72例获得性血栓性血小板减少性紫癜患者的心血管事件单中心临床观察  

Cardiovascular events in patients with thrombotic thrombocytopenic purpura:a single⁃center experience

作　　者：赵思叶 刘颖[1] 王雄[2] 唐宁 李登举[1] Zhao Siye;Liu Ying;Wang Xiong;Tang Ning;Li Deng-ju(Department of Hematology,Tongji Hospital Affiliated to Tongji Medical College of Huazhong University of Science and Technology,Wuhan 430030,China;Department of Clinical Laboratory,Tongji Hospital Affiliated to Tongji Medical College of Huazhong University of Science and Technology,Wuhan 430030,China)

机构地区：[1]华中科技大学同济医学院附属同济医院血液科,武汉430030 [2]华中科技大学同济医学院附属同济医院检验科,武汉430030

出　　处：《血栓与止血学》2022年第6期1203-1208,共6页Chinese Journal of Thrombosis and Hemostasis

摘　　要：目的 研究获得性血栓性血小板减少性紫癜(TTP)患者的心血管事件发生情况及其对临床预后的影响。方法 回顾性分析自2016年1月至2022年5月住院患者中诊断为获得性TTP的72例患者的临床资料及预后,根据预后分为死亡组及非死亡组,比较两组患者临床特征的差异,分析死亡相关危险因素。结果 纳入的72例TTP患者中23.6%(17/72)具有心血管系统临床表现,包括胸闷、胸痛,心悸,呼吸困难,双下肢水肿;69.4%(50/72)心肌肌钙蛋白I(cTnI)升高;66.7%(48/72)N-末端脑钠肽前体(NT-proBNP)升高;40.3%(29/72)具有心电图异常表现;34.7%(25/72)具有超声心动图异常表现。与非死亡组相比,死亡组cTNI、肌酸激酶同工酶(CK-MB)、NT-proBNP水平更高,年龄更大,具有神经精神症状的比例更高,尿素氮、肌酐水平更高,eGFR水平更低,谷草转氨酶(AST)、间接胆红素(I-BIL)及乳酸脱氢酶(LDH)水平更高(P<0.05)。Logistic多因素回归分析发现,年龄、I-BIL及cTNI>449.2 pg/mL是死亡的危险因素。结论 多数TTP患者有不同程度的心脏损伤表现。高龄、血管内溶血程度重以及心肌损伤均明显增加了TTP不良预后转归。Objective To study the incidence of cardiovascular events in patients with acquired thrombotic thrombocytopenic purpura(TTP)and its effect on clinical prognosis.Methods The clinical data and prognosis of 72 patients diagnosed with acquired TTP in hospitalized patients from January 2016 to May 2022 were retrospectively analyzed.According to the prognosis,they were divided into a death group and a non⁃death group.Differences and risk factors for death were analyzed.Results 23.6%(17/72)of the 72 TTP patients included had clinical manifestations of the cardiovascular system,including chest tightness,chest pain,palpitations,dyspnea,and edema of both lower extremities;Cardiac troponin I(cTnI)was elevated in 69.4%(50/72),and N⁃terminal pro⁃brain natriuretic peptide(NT⁃proBNP)was elevated in 66.7%(48/72);40.3%(29/72)had abnormal electrocardiogram;34.7%(25/72)had abnormal echocardiographic findings.Compared with the non⁃death group,the death group had higher levels of cTNI,creatine kinase isoenzyme(CK⁃MB),NT⁃proBNP,older age,higher proportion of neuropsychiatric symptoms,higher blood urea nitrogen and creatinine levels,eGFR levels were lower,aspartate aminotransferase(AST),indirect bilirubin(I⁃BIL)and lactate dehydrogenase(LDH)levels were higher(P<0.05).Logistic multivariate regression analysis found that age,I⁃BIL and cTNI>449.2 pg/mL were risk factors for death.Conclusion Most TTP patients have different degrees of cardiac injury.Advanced age,severe intravascular hemolysis and myocardial injury significantly increased the poor prognosis of TTP.

关 键 词：血栓性血小板减少性紫癜 心血管事件 死亡危险因素 

分 类 号：R558.2[医药卫生—血液循环系统疾病]