替罗非班诱导血小板减少症临床观察及干预分析  被引量:10

Clinical observation and intervention of tirofiban induced thrombocytopenia

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作  者:李红[1] 贾若飞[1] 贺建勋[2] 宋扬[2] 金泽宁[1] LI Hong;JIA Ruofei;HE Jian-xun;SONG Yang;JIN Ze-ning(Department of Emergency Medicine,Beijing Anzhen Hospital,Capital Medical University,Beijing 100029,China)

机构地区:[1]首都医科大学附属北京安贞医院急诊危重症中心,北京100029 [2]首都医科大学附属北京安贞医院检验科,北京100029

出  处:《中国介入心脏病学杂志》2019年第5期265-270,共6页Chinese Journal of Interventional Cardiology

基  金:北京市卫生系统高层次卫生技术人才培养计划(2015-3-055);北京中医药科技发展资金项目(JJ2015-30)

摘  要:目的研究血小板糖蛋白(GP)Ⅱb/Ⅲa受体拮抗药(替罗非班)诱导血小板减少症(GIT)的影响因素与干预效果。方法纳入北京安贞医院2013年1月至2016年12月2003例经皮冠状动脉介入治疗(PCI)围术期接受替罗非班治疗的患者为研究对象,分为GIT组(36例)与血小板未减少组(1967例),比较两组临床资料与实验室指标。根据是否应用激素和(或)丙种球蛋白干预将36例GIT组患者分为两个亚组,分别为干预组(16例)与未干预组(20例),比较两组血小板参数、血小板恢复时间、出血分级、出血时间。结果 (1)GIT组年龄[(64.34±5.29)岁比(57.38±12.01)岁,P<0.001]、肌酸酐(Cr)[(118.23±37.61)μmol/L比(102.92±33.54)μmol/L,P=0.007]均显著高于血小板未减少组,但吸烟史比例(30.6%比49.5%,P=0.024)、血小板计数(PLT)[(165.44±56.17)×10~9/L比(212.29±73.72)×10~9/L,P<0.001]、肾小球滤过率(GFR)[(82.46±12.45)ml/min比(94.67±15.93)ml/min,P<0.001]均显著低于血小板未减少组,差异均有统计学意义。logistic多因素回归分析显示,年龄(OR 2.658,95%CI 1.623~3.792,P<0.001)、PLT基础值(OR 3.201,95%CI 2.259~5.407,P<0.001)、GFR(OR 3.566,95%CI 1.358~6.215,P<0.001)为GIT独立危险因素。(2)干预组停药后PLT[(152.42±66.17)×10~9/L比(108.42±61.17)×10~9/L,P=0.046]、血小板分布宽度(PDW)[(16.79±2.75)%比(15.02±2.15)%,P=0.037]、平均血小板体积(MPV)[(9.84±2.01)fl比(8.32±1.78)fl,P=0.022]均显著高于未干预组,差异均有统计学意义。干预组出血分级、血小板恢复正常时间与未干预组比较,差异均无统计学意义(均P>0.05),但血小板升高时间[(26.11±12.54)h比(52.68±31.59)h,P<0.05]显著短于未干预组。干预组泌尿系统出血率、呼吸系统出血率、黏膜出血率、穿刺部位渗血率与未干预组比较,差异均无统计学意义(均P>0.05)。结论年龄、吸烟史、PLT、肾功能均为相关影响因素,积极控制相关因素可以降低血小板减少风险。GIT发生后�Objective To study the influencing factors and intervention effects of tirofiban induced thrombocytopenia. Methods Two thousand and three patients who were treated with tirofiban during peri-PCI in Beijing Anzhen Hospital, Capital Medical University from January 2013 through December 2016 were selected as study they were subjects and divided into the thrombocytopenia group (n=36) and the non-thrombocytopenia group(n=1967) according to the occurrence of thrombocytopenia. Clinical data and laboratory indexes were compared between the two groups. The 36 cases of tirofiban induced thrombocytopenia were farther divided into the intervention group (n =16) and the nonintervention group (n=20) according to the use of hormone and gamma globulin intervention. The platelet parameters, platelet recovery time, grade of bleeding and bleeding time were compared between the two groups. Results The incidence of thrombocytopenia was 1.8% in 4 years. There were signifi cant diff erences in age, smoking history, serum creatinine (Cr), platelet count (PLT) and glomerular filtration rate (GFR) between the thrombocytopenia group and the non-thrombocytopenia group(P<0.05). Multivariate logistic regression analysis showed that age (OR 2.658,95%CI 1.623–3.792,P<0.001), baseline PLT(OR 3.201,95%CI 2.259–5.407,P<0.001)and GFR(OR 3.566,95%CI 1.358–6.215, P<0.001) were independent risk factors for GP Ⅱb/Ⅲa inhibitor induced thrombocy topenia.The grade of bleeding, urinary system bleeding rate, respiratory system bleeding rate, mucosal bleeding rate, puncture site bleeding rate and platelet recovery time showed no signifi cant diff erences between the intervention group and the non-intervention group(P>0.05). Conclusions Age,smoking history,PLT count and renal function are infl uencing factors of tirofi ban induced thrombocytopenia. Active control of related factors can reduce the risk of thrombocytopenia. Medication should be discontinued immediately after the occurrence of tirofi ban induced thrombocytopenia, and drug intervention

关 键 词:血小板减少症 替罗非班 冠心病 

分 类 号:R558.2[医药卫生—血液循环系统疾病]

 

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