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目的探讨替罗非班引起血小板减少的危险因素。方法收集2013年1月至2014年6月734例接受替罗非班抗栓治疗的冠状动脉粥样硬化患者的临床资料,根据用药后血小板计数分为血小板减少组和血小板未减少组,收集相关临床危险因素,并进行Logistic逐步分析,计算各危险因素的比值比及其95%置信区间。结果入组患者中69例患者发生了血小板减少。Logistic多因素逐步回归分析显示,年龄>65岁(OR=2.58,95%CI:1.54-4.33,P<0.05),用药前丙氨酸转氨酶>75 U·L~(-1)(OR=2.39,95%CI:1.26-4.58,P<0.05)和用药前肾小球滤过率<60 mL·min~(-1)·1.73 m~(-2)(OR=3.34,95%CI:1.89-5.88,P<0.05)为独立危险因素。出现血小板减少的中位时间和停药后血小板恢复的中位时间均为1 d。结论高龄、丙氨酸转氨酶升高和肾功能不全为替罗非班相关血小板减少的主要危险因素,因此对于此类患者需密切监测血小板计数,降低出血风险。
Objective To explore the risk factors for thrombocytopenia caused by tirofiban. Methods The clinical data of 734 patients with coronary atherosclerosis treated with tirofiban antithrombotic therapy from January 2013 to June 2014 were collected and divided into thrombocytopenia group and no platelet reduction group according to the platelet count after treatment, Clinical risk factors, and Logistic stepwise analysis to calculate the ratio of risk factors and their 95% confidence interval. Results Thrombocytopenia occurred in 69 of the patients enrolled. Logistic regression analysis showed that age> 65 years (OR = 2.58, 95% CI: 1.54-4.33, P <0.05), and ALT> 75 U · L -1 , 95% CI: 1.26-4.58, P <0.05), and the glomerular filtration rate before treatment was less than 60 mL · min -1 · 1.73 m -2 (OR = 3.34, 95% CI 1.89 -5.88, P <0.05) as independent risk factors. The median time to thrombocytopenia and median platelet recovery after discontinuation were both 1 d. Conclusions Aging, elevated alanine aminotransferase and renal insufficiency are the major risk factors for tirofiban-induced thrombocytopenia. Therefore, patients with such patients should be closely monitored for platelet count and reduced risk of bleeding.