血小板分布宽度与持续性心房颤动患者华法林抗凝治疗稳定性的相关性

Correlation between platelet distribution width and anticoagulant stability of warfarin in patients with persistent atrial fibrillation

目的探索血小板分布宽度(PDW)与持续性心房颤动患者华法林抗凝治疗稳定性之间的相关性。方法选取2018年1月至2019年12月就诊于九江市第一人民医院的138例使用华法林抗凝治疗的持续性心房颤动患者,根据PDW是否升高分组(PDW降低组、正常范围组、升高组)并进行亚组分层,分析PDW与华法林抗凝治疗稳定性[用国际化标准比值(INR)在治疗目标范围内的时间百分比(TTR)表示]的关系,同时分析PDW对于华法林抗凝治疗稳定性达标方面的预测价值。结果PDW降低组、正常范围组、升高组的PDW、TTR比较差异有统计学意义(F=30.322、10.745,均P<0.01)。不同抗凝质量患者的PDW分布比较差异有统计学意义(χ^(2)=9.532,P<0.05)。ROC曲线显示,PDW预测华法林抗凝稳定性的曲线下面积(AUC)为0.621,95%CI:0.524~0.737,P=0.023。PDW<14%、14%~<16%、16~<18%、≥18%四组间的PDW、TTR比较差异有统计学意义(F=18.075、11.638,均P<0.01)。而PDW<14%、14%~<16%、16~<18%三个亚组间PDW、TTR比较差异无统计学意义(P=0.843,P=0.401)。16~<18%、≥18%两个亚组间的PDW、TTR比较差异均有统计学意义(t=4.154、6.712,均P<0.01)。结论血小板分布宽度与华法林抗凝治疗稳定性的达标率具有较强的相关性,可以考虑作为预测华法林抗凝治疗稳定性达标的随访参数。

Objective To explore the correlation between platelet distribution width(PDW)and the stability of warfarin anticoagulant therapy in patients with persistent atrial fibrillation.Methods 138 patients with persistent atrial fibrillation treated with warfarin in Jiujiang First People′s Hospital from January 2018 to December 2019 were selected.They were divided into groups according to whether PDW increased(PDW decreased group,normal group,PDW increased group)and subgroups stratification was performed.After stratification,the relationship between PDW and the stability of warfarin anticoagulation treatment[expressed as the percentage of time of International normalized ratio(INR)within the treatment target range(TTR)]was analyzed.At the same time,the predictive value of PDW for the stability of warfarin anticoagulation treatment was analyzed.Results There were significant difference in PDW and TTR among the PDW decreased group,normal group,PDW increased group(F=30.322,10.745,all P<0.01).The PDW distribution of patients with different anticoagulation quality was significantly different(χ^(2)=9.532,P<0.05).Receiver operating characteristic(ROC)curve showed that the area under curve(AUC)of PDW in predicting warfarin anticoagulant stability was 0.621(95%CI:0.524-0.737).There was significant difference in PDW and TTR among the PDW<14%,14%-<16%,16-<18%and≥18%groups(F=18.075,11.638,all P<0.01).There was no significant difference in PDW and TTR among the three subgroups of PDW<14%,14%-<16%and 16-<18%(P=0.843,P=0.401).There were significant difference in PDW and TTR between the two subgroup of PDW 16-<18%、≥18%(t=4.154,6.712,all P<0.01).Conclusions PDW is correlated with the standard rate of warfarin anticoagulant stability,and can be used to predict the standard rate of warfarin anticoagulant stability.