背景最近研究表明静脉血栓栓塞症时患者存在血小板活化状态。目的探讨血小板指标在急性肺栓塞患者中的变化及评估病情预后的价值。方法选取2007年6月-2013年6月新疆医科大学第一附属医院住院诊断为急性肺栓塞的患者128例为研究组，另选取同时期来我院体检的健康者130例为对照组，检测两组血压、心率、血常规、血脂水平，比较不同栓塞程度急性肺栓塞患者外周血中血小板计数（ PLT）、血小板平均体积（ MPV）和血小板分布宽度（ PDW），分析血小板指标与其他观察指标的相关性，动态观察治疗前、治疗3个月后、治疗6个月后血小板指标的变化并采用多因素Logistic回归分析影响肺栓塞的因素。结果对照组与研究组收缩压、舒张压、心率、血红蛋白、平均红细胞血红蛋白量、红细胞平均血红蛋白浓度、PLT、PDW、三酰甘油、总胆固醇水平比较，差异均无统计学意义（P﹥0.05）；两组MPV比较，差异有统计学意义（P﹤0.05）。不同程度急性肺栓塞患者PLT、MPV比较，差异有统计学意义（P﹤0.05）；其中低危组、中危组PLT高于高危组，MPV低于高危组（P﹤0.05）。3组PDW比较，差异无统计学意义（P﹥0.05）。对照组中，PDW与MPV呈正相关（r＝0.335，P＝0.000），PDW与PLT无直线相关关系（r＝-0.034，P＝0.700），PLT与MPV无直线相关关系（r＝-0.125，P＝0.161）。研究组中，MPV与PDW呈正相关（r＝0.212，P＝0.016），PDW与PLT呈负相关（r＝-0.292，P＝0.001），PLT与MPV呈负相关（r＝-0.271， P＝0.002）。8例患者治疗前、治疗3个月后、治疗6个月后PLT、MPV、PDW比较，差异均无统计学意义（ F值分别为0.894、0.934和0.132，P值分别为0.386、0.416和0.877）。多因素Logistic回归分析结果显示，年龄、吸烟史及MPV及PDW与肺栓塞有回归关系（P﹤0.05）。结论 PLT及MPV对判断肺栓塞严重程度有一定临床意义，但不能单纯在短期时间（治疗后6个月内）内评估治疗后患者病情好转程度。%Background Recent studies have demonstrated that platelet activation state occurs in patients with venous thromboembolism. Objective To discuss the changes of platelet parameters in patients with acute pulmonary thromboembolism and the value of prognosis evaluation. Methods The study group was consisted of 128 patients who were confirmed the acute pul-monary embolism in the First Teaching Hospital of Xinjiang Medical University from June 2007 to June 2013. And 130 healthy sub-jects selected at the same time from the hospital physical examination cases as the matched control group,two groups were given physical examination,cardiac ultrasound and biochemical examination. The two groups were detected peripheral blood platelet count(PLT),mean blood platelet volume(MPV)and platelet distribution width(PDW). Based on the result,the researchers analyzed the correlation between platelet index and other observed indexes,dynamically observed the changes of platelet index be-fore treatment,3 months and 6 months after treatment and used multiple logistic regression analysis to determine the influencing factors for pulmonary embolism. Results No significant differences were found in systolic pressure,diastolic pressure,heart rate,hemoglobin,mean corpuscular hemoglobin,mean corpuscular hemoglobin concentration,PLT,PDW,triglyceride,total cholesterol between the control group and the research group(P﹥0. 05);MPV differences between two groups were statistically significant(P﹤0. 05). PLT and MPV differences among pulmonary embolism patients with different degrees of embolization were significant(P﹤0. 05);PLT in low risk group and medium risk group was highter than that in high risk group and the case of MPV was just the opposite(P﹤0. 05). No significant difference of PDW was found between the three groups(P﹥0. 05). In the control group,the correlation between MPV and PDW was positive(r=0. 335,P=0. 000),no linear correlation between PDW and PLT(r= -0. 034,P=0. 700)and no linear correlation between PLT and MPV(r= -0. 125,P=0. 161). In the study group,the correlation between MPV and PDW was positive(r=0. 212,P=0. 016);PDW was negatively correlated with PLT(r= -0. 292,P=0. 001)and PLT was negatively correlated with MPV(r= -0. 271,P=0. 002). There were no signifi-cant difference in PLT,MPV,PDW levels of the 8 cases of patients before treatment,3 months,and 6 months after treatment (F=0. 894,0. 934,0. 132,P =0. 386,0. 416,0. 877). Multiple Logistic regression analysis showed that age,smoking history,MPV and PDW had regression relation with pulmonary embolism(P﹤0. 05). Conclusion MPV and PLT have certain clinical significance in judging the severity of embolism,but the changes of MPV and PLT within the short time( within 6 months after treatment)can't simply be used to assess the recovery degree of the patients.
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