经导管主动脉瓣置换术后血小板减少发生规律及相关因素分析  

Acquired thrombocytopenia after transcatheter aortic valve replacement:occurrence regularity and clinical correlates

作　　者：刘松涛 蔡新勇[1] 邵靓 刘员员[1] 黄笑 朱虹岷[1] 洪浪[1] 詹宇亮 LIU Song-tao;CAI Xin-yong;SHAO Liang;LIU Yuan-yuan;HUANG Xiao;ZHU Hong-min;HONG Lang;ZHAN Yu-liang(Department of Cardiology,Jiangxi Provincial People's Hospital,the First Affiliated Hospital of Nanchang Medical College,Nanchang 330006,China)

机构地区：[1]江西省人民医院(南昌医学院第一附属医院)心内科,江西南昌330006

出　　处：《中国介入心脏病学杂志》2023年第9期654-658,共5页Chinese Journal of Interventional Cardiology

摘　　要：目的探讨经导管主动脉瓣置换术(TAVR)术后血小板减少发生规律及相关因素。方法选取2021年1月至2022年12月在江西省人民医院行TAVR患者111例,依据术后血小板减少较基线值≥30%分为术后血小板减少组及术后血小板正常组。对比两组病例资料,分析TAVR术后血小板减少的发生规律及相关因素。结果在111例TAVR患者中,术后血小板减少组72例(64.9%),其中80.5%患者在术后第2~4天血小板计数降低至最低值,94.4%患者出院前血小板计数恢复基线水平;术后血小板正常组39例(35.1%)。术后血小板减少组与术后血小板正常组患者中术后白细胞计数[(12.69±3.74)×10^(9)/L比(10.00±3.48)×10^(9)/L,P<0.001]、术后中性粒细胞百分比[(87.51±6.52)%比(79.60±11.01)%,P<0.001]、术后血红蛋白[(94.50±18.30)g/L比(108.80±17.50)g/L,P<0.001]、术后血小板计数[(89.38±42.26)×10^(9)/L比(144.21±40.04)×10^(9)/L,P<0.001]、术后C反应蛋白[(34.84±40.25)mg/L比(12.59±10.94)mg/L,P=0.048]、术后降钙素原[(1.55±3.81)ng/ml比(0.24±0.24)ng/ml,P=0.020]、手术时间[(132.85±25.05)min比(115.13±10.48)min,P<0.001]比较,差异均有统计学意义。经二元Logistic单因素回归方程分析,手术时间是TAVR术后血小板减少的影响因素,差异有统计学意义(OR 1.062,95%CI 1.028~1.098,P<0.001)。结论TAVR术后发生血小板减少是一种常见的现象,且具有自限性,大部分患者在出院前血小板能恢复至基线水平。炎症反应可能是TAVR术后血小板减少的潜在机制。较长的手术时间与术后血小板减少独立相关。Objective To analyze the occurrence regularity and clinical correlates of thrombocytopenia after transcatheter aortic valve replacement(TAVR).Methods A total of 111 patients who underwent TAVR in our hospital from January 2021 to December 2022 were included and divided into two groups:postoperative thrombocytopenia group and postoperative platelet normal group based on postoperative platelet count≥30%compared to the baseline value.The data of two groups was compared and the regularity and related factors of thrombocytopenia after TAVR were analyzed.Results Among the 111 TAVR patients,72(64.9%)showed a decrease of≥30%in platelet count compared to baseline.Among them,80.5%of patients had a minimum platelet count 2–4 days after TAVR,and 94.4%of patients had their platelet count restored to baseline before discharge.The number of patients with postoperative leukocyte count,postoperative neutrophil count,postoperative hemoglobin,postoperative platelet count,postoperative C-reactive protein,postoperative pro Calcitonin,and surgical time were statistically different between the two groups(all P<0.05).Through binary Logistic regression analysis,it was found that surgical time is a influencing factor for the occurrence of thrombocytopenia after TAVR(P<0.001).Conclusions Thrombocytopenia after TAVR is a common phenomenon and has selflimiting characteristics.Most patients can recover their platelets to normal levels before discharge.Inflammatory response may be a potential mechanism of thrombocytopenia after TAVR surgery.Long surgical time is independently associated with postoperative thrombocytopenia.

关 键 词：经导管主动脉瓣置换术 血小板减少 

分 类 号：R541[医药卫生—心血管疾病]