中国呼吸与危重监护杂志

中国呼吸与危重监护杂志

血小板动态下降对急性呼吸窘迫综合征的预后评估价值

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目的探究血小板变化与急性呼吸窘迫综合征(ARDS)患者预后的关系。方法通过回顾性分析方法纳入复旦大学附属中山医院 2008 年至 2015 年收治的 275 例 ARDS 患者,从病案系统中采集患者的临床症状、实验室检查指标、疾病转归等信息。用 COX 回归分析、Kaplan-Meier 生存曲线等统计学方法分析疾病前 3 d 内血小板下降与 ARDS 预后的关系,并进行亚组分析。结果按照纳入与排除标准,共 233 例患者入组,根据其疾病前 3 d 内血小板计数分为下降组和非下降组。单因素分析、COX 回归分析、Kaplan-Meier 生存曲线均显示两组的预后差异有统计学意义(均 P<0.05)。根据初始的血小板计数和 3 d 内血小板变化情况把所有入组患者分为 9 个亚组。通过比较这些亚组的死亡率得到两个风险组,包括持续性低血小板组(初始血小板计数<139×109/L,且疾病前 3 d 血小板增加<16×109/L),以及血小板下降组(初始血小板计数≥139×109/L,且疾病前 3 d 血小板下降>30×109/L)。其余亚组合并为非风险组。将两个风险组合并后与非风险组进行比较,单因素分析、COX 回归分析、Kaplan-Meier 生存曲线均显示风险组与非风险组的预后差异有统计学意义(均 P<0.05),各项凝血功能指标差异无统计学意义(均P>0.05)。血小板计数也可以作为风险组中手术亚组(P=0.003)、非高血压亚组(P=0.018)和肺炎亚组(P<0.001)的独立预后指标。结论血小板低下、血小板减少与 ARDS 的不良预后相关,可以作为临床预后评价的指标。

ObjectiveTo investigate the relationship between platelets changes and outcomes of acute respiratory distress syndrome (ARDS) patients.MethodsA total of 275 ARDS patients treated in Zhongshan Hospital of Fudan University were retrospectively enrolled from 2008 to 2015. Their clinical characteristics, experimental test results and disease outcomes were obtained from the archived medical records. The correlation between the decreasing of platelet within three days and the prognosis of ARDS and in each subgroup were analyzed by statistical methods, including COX analysis and Kaplan-Meier curve.ResultsThere were 233 patients validly selected through eliminating those with exclusion criteria. They were divided into a decreasing group and a non-decreasing group according to their platelet counts in three days. There was significant difference in the ontcome between the two groups with the univariate analysis, the COX analysis and Kaplan-Meier curve (all P<0.05). According to the initial platelet count and change of platelet in 3 days all the patients were categorized into 9 subgroups. The mortality among them was compared and two risk groups were defined, including a persistently low platelet group (the initial platelet count <139×109/L with an increase less than 16×109/L during the first three days after the diagnosis), and a decreased platelet group (the initial platelet count ≥139×109/L and platelet count decreased more than 30×109/L during the first three days after the diagnosis). The other subgroups made up a non-risk group. Merging two risk groups as one risk group and comparing with the non-risk group, there were significant differences in the outcome between two groups with the univariate analysis, the multiplicity COX analysis and Kaplan-Meier curve (all P<0.05), the differences of coagulation function indexes were not significant (allP>0.05). The platelet count of the risk group was also an independent risk factor for ARDS mortality in the surgery subgroup (P=0.003), the non-hypertension subgroup (P=0.018) and the pneumonia subgroup (P<0.001).ConclusionLow platelets and declining platelets are closely associated with poor prognosis in most ARDS patients, which might be applied in clinical prognosis evaluation.

关键词: 急性呼吸窘迫综合征; 血小板; 预后

Key words: Acute respiratory distress syndrome; Platelets; Prognosis

引用本文: 张东辉, 王颖, 陈翠翠, 侯东妮, 唐薪竣, 蒋进军, 杨冬, 巨默涵, 宋元林. 血小板动态下降对急性呼吸窘迫综合征的预后评估价值. 中国呼吸与危重监护杂志, 2018, 17(5): 492-498. doi: 10.7507/1671-6205.201804026 复制

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