平均血小板体积与继发孔型房间隔缺损相关性肺动脉高压关系的研究

摘要

Objective To observe changes in mean platelet volume ( MPV) and investigate its possibility as a predictor and influence in patients with pulmonary artery hypertension associated with secundum atrial septal defect (ASD-PAH) . Methods 627 patients who suffered from secundum ASD were included in the study from the First Affiliated Hospital of Xinjiang Medical University Heart Center between January 2010 and March 2014. Patients were divided into two groups based on whether they had PAH or not (PAH group, n = 420 and non-PAH group, n = 207) . We also included 690 healthy people as a control group who received routine body check up at the same time. Examinations including complete blood count, serum biochemistry and ECG were done. Right heart catheterization examination was performed in patients who suffered from secundum ASD. Results The MPV was significantly higher in secundum ASD patients than in the control group [ (9. 4 ± 1. 6) fl vs. (8. 9 ± 1. 5) fl, P ﹤ 0. 001] . No significant difference was observed in MPV between PAH group and non-PAH group (P = 0. 268) . In univariate and multivariate logistic regression analysis, age ( OR 1. 401, 95% CI 1. 087 to 1. 806, P = 0. 009), RV diameter (OR 1. 101, 95% CI 1. 026 - 1. 181, P = 0. 008) and ASD defect diameter (OR 1. 064, 95% CI 1. 013 - 1. 118, P = 0. 013) were associated with ASD-PAH. Conclusions Our study demonstrated that age, RV diameter and ASD defect diameter were associated with ASD-PAH. Platelet activation exists in ASD-PAH, but this may not be the precipitating cause that contribute to the pathogenesis of ASD-PAH. MPV at admission does not predict the risk of PAH in patients with secundum ASD.%目的：探讨继发孔型房间隔缺损相关性肺动脉高压(ASD-PAH)与血小板活化标志物平均血小板体积(MPV)的关系及其影响因素。方法纳入2010年1月至2014年3月就诊于新疆医科大学第一附属医院心脏中心行介入治疗的先天性心脏病(CHD)患者中继发孔型 ASD 患者627例作为 ASD 组,根据有无 PAH 再分为无 PAH 组207例,PAH 组420例；选择同时间段就诊于新疆医科大学第一附属医院体检中心的690例健康人群作为对照组。所有患者均进行血细胞参数检查、生化检查、心电图检查等,其中继发孔型 ASD 组患者均行右心导管检查。结果继发孔型 ASD 组 MPV 值较对照组高[(9.4±1.6) fl 比(8.9±1.5) fl,P ﹤0.001],在 ASD 患者亚组间比较,MPV 值的差异无统计学意义( P =0.268)。 ASD-PAH 独立影响因素的 Logistic 回归分析显示,年龄(每10年,OR 1.401,95% CI 1.087~1.806,P =0.009)、右心室舒张末期内径(OR 1.101,95% CI 1.026~1.181, P =0.008)、ASD 直径(OR 1.064,95% CI 1.013~1.118,P =0.013)是继发孔型 ASD-PAH 的独立危险因素。结论年龄、右心室舒张末期内径、ASD 直径是影响继发孔型 ASD 发生、发展的相关因素。PAH 患者中存在血小板活化,而血小板活化可能不是影响 PAH 发生、发展的直接原因。