急性冠脉综合征患者低分子肝素诱导血小板减少症的危险因素分析

目的：分析急性冠脉综合征（ACS）患者发生低分子肝素诱导血小板减少症（HIT）的相关危险因素。方法：收集某院2011年1月-2017年11月出院的ACS且使用低分子肝素抗凝治疗的患者资料，调查血小板减少的发生情况，并通过单因素和多因素Logistic回归分析，得出肝素诱导的HIT的独立危险因素。结果：共纳入190例患者（HIT组48例，对照组142例）。年龄≥ 70岁（t=4.274，P=0.042）、血小板基础值（t=6.442，P=0.000）、肾功能肌酐水平（t=-4.080，P=0.000）、血红蛋白水平（t=3.337，P=0.001）、肝功能谷丙转氨酶（t=-2.253，P=0.025）、联合使用抗菌药物（t=27.023，P=0.000）以及联合使用替罗非班（t=4.656，P=0.031）在HIT组与对照组之间差异有显著性。对以上指标进一步进行多因素Logistic回归分析，得到高龄（OR=0.183，P=0.008）、血小板基础值低（OR=0.960，P=0.000）、肾功能肌酐水平高（OR=1.023，P=0.005）、联合使用抗菌药物（OR=0.191，P=0.003）、联合使用替罗非班（OR=3.500，P=0.041）是HIT发生的独立危险因素。结论：ACS患者在使用低分子肝素时应警惕HIT的发生，尤其年龄≥ 70岁、血小板基础值低、肾功能肌酐值高、联合使用抗菌药物及联合使用替罗非班的患者。

Risk factors for low molecular weight heparin induced thrombocytopenia in ACS patients

OBJECTIVE To analyze the risk factors of low molecular weight heparin induced thrombocytopenia (HIT) in patients with acute coronary syndromes (ACS).METHODS The data of ACS patients treated with low molecular weight heparin between January 2011 and November 2017 were collected.Prevalence and risk factors for HIT were investigated and identified by univariate and multivariate logistic regression analyses.RESULTS A total of 190 patients were enrolled (48 in the HIT group and 142 in the control group).Between two groups,age ≥ 70 y (t=4.424,P=0.042),baseline platelet count (t=6.442,P=0.000),blood creatinine (t=-4.080,P=0.000),hemoglobin (t=3.337,P=0.001),alanine aminotransferase (t=-2.253,P=0.025),combined antibiotics (t=27.023,P=0.000) or tirofiban (t=4.656,P=0.031) were statistically different.Multivariate logistic regression analysis showed that advanced age (OR=0.183,P=0.008),lower baseline platelet count (OR=0.960,P=0.000),higher blood creatinine (OR=1.023,P=0.005),combined antibiotics (OR=0.191,P=0.003) or tirofiban (OR=3.500,P=0.041) were significant risk factors for HIT.CONCLUSION ACS patients should be closely monitored for HIT during low molecular weight heparin therapy,especially in those with advanced age,lower baseline platelet count,higher blood creatinine,and treated with antibiotics or tirofiban simultaneously.