外周血基线血小板计数水平对老年冠心病患者长期预后的影响  

Effect of baseline peripheral blood platelet count on long⁃term prognosis in elderly patients with coronary atherosclerotic heart disease

作　　者：李双双[1] 马依彤[2] 郑颖颖[2] 吴婷婷[2] 谢翔[2] Li Shuangshuang;Ma Yitong;Zheng Yingying;Wu Tingting;Xie Xiang(Department of Respiratory,First Affiliated Hospital of Xinjiang Medical University,Urumqi 830011,China;Department of Cardiology,First Affiliated Hospital of Xinjiang Medical University,Urumqi 830011,China)

机构地区：[1]新疆医科大学第一附属医院呼吸中心,乌鲁木齐830011 [2]新疆医科大学第一附属医院心脏中心,乌鲁木齐830011

出　　处：《中国医药》2023年第7期976-980,共5页China Medicine

基　　金：国家自然科学基金(82170345)。

摘　　要：目的探讨外周血基线血小板计数(PLT)水平对老年冠心病(冠状动脉粥样硬化性心脏病)患者长期预后的影响。方法纳入2008年1月至2016年12月在新疆医科大学第一附属医院确诊为冠心病的老年(年龄≥60岁)患者共3024例,并对其进行规律随访,最长随访时间达10年,随访终点设定为全因死亡、心源性死亡、主要不良心血管事件(MACE)。入院时通过血常规检测获得基线PLT水平。根据入院时基线PLT水平将患者分为PLT低水平组(PLT<199.5×10^(9)/L,n=1468)和PLT高水平组(PLT≥199.5×10^(9)/L,n=1556)。采用多因素Cox比例风险模型回归分析方法分析不同PLT水平对老年冠心病患者长期预后的影响。结果PLT高水平组全因死亡、心源性死亡、MACE的发生率均高于PLT低水平组,差异均有统计学意义(均P<0.05)。Kaplan⁃Meier单因素生存分析结果显示,与PLT低水平组比较,PLT高水平组患者全因死亡、心源性死亡、MACE的累积死亡风险均增加(均P<0.05)。在调整年龄、性别、吸烟、饮酒等混杂因素后应用多因素Cox比例风险模型回归分析结果显示,与PLT低水平组相比,PLT高水平组全因死亡风险增加46.6%(风险比=1.466,95%置信区间:1.063~2.022,P=0.020)、心源性死亡风险增加60.1%(风险比=1.601,95%置信区间:1.100~2.330,P=0.014)、MACE风险增加51.9%(风险比=1.519,95%置信区间:1.207~1.911,P<0.001)。结论入院时基线PLT水平升高显著增加老年冠心病患者不良事件的发生率,其基线水平升高可作为长期全因死亡、心源性死亡、MACE的独立危险因素。Objective To explore the impact of baseline platelet count(PLT)levels in peripheral blood on the long⁃term prognosis of elderly patients with coronary atherosclerotic heart disease.Methods A total of 3024 elderly patients(≥60 years old)who were diagnosed with coronary atherosclerotic heart disease in the First Affiliated Hospital of Xinjiang Medical University from January 2008 to December 2016 were included,and they were regularly followed up for a maximum of 10 years.The follow⁃up endpoints were set as all⁃cause mortality(ACM),cardiac mortality(CM),major adverse cardiovascular events(MACE).The acute baseline PLT was obtained by blood routine examination at admission.According to the baseline PLT level at admission,the patients were divided into PLT low level group(PLT<199.5×10^(9)/L,n=1468)and PLT high level group(PLT≥199.5×10^(9)/L,n=1556).The impact of different PLT levels on the long⁃term prognosis of elderly coronary atherosclerotic heart disease was analyzed by multivariate Cox proportional⁃hazards model regression analysis methed.Results The incidence of ACM,CM,and MACE in the PLT high level group was significantly higher than that in the PLT low level group,with statistical significance(all P<0.05).The Kaplan⁃Meier univariate survival analysis showed an increased cumulative risk of death for ACM,CM,and MACE in patients with high levels of PLT(all P<0.05).After adjusting for confounding factors such as age,gender,smoking,and alcohol consumption,multivariate Cox proportional⁃hazards model regression analysis results showed that compared to the PLT low level group,the PLT high level group had a 46.6%increase in ACM risk(hazard ratio=1.466,95%confidence interval:1.063⁃2.022,P=0.020),a 60.1%increase in CM risk(hazard ratio=1.601,95%confidence interval:1.100⁃2.330,P=0.014),and a 51.9%increase in MACE risk(hazard ratio=1.519,95%confidence interval:1.207⁃1.911,P<0.001).Conclusion Elevated baseline PLT levels at admission significantly increase the incidence of adverse events in elderly

关 键 词：冠心病(冠状动脉粥样硬化性心脏病) 血小板计数 长期预后 

分 类 号：R541[医药卫生—心血管疾病]