocytopenia have a higher risk of bleeding events and blood transfusion during hospitalization.