血小板参数对急性肺血栓栓塞症诊断及预后评估价值的研究

摘要

目的 探讨血小板参数在急性肺血栓栓塞症(PTE)患者中的变化及其在诊断和病情评估方面的价值.方法 选取2007年1月-2011年3月期间确诊为急性PTE的患者48例为研究组,对照组为50例同期来我院查体的健康者,其年龄、性别、体质指数等因素与研究组相比差异均无统计学意义(P＞0.05),分析急性PTE患者的一般临床情况、动脉血气分析结果、右心室内径、栓塞面积、是否合并肺动脉高压和下肢深静脉血栓(DVT),同时分别检测两组对象外周血中血小板计数、血小板平均容积(MPV)和血小板分布宽度(PDW),比较两者血小板计数、MPV、PDW的差别,并与其他观察指标做相关分析.结果 与对照组相比较,急性PTE患者血小板计数明显低于后者 [(183.5±34.8)g/L vs.(245.8±55.4)g/L,t=-3.104,P=0.003],MPV则明显高于对照组 [(11.0±0.8)fl vs.(9.9±0.8)fl,t=5.195,P＜0.001];简单相关分析发现急性PTE组血小板计数与右心室内径之间呈负相关关系(r=-0.382,P=0.027),MPV与右心室内径之间呈正相关关系(r=0.759,P=0.004);线性回归分析结果发现急性PTE患者MPV与右心室内径独立相关(β=0.629,P=0.021).结论 急性PTE发生后患者血液中血小板计数减低,而MPV明显升高,且与右室内径明显相关,测定血小板参数对急性PTE的诊断和判断疾病的严重程度均有参考价值.%Objective To investigate the changes of platelet parameters in patients with acute pulmonary thromboem-bolism ( PTE ) and explore their values in the diagnosis and prognosis of this disease. Methods Forty - eight patients with confirmed acute PTE in our hospital between January 2007 and March 2011 were enrolled as the observation group, and 50 subjects who received health check - up during the same period as the control group. No significant differences were observed between the two groups in age, gender, and body mass index ( BMI ) ( P > 0. 05 ) . The arterial blood gas, right ventricular internal dimension ( RVID ), embolization area, complications of pulmonary artery hypertension, and deep venous thrombosis ( DVT ) of lower extremity were examined and recorded. Peripheral blood platelet count ( PBPC ), mean platelet volume ( MPV ), and platelet distribution width ( PDW ) of subjects in the two groups were measured and compared. Correlations between platelet parameters and other clinical findings were analyzed. Results The platelet count in the observation group was significantly lower than that in the control group [ ( 183. 5 ±34. 8 ) g/L vs. ( 245. 8 ±55. 4 ) g/L, t = -3. 104, P =0. 003 ], while MPV was significantly higher [ ( 11. 0 ±0. 8 ) fl vs. ( 9. 9 ±0. 8 ) fl, t = 5. 195, P <0. 001 ]. Simple correlation analysis in the study group showed that PBPC was negatively correlated with RVID ( r = - 0. 382, P = 0. 027 ), and MPV was positively correlated with RVID ( r = 0. 759, P = 0. 004 ) . Linear regression analysis in the study group showed that MPV was independently correlated with RVID ( β =0. 629, P =0. 021 ) . Conclusion Higher MPV and lower PBPC are noticed in patients with acute PTE, and MPV is correlated with RVID. Platelet parameters are helpful for the diagnosis of acute PTE and evaluating the severity of disease.