血小板增多与慢性阻塞性肺疾病伴低危肺栓塞患者住院全因死亡的相关性分析  

Relationship between thrombocytosis and all-cause in-hospital mortality in patients with chronic obstructive pulmonary disease and low-risk pulmonary embolism

作　　者：郭璐 杨阳 蒋红丽[2] 龚道明 高凌云 杨雁 张静 钟甜 刘跃建 解郑良 

机构地区：[1]四川省医学科学院.四川省人民医院电子科技大学附属医学院呼吸与危重症医学科,四川成都610072 [2]四川大学华西医院中西医结合科呼吸组,四川成都610041 [3]资阳市人民医院呼吸内科,四川资阳641300 [4]四川省医学科学院.四川省人民医院电子科技大学附属医学院城东病区呼吸内科,四川成都610101

出　　处：《中国呼吸与危重监护杂志》2018年第1期20-26,共7页Chinese Journal of Respiratory and Critical Care Medicine

基　　金：四川省卫生厅科研基金(090442)

摘　　要：目的探索血小板增多与慢性阻塞性肺疾病(简称慢阻肺)伴低危肺栓塞患者住院全因死亡的相关性。方法采用临床多中心回顾性研究,选取2005年10月至2017年2月因急性肺栓塞住院的慢阻肺患者,根据肺栓塞严重指数(PESI)排除中高危肺栓塞患者,纳入慢阻肺伴低危肺栓塞患者作为研究对象。采集入院时血小板计数,将患者分为血小板增多组与非血小板增多组。比较两组患者临床特征及预后,使用多元回归分析血小板增多与住院全因死亡的相关性,并调整混杂变量。结果纳入慢阻肺合并低危肺栓塞的874例成年患者中,191例(21.9%)合并血小板增多。与非血小板增多组比较,血小板增多组具有更低的体重指数[(20.9±3.3)kg/m^2比(25.1±3.8)kg/m^2,P=0.01]、更低水平的第1秒用力呼气容积[(0.9±0.4)L比(1.3±0.3)L,P=0.001]和动脉血氧分压[(7.8±1.2)k Pa比(9.7±2.3)k Pa,P=0.003],以及更高的心血管合并症发生率和肺动脉收缩压[(46.5±20.6)mmHg比(34.1±12.6)mmHg,P=0.001]。校正混杂因素后,血小板增多与住院全因死亡相关(OR=1.53,95%CI1.03~2.29),而口服抗血小板药物(OR=0.71,95%CI 0.31~0.84)为保护性因素。结论血小板增多是慢阻肺伴低危肺栓塞患者住院全因死亡的独立危险因素,抗血小板治疗可能对这类高危人群具有保护性作用。Objective To explore the relationship between thrombocytosis and all-cause in-hospital mortality in patients with chronic obstructive pulmonary disease （COPD） and low-risk pulmonary embolism （PE）. Methods In a multicenter retrospective study on clinical characteristics, COPD patients with proven acute PE between October 2005 and February 2017 were enrolled. The patients in risk classes III-V on the basis of the PESI score were excluded. The patients with COPD and low-risk PE were divided into two groups of those with thrombocytosis and without thrombocytosis after extracting platelet count on admission. The clinical characteristics and prognosis of the two groups were compared. Multivariate logistic regression was performed to reveal an association between thrombocytosis and all-cause in-hospital mortality after confounding variables were adjusted. Results A total of 874 consecutive patients with COPD and PE at low risk were enrolled in which 191 （21.9%） with thrombocytosis. Compared with those without thrombocytosis, the thrombocytopenic group had significantly lower body mass index [（20.9±3.3） kg/m2 vs. （25.1±3.8） kg/m2, P=0.01], lower levels of forced expiratory volume in one second （FEV1） [（0.9±0.4） L vs. （1.3±0.3） L, P=0.001] and lower partial pressure of oxygen in the arterial blood （PaO2） [（7.8±1.2） kPa vs. （9.7±2.3） kPa, P=0.003]. The COPD patients with thrombocytosis had a higher proportion of cardiovascular complications as well as higher level of systolic pulmonary arterial pressure （sPAP） [（46.5±20.6） mm Hg vs. （34.1±12.6） mm Hg, P=0.001]. Multivariate logistic regression analysis after adjustment for confounders revealed that thrombocytosis was associated with all-cause mortality in hospitalized patients with COPD and low-risk PE （adjusted OR=1.53, 95%CI 1.03-2.29）, and oral antiplatelet treatment was a protective factor （adjusted OR=0.71, 95%CI 0.31-0.84）. Conclusions Thrombocytosis is an independent risk factor for all-cause in

关 键 词：慢性阻塞性肺疾病 肺栓塞 血小板增多 肺动脉高压 死亡率 

分 类 号：R563.8[医药卫生—呼吸系统] R563.9[医药卫生—内科学]