血小板体积参数与非瓣膜性房颤患者血栓栓塞风险相关性研究

发布时间：2018-05-17 05:11

本文选题：心房颤动 + CHA2DS2-VASc评分　；参考：《西安医学院》2017年硕士论文

【摘要】：背景与目的血栓栓塞是房颤最严重的并发症之一,对房颤患者血栓栓塞风险进行预测具有非常重要的临床意义。CHA2DS2-VASc评分作为目前公认的血栓风险评价手段,虽已广泛应用于临床,但其内容仅限于患者的一般情况及病史资料,临床应用仍有一定的缺陷。血小板体积参数是衡量血小板体积大小分布的指标,既往研究发现血小板体积参数能够反映血小板活性和功能,与患者发生长期不良心血管事件相关。目前尚无研究对血小板体积参数与非瓣膜性房颤患者血栓栓塞风险之间关系进行分析。本研究旨在对血小板体积参数与房颤患者血栓栓塞风险间的关系进行探讨,进一步了解血小板体积参数是否可以作为新的指标纳入CHA2DS2-VASc评分系统。方法本研究连续入选2014年10月到2015年12月期间以“房颤”入住陕西省人民医院心内一科且符合入选和排除标准的患者182人。参考CHA2DS2-VASc评分对患者进行评分并分组:中低危组2分,高危组≥2分。采集患者一般信息、既往病史及服药情况、血生化指标及超声心动图参数,并对所有患者随访其1年内血栓栓塞事件的发生情况。统计分析两组之间的差异。采用logistic回归分析患者血栓栓塞风险增加的相关参数。应用受试者工作特征(ROC)曲线描述其参考价值并计算cutoff值。结果1.本研究连续入选患者182人,平均年龄为(71.6±10.31)岁,其中女性占50.0%(91/182)。根据CHA2DS2-VASc评分对患者血栓栓塞风险进行评分并分组:中低危组41人(22.5%),高危组141人(77.5%)。对患者一般资料、既往病史、入院生化等指标进行分析,结果显示:(1)两组之间的女性比例(33.33%vs.55.00%,p=0.011)、高血压病史(11.90%vs.60.00%,p=0.010)、糖尿病病史(7.14%vs.23.57%,p=0.012)、缺血性疾病史(2.44%vs.40.00%,p=0.000)、他汀类使用(38.10%vs.62.86%,p=0.004)、高血压病史长短((1.19±5.01)vs.(9.50±12.57),p=0.000)差异有明显统计学意义;(2)高危组和中低危组之间PDW[(16.45±2.37)vs.(14.24±2.81)(P0.05)],FDP[(2.79±0.41)vs.(5.16±8.03),p=0.010]之间存在统计学差异具(p0.05);(3)两组患者舒张压之间存在统计学差异[(74.55±8.82)vs.(76.84±11.07),p=0.047)];(4)logistic回归分析显示,年龄、高血压、血栓性疾病、PDW是非瓣膜性房颤患者高血栓栓塞风险的独立影响因素(p0.05)。2.所有患者经1年随访,出现血栓栓塞事件者为40人(21.98%)。根据出现血栓事件与否分组,比较其一般资料、既往病史、入院生化指标,统计分析示:(1)两组间年龄[(77.13±7.74)vs.(70.49±9.86),p=0.023]、高血压病(67.50%vs.43.66%,p=0.027)及其病史长短[(16.06±16.73)vs.(5.19±8.68),p=0.000]、缺血性疾病病史(53.33%vs.26.79%,p=0.005)的差异存在统计学意义(P0.05);(2)两组在PDW[(16.62±2.27)vs.(15.77±2.71),P=0.026]、MPV/PLT[(0.07±0.02)vs.(0.07±0.03),P=0.033]、FDP[(7.27±11.70)vs.(3.86±5.10),P=0.001]、DD[(1.86±2.92)vs.(1.01±1.53),P=0.002]、HbA1c[(6.71±1.68)vs.(5.78±1.09),P=0.000]之间的差异存在统计学意义(p0.05);(3)logistic回归分析显示年龄是患者1年内出现血栓栓塞事件的独立影响因素(p0.05),PDW不是患者1年内发生血栓事件的独立影响因素。3.ROC曲线分析结果显示:AUC=0.749(0.662-0.837,p=0.000),约登指数计算可知:PDW大于16.15%时,对患者血栓栓塞高风险有较好的预测价值(灵敏度=0.771,特异度=0.714)。结论1.在非瓣膜性房颤患者中,PDW与高血栓栓塞风险显著相关,是非瓣膜性房颤患者高血栓栓塞风险的独立预测因素;2.当PDW大于16.15%时,对患者血栓栓塞高风险有较好的预测价值;3.年龄是非瓣膜性房颤患者1年内出现血栓事件的独立影响因素。
[Abstract]:Background and objective thromboembolism is one of the most serious complications of atrial fibrillation. Predicting the risk of thromboembolism in patients with atrial fibrillation has a very important clinical significance as a widely accepted method of evaluation of thrombus risk. Although it has been widely used in clinical practice, the content of.CHA2DS2-VASc is limited to the general and medical history of patients. The application of platelet volume parameters is an indicator of the distribution of platelet volume. Previous studies have found that platelet volume parameters can reflect platelet activity and function and are associated with long-term adverse cardiovascular events in patients. There is no study on thromboembolic thrombus of platelet volume parameters and non valvular atrial fibrillation patients. This study aims to explore the relationship between platelet volume parameters and thromboembolic risk in patients with atrial fibrillation, and further understand whether the platelet volume parameters can be used as a new indicator for the CHA2DS2-VASc scoring system. Methods this study was continuously selected from October 2014 to December 2015 with "room". 182 patients who were admitted to the heart of the Shaanxi People's Hospital and were eligible for admission and exclusion criteria. The patients were scored by CHA2DS2-VASc scores and divided into groups: 2 in the middle and low risk groups and 2 in the high risk group. The general information, past medical history and medication, blood biochemical index and echocardiographic parameters were collected and followed up for all patients. The occurrence of thromboembolism events in 1 years. Statistical analysis of the differences between the two groups. Logistic regression was used to analyze the related parameters of the increased risk of thromboembolism in patients. The reference value of the subject (ROC) curve was used to describe the reference value and the value of cutoff was calculated. Results 1. patients were enrolled in the study, with an average age of (71.6 + 10.31). Age, women accounted for 50% (91/182). According to the CHA2DS2-VASc score, the risk of thromboembolism was scored and divided into groups: 41 in the middle and low risk group (22.5%) and 141 in high risk group (77.5%). The general data, previous history, and admission biochemical indexes were analyzed. The results showed: (1) the proportion of women (33.33%vs.55.00%, p=0.011), high blood between two groups. The history of 11.90%vs.60.00% (p=0.010), the history of diabetes (7.14%vs.23.57%, p=0.012), the history of ischemic disease (2.44%vs.40.00%, p=0.000), the use of statins (38.10%vs.62.86%, p=0.004), the history of hypertension (1.19 + 5.01) vs. (9.50 + 12.57), P =0.000) had significant statistical significance; (2) PDW[(16.45 + 2.37) between the high risk group and the middle and low risk group. Vs. (14.24 + 2.81) (P0.05)], FDP[(2.79 + 0.41) vs. (5.16 + 8.03), and p=0.010] with statistical difference (P0.05); (3) the diastolic blood pressure in the two groups was statistically different [(74.55 + 8.82) vs. (76.84 + 11.07), p=0.047)]; (4) logistic regression analysis showed that age, hypertension, thrombotic disease, PDW were hyperthrombotic in patients with non valvular atrial fibrillation. The independent influence factor of embolic risk (P0.05).2. all patients were followed up for 1 years, and there were 40 patients (21.98%) with thromboembolism events. According to the incidence of thrombosis or not, the general data, previous medical history and admission biochemical indexes were compared. (1) the age of two groups [(77.13 + 7.74) vs. (70.49 + 9.86), p=0.023], hypertension (67.50%vs) .43.66%, p=0.027) and the length of their medical history [(16.06 + 16.73) vs. (5.19 + 8.68), p=0.000], the difference in the history of ischemic disease (53.33%vs.26.79%, p=0.005) had statistical significance (P0.05); (2) two groups in PDW[(16.62 + 2.27) vs. (15.77 + 2.71), P=0.026], MPV/PLT[(0.07 + 0.02) vs.. The difference between DD[(1.86 + 2.92) vs. (1.01 + 1.53), P=0.002], HbA1c[(6.71 + 1.68) vs. (5.78 + 1.09) and P=0.000] was statistically significant (P0.05); (3) logistic regression analysis showed that age was an independent influence factor (P0.05) in patients with thromboembolism in 1 years, and PDW was not an independent factor of influence factors in thrombus events within 1 years. The results of curve analysis showed that AUC=0.749 (0.662-0.837, p=0.000), Jorden index calculated that when PDW was greater than 16.15%, there was a better predictive value for the high risk of thromboembolism in patients (sensitivity =0.771, specificity =0.714). Conclusion 1. in patients with non valvular atrial fibrillation, PDW is significantly associated with the risk of high thromboembolism, and is higher in patients with non valvular atrial fibrillation. An independent predictor of thromboembolism risk; 2. when PDW was greater than 16.15% had a better predictive value for a patient's high risk of thromboembolism; the 3. age was an independent factor in the occurrence of thrombus events in patients with non valvular atrial fibrillation within 1 years.
【学位授予单位】：西安医学院
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R541.75

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