急性心肌梗死患者介入治疗后血小板高反应性临床危险因素评分构建

发布时间：2018-03-29 23:42

本文选题：血小板反应性　切入点：危险因素　出处：《第二军医大学学报》2017年07期

【摘要】：目的建立预测急性心肌梗死患者介入治疗后血小板高反应性的临床危险因素评分,指导临床个体化抗血小板治疗。方法纳入2013年1月至12月于北京协和医学院阜外医院行冠脉介入术治疗的547例急性心肌梗死患者,收集患者的一般临床资料及术后血栓弹力图。将血栓弹力图最大凝块强度(TEG-MAADP)47mm定义为存在血小板高反应性。利用患者临床常用指标筛选与血小板高反应性相关的危险因素,将多因素logistic回归分析中P0.05的临床指标纳入血小板高反应性危险评分模型,依据比值比(OR)赋予相应分值。结果 547例患者中230例(42.05%)存在血小板高反应性,TEG-MAADP值高于非血小板高反应性患者[(56.16±6.57)mm vs(26.43±13.88)mm,P0.001]。单因素和多因素logistic回归分析发现,高龄(75岁)、女性、合并糖尿病是血小板高反应性的独立危险因素。依据OR值权重赋予高龄(75岁)3分,女性和合并糖尿病各赋2分,分值范围0~7分。依据得分将患者分为3组:0~2分组、3~5分组和6~7分组,结果显示3组间血小板反应性差异有统计学意义,0~2分组患者的血小板反应性低于3~5分和6~7分组[(37.79±18.45)mm vs(50.04±15.91)mm vs(56.50±15.78)mm;P0.001]。受试者工作特征曲线分析显示得分2分能有效预测是否存在血小板高反应性(曲线下面积为0.627,95%CI 0.579~0.675,P0.001)。结论临床风险评分能帮助快速识别可能存在血小板高反应性的患者,从而指导抗血小板个体化治疗。
[Abstract]:Objective to establish a clinical risk factor score for predicting platelet hyperresponsiveness after interventional therapy in patients with acute myocardial infarction. Methods 547 patients with acute myocardial infarction underwent coronary intervention from January to December 2013 in Fuwai Hospital of Peking Union Medical College. To collect the general clinical data of patients and postoperative thromboelastogram. To define the maximum clot strength of thromboelastogram (TEG-MAADP) 47mm as the presence of platelet hyperreactivity. To screen the risk factors associated with platelet hyperreactivity by using the commonly used clinical indexes of patients. The clinical indexes of P0.05 in multivariate logistic regression analysis were included in the platelet hyperresponsiveness risk score model. Results the TEG-MAADP of 547 patients with platelet hyperreactivity was higher than that of non-platelet hyperreactivity patients [56.16 卤6.57)mm vs(26.43 卤13.88mm P0.001]. Univariate and multivariate logistic regression analysis showed that elderly women were 75 years old. Diabetes mellitus was an independent risk factor for platelet hyperresponsiveness. According to the weight of OR value, the elderly were given a score of 3, and the women and the patients with diabetes were given a score of 2, respectively. According to the score, the patients were divided into 3 groups: 0: 0, 2 groups, 3 groups, 5 groups, and 6 groups, The results showed that there were significant differences in platelet reactivity among the three groups. The platelet reactivity was lower than 3 ~ 5 and 6 / 7 groups in two groups [37.79 卤18.45)mm vs(50.04 卤15.91)mm vs(56.50 卤15.78 vs(56.50 P0.001]. The analysis of the operating characteristic curve showed that the two scores could effectively predict the existence of platelet reactivity. Platelet hyperreactivity (area under the curve is 0.62795 CI 0.579U 0.675P0.0010.Conclusion Clinical risk score can help to quickly identify patients with possible platelet hyperreactivity. So as to guide individual antiplatelet therapy.
【作者单位】：中国医学科学院北京协和医学院阜外医院冠心病中心;
【基金】：国家自然科学基金(81470486)~~
【分类号】：R542.22

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