华西医学

华西医学

血小板计数对经介入治疗的 B 型急性主动脉夹层患者长期预后的预测价值

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目的探究入院时血小板计数对经介入治疗的 B 型急性主动脉夹层(acute aortic dissection,AAD)患者长期预后的预测价值。 方法回顾性分析四川大学华西医院 2012 年 1 月—12 月经介入治疗的 B 型 AAD 患者 131 例。收集患者的基本临床资料、血液检查结果、主要心血管不良事件、院内及随访期间存活状态。按血小板计数三分位数将患者分为 3 组,采用χ2 检验分析血小板计数与院内并发症的关系。通过 Kaplan-Meier 生存分析及 Cox 比例风险模型来评估血小板计数与 B 型 AAD 患者生存间的关系。主要终点指标为全因死亡。 结果131 例患者中,院内病死率为 9.9%,随访中位时间 2.1 年,长期病死率为 16.0%。血小板第 1 分位(>200×109/L)组(T1 组)44 例,血小板第 2 分位[(155~200)×109/L]组(T2 组)44 例,血小板第 3 分位(≤155×109/L)组(T3 组)43 例。T3 组死亡率(30.2%)显著高于 T1(4.5%)和 T2 组(13.6%),差异有统计学意义(χ2=10.942,P=0.004)。Kaplan-Meier 生存分析显示 T3 组的累积生存率显著低于 T1 组与 T2 组(69.8% vs. 95.5%,χ2=10.165,P=0.001;69.8% vs. 86.4%,χ2=5.174,P=0.037)。Cox 多因素分析显示年龄[风险比(hazard ratio,HR)=1.043,95% 置信区间(confidence interval,CI)(1.009,1.079),P=0.013]、心率[HR=1.030,95%CI(1.004,1.058),P=0.024]和血小板计数[HR=6.011,95%CI(1.319,27.391),P=0.020]是患者死亡的独立危险因素。年龄大、心率增快、血小板降低会增加患者的死亡风险。 结论血小板计数是影响经介入治疗的 B 型 AAD 患者预后的独立因素,入院时低血小板会增加患者的长期死亡风险。

ObjectivesTo explore the predictive value of platelet count at admission for long-term prognosis in patients with type B acute aortic dissection (AAD) undergoing endovascular therapy (EVT). MethodsWe investigated 131 consecutive patients with type B AAD after EVT in West China Hospital of Sichuan University from January to December 2012. The patients’ basic clinical data, blood test results, major adverse cardiovascular events, and in-hospital and out-hospital survival status were collected. According to the tri-sectional quantiles of platelet counts, the patients were divided into three groups. Chi-square test was used to analyze the correlation between platelet count and hospital complications. Kaplan-Meier survival analysis and Cox regression analysis were used to analyze the relationship between platelet count and survival in patients with type B AAD. The primary endpoint was all-cause death. ResultsThe overall in-hospital mortality of the 131 patients was 9.9%, and the mortality was 16.0% by the end of the follow-up, the median length of which was 2.1 years. There were 44 cases in T1 group (platelet count >200×10 9/L), 44 cases in T2 group [platelet count (155–200)×109/L], and 43 cases in T3 group [platelet count ≤155×109/L]. The mortality in T3 group (30.2%) was higher than that in T1 group (4.5%) and T2 group (13.6%) (P=0.004). Kaplan-Meier survival analysis showed that the cumulative survival rate of T3 group was significantly lower than that of T1 group and T2 group (69.8% vs. 95.5%, χ2=10.165, P=0.001; 69.8% vs. 86.4%, χ2=5.174, P=0.037). Cox multivariate analysis showed that age [hazard ratio (HR)=1.043, 95% confidence interval (CI) (1.009, 1.079), P=0.013], heart rate [HR=1.030, 95%CI (1.004, 1.058), P=0.024], and platelet count [HR=6.011, 95%CI (1.319, 27.391), P=0.020] were independent risk factors for mortality. Older age, rapid heart rate, and lower platelet count would increase the risk of death. ConclusionPlatelet count may be an independent factor that affects the prognosis of patients with type B AAD after EVT, and a low platelet count at admission increases the risk of death.

关键词: 血小板计数; B 型急性主动脉夹层; 介入治疗; 预后

Key words: Platelet count; Type B acute aortic dissection; Endovascular therapy; Prognosis

引用本文: 赖强, 李东泽, 高永莉, 张海宏, 陈瑶, 万智, 曹钰. 血小板计数对经介入治疗的 B 型急性主动脉夹层患者长期预后的预测价值. 华西医学, 2018, 33(11): 1395-1399. doi: 10.7507/1002-0179.201710142 复制

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