血小板计数、大血小板比率、血小板分布宽度在急性肺栓塞诊断中的临床价值
Clinical Value of Platelets Count, Platelet-Larger Cell Ratio and Platelet Distribution Width in the Diagnosis of Acute Pulmonary Embolism
DOI: 10.12677/ACM.2022.1291254, PDF,  被引量   
作者: 许小艳：重庆三峡医药高等专科学校附属人民医院，重庆；李桂琼*：重庆医科大学附属第二医院，重庆
关键词: 肺栓塞；血小板计数；大血小板比率；血小板分布宽度；血小板活化；Pulmonary Embolism； Platelet Count； Platelet-Larger Cell Ratio； Platelet Distribution Width； Platelet Activation
摘要: 研究背景：肺栓塞(Pulmonary embolism, PE)是一种常见的肺血管疾病，但肺栓塞的诊断率低、死亡率高，临床上需要寻找其他更多指标对该病的诊断及治疗起指导作用。血小板是血栓形成过程中不可或缺的因素，血小板相关参数在多种血栓性疾病中的变化情况越来越受到关注。目的：分析血小板计数(Platelet count, PLT)、大血小板比率(Platelet-larger cell ratio, P-LCR)、血小板分布宽度(Platelet distribution width, PDW)在急性肺栓塞(Acute pulmonary embolism, APE)患者诊断及危险分层中的预测价值。方法：回顾性分析2019年1月~2021年12月重庆医科大学附属第二医院收治的APE患者(APE组) 88例临床资料，同时选取相同时间段的健康体检者88例作为对照组。比较2组之间及不同危险分层之间PLT、P-LCR、PDW有无显著差异；分析PLT、P-LCR、PDW对APE诊断的预测价值。结果：APE组PLT低于对照组(P = 0.011)，APE组P-LCR高于对照组(P < 0.001)，APE组PDW高于对照组(P < 0.001)；低危组、中低危组、中高危组、高危组之间PLT、P-LCR、PDW无显著差异(P > 0.05)。结论：PLT在急性肺栓塞患者中降低，P-LCR、PDW在急性肺栓塞患者中升高，对APE诊断有一定预测价值及指导作用，但对肺栓塞危险分层无指导作用。
Abstract: Background: Pulmonary embolism is a common pulmonary vascular disease, but due to the low di-agnosis rate and high mortality rate, more indicators are still needed to guide the diagnosis and treatment in clinic. Platelet is an indispensable factor in the process of thrombosis. At present, many scholars pay attention to the changes of platelet-related parameters in thrombotic diseases. Objective: To analyze the predictive value of platelet count (PLT), platelet-larger cell ratio (P-LCR) and platelet distribution width (PDW) in the diagnosis of acute pulmonary embolism (APE) and risk stratification. Method: A retrospective analysis of the data of 88 patients in the APE group admitted to the Second Affiliated Hospital of Chongqing Medical University from January 2019 to December 2021, and 88 cases of healthy physical examination patients at the same period were selected as the control group. Compare the PLT, P-LCR, PDW level of the two groups and different risk layers, to analyze the predictive value of PLT, P-LCR and PDW for APE diagnosis. Results: PLT in APE group was lower than that in control group (P = 0.011), P-LCR in APE group was higher than that in control group (P < 0.001), and PDW in APE group was higher than that in control group (P < 0.001). There was no significant difference among low-risk group, medium-low risk group, medium-high risk group and high-risk group (P > 0.05). Conclusion: PLT decreased in patients with acute pulmonary embolism, while P-LCR and PDW increased, which has certain predictive value and guiding role in the diagnosis of APE, but it has no guiding effect on risk stratification of pulmonary embolism.
文章引用：许小艳, 李桂琼. 血小板计数、大血小板比率、血小板分布宽度在急性肺栓塞诊断中的临床价值[J]. 临床医学进展, 2022, 12(9): 8686-8694. https://doi.org/10.12677/ACM.2022.1291254

参考文献

[1] 中华医学会呼吸病学分会肺栓塞与肺血管病学组, 中国医师协会呼吸医师分会肺栓塞与肺血管病工作委员会, 全国肺栓塞与肺血管病防治协作组. 肺血栓栓塞症诊治与预防指南[J]. 中华医学杂志, 2018, 98(14): 28.
[2] 蒋玲, 任英, 罗翠花. 肺栓塞与血小板活化标志物[J]. 临床肺科杂志, 2007(7): 691-692.
[3] Brvik, T., Evensen, L.H., Morelli, V.M., et al. (2020) Impact of Respiratory Symptoms and Oxygen Saturation on the Risk of Incident Ve-nous Thromboembolism—The Tromsø Study. Research and Practice in Thrombosis and Haemostasis, 4, 255-262. [Google Scholar] [CrossRef] [PubMed]
[4] Ackermann, M., Verleden, S.E., Kuehnel, M., et al. (2020) Pulmonary Vascular Endothelialitis, Thrombosis, and Angiogenesis in Covid-19. The New England Journal of Medicine, 383, 120-128. [Google Scholar] [CrossRef] 
[5] Akpinar, E.E., Hoşgün, D., Akpinar, S., et al. (2014) In-cidence of Pulmonary Embolism during COPD Exacerbation. Jornal Brasileiro de Pneumologia, 40, 38-45. [Google Scholar] [CrossRef] 
[6] 王汉, 李儒琳. 血清血小板活化因子、脂蛋白(a)、纤维蛋白单体对骨折患者发生近端深静脉血栓评估价值[J]. 创伤与急危重病医学, 2021, 9(2): 120-123.
[7] Larsen, S.B., Grove, E.L., Hvas, A.M. and Kristensen, S.D. (2014) Platelet Turnover in Stable Coronary Artery Disease—Influence of Thrombopoietin and Low-Grade Inflammation. PLOS ONE, 9, e85566. [Google Scholar] [CrossRef] [PubMed]
[8] Umezuluike, B.S., Anikwe, C.C., Nnachi, O.C., Iwe, B.C.A., Ifemelumma, C.C. and Dimejesi, I.B.O. (2021) Correlation of Platelet Parameters with Adverse Maternal and Neonatal Outcomes in Severe Preeclampsia: A Case-Control Study. Heliyon, 7, e08484. [Google Scholar] [CrossRef] [PubMed]
[9] 陈嵩, 张莹, 戴月梅, 西艾木西卡买尔•艾合买提, 王在义, 林勇, 刘晖. 急性肺栓塞患者血小板指标的变化及临床意义[J]. 中国全科医学, 2014, 17(19): 2218-2223.
[10] Simes, J., Becattini, C., Agnelli, G., Eikelboom, J.W., Kirby, A.C., Mister, R., Prandoni, P., Brighton, T.A. and INSPIRE Study Investigators (International Collaboration of Aspirin Trials for Recurrent Venous Thrombo-embolism) (2014) Aspirin for the Prevention of Recurrent Venous Thromboembolism: The Inspire Collaboration. Circu-lation, 130, 1062-1071. [Google Scholar] [CrossRef] 
[11] Hsia, C.W., Tsai, C.L., Sheu, J.R., Lu, W.J., Hsia, C.H., Velusamy, M., Jayakumar, T. and Li, J.Y. (2019) Suppression of Human Platelet Acti-vation via Integrin αIIbβ3 Outside-In Independent Signal and Reduction of the Mortality in Pulmonary Thrombosis by Auraptene. International Journal of Molecular Sciences, 20, Article No. 5585. [Google Scholar] [CrossRef] [PubMed]
[12] 中华医学会心血管病学分会, 中国医师协会心血管内科医师分会肺血管疾病学组, 中国肺栓塞救治团队(PERT)联盟. 急性肺栓塞多学科团队救治中国专家共识[J]. 中华心血管病杂志, 2022, 50(1): 25-35.
[13] Konstantinides, S.V., Meyer, G., Becattini, C., Bueno, H., Geersing, G.J., Harjola, V.P., Huisman, M.V., Humbert, M., Jennings, C.S., Jiménez, D., Kucher, N., Lang, I.M., Lankeit, M., Lorusso, R., Mazzolai, L., Meneveau, N., Áinle, F.N., Prandoni, P., Pruszczyk, P., Righini, M., Torbicki, A., Van Belle, E., Zamo-rano, J.L. and The Task Force for the Diagnosis and Management of Acute Pulmonary Embolism of the European Soci-ety of Cardiology (ESC) (2019) 2019 ESC Guidelines for the Diagnosis and Management of Acute Pulmonary Embo-lism Developed in Collaboration with the European Respiratory Society (ERS): The Task Force for the Diagnosis and Management of Acute Pulmonary Embolism of the European Society of Cardiology (ESC). European Respiratory Jour-nal, 54, Article ID: 1901647. [Google Scholar] [CrossRef] [PubMed]
[14] Bĕlohlávek, J., Dytrych, V. and Linhart, A. (2013) Pulmonary Embolism, Part I: Epidemiology, Risk Factors and Risk Stratification, Pathophysiology, Clinical Presentation, Diagnosis and Nonthrombotic Pulmonary Embolism. Experimental & Clinical Cardiology, 18, 129-138.
[15] Le Gal, G. and Bounameaux, H. (2004) Diagnosing Pulmonary Embolism: Running after the Decreasing Prevalence of Cases among Suspected Patients. Journal of Thrombosis and Haemostasis, 2, 1244-1246. [Google Scholar] [CrossRef] [PubMed]
[16] 董书勤, 闵黎, 杨志义, 王颖. D-二聚体在肺栓塞临床应用中的研究进展[J]. 国际呼吸杂志, 2021, 41(12): 946-950.
[17] 冯霞, 姜明敏. 慢性阻塞性肺疾病抗血小板治疗的研究进展[J]. 中华肺部疾病杂志(电子版), 2018, 11(2): 238-240.
[18] Yang, J., Zhou, X., Fan, X., Xiao, M., Yang, D., Liang, B., Dai, M., Shan, L., Lu, J., Lin, Z., Liu, R., Liu, J., Wang, L., Zhong, M., Jiang, Y. and Bai, X. (2016) mTORC1 Promotes Aging-Related Venous Thrombosis in Mice via Elevation of Platelet Volume and Activation. Blood, 128, 615-624. [Google Scholar] [CrossRef] [PubMed]
[19] Mangalmurti, N.S., Friedman, J.L., Wang, L.C., Stolz, D., Muthukumaran, G., Siegel, D.L., Schmidt, A.M., Lee, J.S. and Albelda, S.M. (2013) The Receptor for Ad-vanced Glycation End Products Mediates Lung Endothelial Activation by RBCs. The American Journal of Physiolo-gy-Lung Cellular and Molecular Physiology, 304, L250-L263. [Google Scholar] [CrossRef] [PubMed]
[20] Maugeri, N., Campana, L., Gavina, M., Covino, C., De Metrio, M., Panciroli, C., Maiuri, L., Maseri, A., D’Angelo, A., Bianchi, M.E., Rovere-Querini, P. and Manfredi, A.A. (2014) Activated Platelets Present High Mobility Group Box 1 to Neutrophils, Inducing Autophagy and Promoting the Extru-sion of Neutrophil Extracellular Traps. Journal of Thrombosis and Haemostasis, 12, 2074-2088. [Google Scholar] [CrossRef] [PubMed]
[21] Günay, E., Sarinc Ulasli, S., Kacar, E., Halici, B., Unlu, E., Tünay, K., Ozkececi, G., Koken, T. and Unlu, M. (2014) Can Platelet Indices Predict Obstruction Level of Pulmonary Vascular Bed in Patients with Acute Pulmonary Embolism? The Clinical Respiratory Journal, 8, 33-40. [Google Scholar] [CrossRef] [PubMed]
[22] Ates, I., Bulut, M., Ozkayar, N. and Dede, F. (2015) Association between High Platelet Indices and Proteinuria in Patients with Hypertension. Annals of Laboratory Medicine, 35, 630-634. [Google Scholar] [CrossRef] [PubMed]
[23] Huang, J., Chen, Y., Cai, Z. and Chen, P. (2015) Diagnostic Value of Platelet Indexes for Pulmonary Embolism. The American Journal of Emergency Medicine, 33, 760-763. [Google Scholar] [CrossRef] [PubMed]
[24] Ma, R., Fu, W., Zhang, J., Hu, X., Yang, J. and Jiang, H. (2021) TMAO: A Potential Mediator of Clopidogrel Resistance. Scientific Reports, 11, Article No. 6580. [Google Scholar] [CrossRef] [PubMed]
[25] Izzi, B., Gialluisi, A., Gianfagna, F., Orlandi, S., De Curtis, A., Magnacca, S., Costanzo, S., Di Castelnuovo, A., Donati, M., de Gaetano, G., Hoylaerts, M.F., Cerletti, C. and Iacoviello, L. (2021) Platelet Distribution Width Is Associated with P-Selectin Dependent Platelet Function: Results from the Moli-Family Cohort Study. Cells, 10, Article No. 2737. [Google Scholar] [CrossRef] [PubMed]
[26] 韩铭欣, 潘萌萌, 宋维, 陈云秋, 柳文娟, 王新琢, 张爽, 焦光宇. 血小板分布宽度在急性肺栓塞诊断及危险分层中的价值[J]. 疑难病杂志, 2020, 19(11): 1111-1114.
[27] Beyazyıldız, E., Çıtırık, M., Şimşek, M., Beyazyıldız, Ö. and Haznedaroğlu, İ.C. (2019) Branch Reti-nal Vein Occlusion Associated with Platelet Activation. Turkish Journal of Medical Sciences, 49, 283-287. [Google Scholar] [CrossRef] [PubMed]

为你推荐