A型急性主动脉夹层患者入院时血小板计数与住院死亡率的相关性研究  

Relationship Between Platelet Counts at Admission and In-hospital Mortality in Patients With Type A Acute Aortic Dissection

作　　者：黄毕[1] 田力[1] 樊晓寒[1] 朱俊[1] 梁岩[1] 李建东[1] 杨艳敏[1] 

机构地区：[1]北京协和医学院中国医学科学院心血管病研究所阜外心血管病医院心血管疾病国家重点实验室急重症中心,北京市100037

出　　处：《中国循环杂志》2014年第10期814-818,共5页Chinese Circulation Journal

基　　金：国家自然科学基金资助项目(编号:81170286)

摘　　要：目的：探讨A型急性主动脉夹层患者入院时血小板计数与住院死亡率的相关性。方法：连续入选2012-02至2013-05就诊于我院并经计算机断层扫描（CT）证实的A型急性主动脉夹层患者183例，男性126例（68.9%）。分组：①根据患者住院期间是否存活分为存活组（n=157）,死亡组（n=26）；②根据血小板计数五分位值将患者分五组，即血小板计数第1分位（≤119×109/L）组（Q1组，n=36），血小板计数第2分位（120~149×109/L）组（Q2组，n=37），血小板计数第3分位（150~173×109/L）组（Q3组，n=36），血小板计数第4分位（174~228×109/L）组（Q4组，n=37），血小板计数第5分位（〉228×109/L）组（Q5组，n=37）；③按入院时血小板计数分为≤119×109/L组（n=36）和〉119×109/L组（n=147），再根据是否接受手术治疗将其分为≤119×109/L手术者（n=18）、≤119×109/L非手术者（n=18）和〉119×109/L手术者（n=96）、〉119×109/L非手术者（n=51）。采集患者入院时的基线资料及静脉血标本，检测血小板计数、白细胞、D-二聚体等值。主要终点事件为住院死亡率。结果：183例A型急性主动脉夹层患者总住院死亡率为14.3%。死亡组与存活组比较，血小板计数显著减少、血压较低、D-二聚体水平较高； Q1组患者死亡率（38.9%）显著高于Q2、Q3、Q4和Q5四组（10.8%、11.1%、8.1%和2.7%），差异均有统计学意义（P〈0.001）。Q5组较Q1组死亡风险增加（HR=11.2，95%CI 2.13~123.3，P=0.007），在调整了年龄、性别等影响预后的因素后，血小板计数≤119×109/L无论在手术治疗进入Cox模型前（HR3.90，95%CI 1.67~9.09， P=0.002）还是进入模型后（HR2.67，95%CI 1.15~6.19，P=0.023）均增加住院死亡风险。结论：A型急性主动脉夹层患者入院时血小板计数≤119×109/L住院死亡率风险明显增加。即使接受手术治疗，血小板计数值较低的患者仍与住院死Objective： To explore the relationship between platelet counts at admission and in-hospital mortality in patients with type A acute aortic dissection （AAD）. Methods： We investigated 183 consecutive patients with CT conifrmed diagnosis of type A AAD treated in our hospital from 2012-02 to 2013-05. There were 126 （68.9%） male and the patients were divided into 3 sets of groups.①In-hospital surviving group,n=157 and In-hospital death group,n=26.②According to platelet counts, the patients were divided into 5 groups： Q1 group, platelet counts ≤ 119×109/L,n=36, Q2 group, platelet （120-149） ×109/L,n=37, Q3 group, platelet （150-173）×109/L, n=36, Q4 group, platelet （174-228）×109/L,n=37, Q5 group, platelet 〉228×109/L,n=37.③At admission, platelet ≤ 119×109/L,n=36 and platelet 〉119×109/L,n=147. In addition, the patients were further divided into another 4 groups based on operative condition： platelet ≤ 119×109/L with operation,n=18, without operation,n=18; platelet 〉 119×109/L with operation,n=96, without operation,n=51. The basic information at admission including platelet counts, WBC and D-dimer were studied in all groups, the primary endpoint was in-hospital mortality. Results： The overall in-hospital mortality was 14.3%. Compared with In-hospital surviving group, the In-hospital mortality group had decreased platelet counts, lower blood pressure and higher level of D-dimer. The mortality in Q1 group （38.9%） was higher than those in Q2, Q3, Q4 and Q5 groups （10.8%, 11.1%, 8.1% and 2.7%）, allP〈0.001. The risk of death in Q5 group was higher than Q1 group （HR=11.2, 95% CI 2.13-123.3,P=0.007）. With adjusted age, gender and other relevant factors, when platelet counts ≤ 119×109/L, the risk of in-hospital mortality with Cox multivariate model I analysis was （HR3.90, 95% CI 1.67-9.09,P=0.002）, with Cox model II was （HR=2.67, 95% CI 1.15 -6.19,P=0.023）. Conclusion： AAD patients with admission platelet counts ≤ 119×109/L had the high risk of in

关 键 词：血小板计数 急性主动脉夹层 住院死亡率 

分 类 号：R541[医药卫生—心血管疾病]