作者：周启保，罗潇，陈玲，李菊香，徐劲松

单位：

1.332000江西省九江市第一人民医院心血管内科　2.330000江西省南昌市，南昌大学第二附属医院心血管内科

Units：

1.Department of Cardiology, Jiu Jiang NO.1 People's Hospital, Jiujiang 332000, China 2.Department of Cardiology, the Second Affiliated Hospital of Nanchang University, Nanchang 330000, China

关键词：

心房颤动；血小板分布宽度；稳定性；变异性；治疗目标范围内的时间百分比

Keywords：

Atrial fibrillation; Platelet distribution width; Stability; Variability; Time within therapeutic range

CLC：

R 541.75

DOI：

10.12114/j.issn.1008-5971.2023.00.266

Funds：

江西省卫生健康委科技计划项目（202211818）；九江市第一人民医院青年课题（JJSDYRMYYQNKT2021-08）

摘要：

　目的　分析血小板分布宽度（PDW）稳定性、变异性与持续性非瓣膜性心房颤动患者治疗目标范围 内的时间百分比（TTR）的关系。方法　选取2020—2022年九江市第一人民医院收治的持续性非瓣膜性心房颤动患 者121例为研究对象。收集患者的一般资料。所有患者在开始口服华法林进行抗凝治疗的前6个月中至少检测过3次 PDW，计算TTR时再次检测PDW。通过前3次检测的PDW处于参考范围的次数判断PDW的稳定性，根据判断结果将患 者分为极不稳定组（0次，30例）、不稳定组（1次，39例）、中等程度稳定组（2次，31例）、较高程度稳定组（3 次，21例），并计算平均PDW。根据PDW变异率将患者分为低变异组（＜10%，53例）、中变异组（10%～＜20%， 48例）、高变异组（≥20%，20例）。持续性非瓣膜性心房颤动患者TTR达标影响因素分析采用多因素Logistic回归分 析。结果　不稳定组TTR高于极不稳定组（P＜0.05）；中等程度稳定组TTR、TTR达标率高于极不稳定组，TTR高于 不稳定组（P＜0.05）；较高程度稳定组TTR、TTR达标率高于极不稳定组、不稳定组、中等程度稳定组（P＜0.05）。 高变异组TTR达标率低于低变异组、中变异组（P＜0.05）。多因素Logistic回归分析结果显示，平均PDW〔OR=0.882， 95%CI（0.812，0.958）〕和PDW不稳定〔OR=0.008，95%CI（0.001，0.058）〕、中等程度稳定〔OR=0.012，95%CI （0.002，0.072）〕、较高程度稳定〔OR=0.037，95%CI（0.007，0.193）〕、高变异〔OR=10.618，95%CI（1.316， 85.652）〕是持续性非瓣膜性心房颤动患者TTR达标的影响因素（P＜0.05）。结论　PDW不稳定、中等程度稳定、较 高程度稳定是持续性非瓣膜性心房颤动患者TTR达标的保护因素，而PDW高变异是其危险因素。

Abstract：

　Objective To analyze the relationship between the stability and variability of platelet distribution width (PDW) and time within therapeutic range (TTR) in patients with persistent non valvular atrial fibrillation. Methods A total of 121 patients with persistent non valvular atrial fibrillation in Jiu Jiang NO.1 People's Hospital from 2020 to 2022 were selected as the research subjects. General information of patients was collected. All patients had been tested for PDW at least 3 times in the first 6 months before starting oral warfarin anticoagulant therapy, and PDW was measured again when TTR was calculated. PDW stability was determined by the number of PDW in the reference range of the first three tests. According to the results, the patients were divided into extremely unstable group (0 times, 30 cases) , unstable group (1 time, 39 cases) , moderately stable group (2 times, 31 cases) , and highly stable group (3 times, 21 cases) , and the average PDW was calculated. According to the PDW variation rate, the patients were divided into low variation group ( < 10 %, 53 cases) , medium variation group (10% ≤ PDW variation rate < 20%, 48 cases) and high variation group ( ≥ 20%, 20 cases) . The influencing factors of TTR compliance in patients with persistent non valvular atrial fibrillation were analyzed by multivariate Logistic regression analysis. Results The TTR of the unstable group was higher than that of the extremely unstable group (P < 0.05) ; the TTR and TTR compliance rates in the moderately stable group were higher than those in the extremely unstable group, and the TTR was higher than that in the unstable group (P < 0.05) ; the TTR and TTR compliance rates in the highly stable group were higher than those in the extremely unstable group, unstable group, and moderately stable group (P < 0.05) . The TTR compliance rate of the high variant group was lower than that of the low variant group and medium variant group (P < 0.05) . The results of multivariate Logistic regression analysis showed that the average PDW [OR=0.882, 95%CI (0.812, 0.958) ] , unstable PDW [OR=0.008, 95%CI (0.001, 0.058) ] , moderately stable PDW [OR=0.012, 95%CI (0.002, 0.072) ] , highly stable PDW [OR=0.037, 95%CI (0.007, 0.193) ] , highly variable PDW [OR=10.618, 95%CI (1.316, 85.652) ] were influencing factors for TTR compliance in patients with persistent non valvular atrial fibrillation ( P < 0.05) . Conclusion Unstable, moderately stable, and highly stable PDW are protective factors for TTR compliance in patients with persistent non valvular atrial fibrillation, while highly variable PDW is a risk factor for it.

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