2023 年第 7 期 第 18 卷

外周血基线血小板计数水平对老年冠心病患者长期预后的影响

Effect of baseline peripheral blood platelet count on long-term prognosis in elderly patients with coronary atherosclerotic heart disease

作者：李双双1马依彤2郑颖颖2吴婷婷2谢翔2

英文作者：Li Shuangshuang1 Ma Yitong2 Zheng Yingying2 Wu Tingting2 Xie Xiang2

单位：1新疆医科大学第一附属医院呼吸中心，乌鲁木齐830011；2新疆医科大学第一附属医院心脏中心，乌鲁木齐830011

英文单位：1Department of Respiratory First Affiliated Hospital of Xinjiang Medical University Urumqi 830011 China; 2Department of Cardiology First Affiliated Hospital of Xinjiang Medical University Urumqi 830011 China

关键词：冠心病（冠状动脉粥样硬化性心脏病）；血小板计数；长期预后

英文关键词：Coronaryatheroscleroticheartdisease;Plateletcount;Long-termprognosis

• 摘要：

• 目的  探讨外周血基线血小板计数(PLT)水平对老年冠心病（冠状动脉粥样硬化性心脏病）患者长期预后的影响。方法  纳入2008年1月至2016年12月在新疆医科大学第一附属医院确诊为冠心病的老年(年龄≥60岁)患者共3 024例，并对其进行规律随访，最长随访时间达10年，随访终点设定为全因死亡、心源性死亡、主要不良心血管事件(MACE)。入院时通过血常规检测获得基线PLT水平。根据入院时基线PLT水平将患者分为PLT低水平组(PLT＜199.5×109/L，n=1 468)和PLT高水平组(PLT≥199.5×109/L，n=1 556)。采用多因素Cox比例风险模型回归分析方法分析不同PLT水平对老年冠心病患者长期预后的影响。结果  PLT高水平组全因死亡、心源性死亡、MACE的发生率均高于PLT低水平组，差异均有统计学意义(均P＜0.05)。Kaplan-Meier单因素生存分析结果显示，与PLT低水平组比较，PLT高水平组患者全因死亡、心源性死亡、MACE的累积死亡风险均增加（均P＜0.05）。在调整年龄、性别、吸烟、饮酒等混杂因素后应用多因素Cox比例风险模型回归分析结果显示，与PLT低水平组相比，PLT高水平组全因死亡风险增加46.6%(风险比=1.466，95%置信区间：1.063～2.022，P=0.020)、心源性死亡风险增加60.1%(风险比=1.601，95%置信区间：1.100～2.330，P=0.014)、MACE风险增加51.9%(风险比=1.519，95%置信区间：1.207～1.911，P＜0.001)。结论  入院时基线PLT水平升高显著增加老年冠心病患者不良事件的发生率，其基线水平升高可作为长期全因死亡、心源性死亡、MACE的独立危险因素。

• Objective  To explore the impact of baseline platelet count (PLT) levels in peripheral blood on the long-term prognosis of elderly patients with coronary atherosclerotic heart disease. Methods  A total of 3 024 elderly patients (≥60 years old) who were diagnosed with coronary atherosclerotic heart disease in the First Affiliated Hospital of Xinjiang Medical University from January 2008 to December 2016 were included, and they were regularly followed up for a maximum of 10 years. The follow-up endpoints were set as all-cause mortality(ACM), cardiac mortality(CM), major adverse cardiovascular events (MACE). The acute baseline PLT was obtained by blood routine examination at admission. According to the baseline PLT level at admission, the patients were divided into PLT low level group (PLT＜199.5×109/L, n=1 468) and PLT high level group (PLT≥199.5×109/L, n=1 556). The impact of different PLT levels on the long-term prognosis of elderly coronary atherosclerotic heart disease was analyzed by multivariate Cox proportional-hazards model regression analysis methed. Results  The incidence of ACM, CM, and MACE in the PLT high level group was significantly higher than that in the PLT low level group, with statistical significance (all P＜0.05). The Kaplan-Meier univariate survival analysis showed an increased cumulative risk of death for ACM, CM, and MACE in patients with high levels of PLT(all P＜0.05). After adjusting for confounding factors such as age, gender, smoking, and alcohol consumption, multivariate Cox proportional-hazards model regression analysis results showed that compared to the PLT low level group, the PLT high level group had a 46.6% increase in ACM risk (hazard ratio=1.466, 95% confidence interval: 1.063-2.022, P=0.020), a 60.1% increase in CM risk (hazard ratio=1.601, 95% confidence interval: 1.100-2.330, P=0.014), and a 51.9% increase in MACE risk (hazard ratio=1.519, 95% confidence interval: 1.207-1.911, P＜0.001). Conclusion  Elevated baseline PLT levels at admission significantly increase the incidence of adverse events in elderly patients with coronary atherosclerotic heart disease, and their elevated baseline levels can serve as independent risk factors for long-term ACM, CM, and MACE.