连续性静脉-静脉血液滤过治疗中血小板减少的发生率和危险因素分析  

Incidence and risk factors of thrombocytopenia in patients receiving continuous veno-venous hemofiltration

作　　者：邬步云[1] 龚德华[1] 徐斌[1] 何群鹏[1] 刘志红[1] 季大玺[1] 

机构地区：[1]南京大学医学院,南京军区南京总医院,国家肾脏疾病临床医学研究中心,全军肾脏病研究所,博士研究生南京210016

出　　处：《肾脏病与透析肾移植杂志》2014年第2期121-127,共7页Chinese Journal of Nephrology,Dialysis & Transplantation

基　　金：国家自然科学基金资助项目(81070608);十二五国家科技支撑计划(2011BAI10B07)

摘　　要：目的:回顾性分析接受连续性静脉-静脉血液滤过(CVVH)的患者中血小板下降与血小板减少症(TP)的发生率和相关的危险因素。方法:2008年11月至2012年10月在南京军区南京总医院肾脏科首次行CVVH治疗,72h、有连续4d血常规记录的患者纳入研究,排除除脓毒症外有其他因素可能影响血小板计数(PLT)的患者。分析治疗前后PLT、疾病严重程度和预后。结果:共纳入125例接受CVVH治疗的危重症患者,男性97例,女性28例。平均年龄51.8±18.7岁,平均APACHEⅡ评分17.8±6.5分。CVVH治疗3d内,60.8%的患者PLT下降≥20%(血小板减少),16.0%的患者PLT下降≥50%(严重血小板减少)。TP(PLT≤100×109/L)和严重TP(PLT≤50×109/L)的发生分别为53.6%和16.0%。严重血小板减少组相比无严重血小板减少的患者生存率有显著性降低(35.0%vs 59.0%,P=0.012),而严重TP相比无严重TP患者生存率无显著性差异(45.0%vs 57.1%,P=0.308)。多因素回归分析显示CVVH中严重血小板减少的独立的危险因素包括女性、高龄、较长病程;严重TP的独立危险因素为治疗前TP。结论:在接受CVVH治疗的患者中血小板减少和TP的发生十分常见。CVVH治疗后PLT下降幅度相比PLT更可能影响生存率。临床需要我们识别CVVH中严重血小板减少的高危因素,预防严重血小板减少的发生。Objective： A retrospective analysis was made to investigate the incidence of platelet decline and related risk factors in patients receiving CRRT. Methodology： From November 2008 to October 2012, all patients receiving continuous veno- venous hemofiltration （CVVH） in Jinling hospital were screened, Only patients matching following criteria were enrolled for further analysis：uninterrupted CVVH for more than 72h, with records of blood test for consecutive four days, ruling out pre-existing conditions maybe affecting platelet counts. The levels of platelet were counted before and during CVVH, and the illness severity, and outcome were also analyzed at the same time. Results：They were 125 patients,97 males and 28 females,with a mean age of （51.8±18.7） years. The mean APACHE II score was 17.8± 6. 5. During three-day CVVH, 60. 8% patients had a decline of platelet count more than 20%, and 16% patients had a decline more than 50% ;the percentage of thrombocytopenia （PLT ≤ 100x 109/L） and severe thrombocytopenia （PLT ≤ 50x 109/L） was 53.6% and 16. 0%, respectively. There were no differences of mean platelet volume （MPV） between before CVVH and during CVVH. The patients with platelet decline more than 50% had a significantly lower survival rate than others （35.0% vs 59. 0% ,P= 0. 012）, while patients with severe thrombocytopenia had a survival rate similar with others （45.0% vs 57. 1%, P = 0. 308 ）. Female gender, older age and longer course of the disease were independent risk factors of platelet decline more than 50%, and thrombocytopenia before CVVH was the independent risk factor of severe thrombocytopenia after CVVH. Conclusion：Platelet decline and thrombocytopenia are quite common in patients receiving CVVH. The extent of platelet decline rather than absolute count during CVVH may affect survival rate. The risk factors of platelet decline more than 50% included female gender,older age and longer course of the disease.

关 键 词：连续性静脉-静脉血液滤过 血小板下降 血小板减少症 发生率 危险因素 

分 类 号：R692.5[医药卫生—泌尿科学]