| Objective: Acute pulmonary embolism is presently the most prevalent manifestation of pulmonary circulation diseases in our country. In recent years, more and more people have developed to pulmonary embolism, which has had the leading cause of complications and death and impacted the quality of people’s life. It is well established that diagnosis, prevention and evaluation of pulmonary embolism become focus of attention among clinical physician. The function of platelet influence pathophysiology of pulmonary embolism directly or indirectly. Platelet distribution width is one of the most important parameter which stands for the difference of platelet volume. In this study, we tried to investigate the evaluation of platelet distribution width on prediction, diagnosis and assessment of pulmonary embolism. We compared clinical characteristic and platelet distribution width among massive pulmonary embolism, submassive pulmonary embolism and none-massive pulmonary embolism patients.Methods: A total of 70 patients who had been diagnosed as pulmonary embolism in our department, were enrolled into this study from March 2013 to March 2015. All patients including 10 massive pulmonary embolism patients(massive pulmonary embolism group, male 7, female 3, age 58.90 ± 7.52), 30 submassive pulmonary embolism patients(submassive pulmonary embolism group, male 20, female 10, age 60.50 ± 8.08), 30 none-massive pulmonary embolism patients(none-massive pulmonary embolism group, male 18, female 12, age 59.87 ± 7.62). Control group(control group, male 39, female 31, age 61.26 ± 8.42) contains 70 contemporary patients matched with age and gender. Retrospective analysis the correlation between platelet distribution width and clinical basic data, heart rate, blood pressure, hepatic function, renal function, arterial blood gas analysis, fibrinogen, D-Dimer, c TNI, erythrocyte sedimentation rate, right ventricular diameter, pulmonary hypertension, deep venous thrombosis.Results:1 Comparison of baseline demographics and clinical features among the four groups: No significant differences were found with respect to baseline demographics and clinical features, such as age, gender, body mass index, smoking history, family history, level of serum creatinine, level of uric acid, level of glutamic-pyruvic transaminase and the rate of lower extremity vein thrombus(all P>0.05).2 Comparison of blood gas analysis and vital signs among the four groups: There was no significant difference among the four groups in levels of hemoglobin(P>0.05). Oxygen pressure, oxygen pressure and carbon dioxide pressure of massive pulmonary embolism group, submassive pulmonary embolism group and none-massive pulmonary embolism group were significantly lower than that of control group(all P<0.05). And heart rate and respiratory rate of massive pulmonary embolism group, submassive pulmonary embolism group and none-massive pulmonary embolism group were superior than that of control group(all P<0.05). There was no significant difference between massive pulmonary embolism group and submassive pulmonary embolism group with respect to oxygen pressure, oxygen pressure, carbon dioxide, heart rate and respiratory rate(all P>0.05). Oxygen pressure and oxygen pressure of massive pulmonary embolism group were significantly lower than that of none-massive pulmonary embolism group(all P<0.05). Systolic blood pressure and diastolic blood pressure in massive pulmonary embolism group were significantly lower than that of submassive pulmonary embolism group, none-massive pulmonary embolism group, and control group(all P<0.05).3 Comparison of coagulation and fibrinolysis system parameter, ESR and c TNI among the four groups: levels of fibrinogen, D-dimer, erythrocyte sedimentation rate and c TNI of massive pulmonary embolism group, submassive pulmonary embolism group and none-massive pulmonary embolism group were significantly higher than that of control group(all P<0.05). There was no significant difference between massive pulmonary embolism group and submassive pulmonary embolism group with respect to levels of fibrinogen, D-dimer, erythrocyte sedimentation rate or c TNI(all P>0.05). Levels of D-dimer, erythrocyte sedimentation rate and c TNI of massive pulmonary embolism group were significantly higher than that of none-massive pulmonary embolism group(all P<0.05).4 Comparison of echocardiogram among the four groups: levels of right ventricular diameter and pulmonary artery pressure of massive pulmonary embolism group, submassive pulmonary embolism group and none-massive pulmonary embolism group were significantly higher than that of control group(all P<0.05). There was no significant difference between massive pulmonary embolism group and submassive pulmonary embolism group with respect to levels of right ventricular diameter and pulmonary artery pressure(all P>0.05). Levels of right ventricular diameter of massive pulmonary embolism group were significantly higher than that of none-massive pulmonary embolism group(P<0.05).5 Comparison of platelet parameters among the four groups: levels of blood platelet count of massive pulmonary embolism group, submassive pulmonary embolism group and none-massive pulmonary embolism group were significantly lower than that of control group(all P<0.05). And levels of platelet distribution width of massive pulmonary embolism group, submassive pulmonary embolism group and none-massive pulmonary embolism group were higher than that of control group(all P<0.05). There was no significant difference between massive pulmonary embolism group and submassive pulmonary embolism group with respect to levels of blood platelet count and platelet distribution width(all P>0.05). Levels of blood platelet count of massive pulmonary embolism group were significantly lower than that of none-massive pulmonary embolism group(P<0.05). And Levels of platelet distribution width of massive pulmonary embolism group were significantly higher than that of none-massive pulmonary embolism group(P<0.05).6 Correlation analysis of platelet distribution width: Correlation analysis found that platelet distribution width was negatively correlated with oxygen pressure(r=-0.842,P<0.001), oxygen saturation(r=-0.262,P=0.028) and blood platelet count(r=-0.698,P<0.001); platelet distribution width was positively correlated with heart rate(r=0.307,P=0.010), fibrinogen(r=0.594,P<0.001), D-dimer(r=0.507,P<0.001), right ventricular diameter(r=0.626,P<0.001), and pulmonary artery pressure(r=0.481,P<0.001).7 Predictors of massive pulmonary embolism or submassive pulmonary embolism by logistic regression analysis: Multivariate logistic regression model was tested to explore predictive factors of massive pulmonary embolism or submassive pulmonary embolism. Age, gender, body mass index, thrombus of lower extremity veins, blood platelet count and platelet distribution width>18% were enrolled in multivariate logistic model. By corrected age, gender, body mass index, and blood platelet count, the risk of massive pulmonary embolism or submassive pulmonary embolism would increase under the conditions of below: thrombus of lower extremity veins(P=0.012, OR=1.310, 95%CI: 1.004~5.846) and platelet distribution width>18%(P=0.003, OR=1.637, 95%CI: 1.108~4.674)Conclusion:1 The patients with massive pulmonary embolism or submassive pulmonary embolism would share the features of higher platelet distribution width and lower blood platelet count.2 Platelet distribution width was negatively correlated with oxygen pressure, oxygen saturation and blood platelet count; platelet distribution width was positively correlated with heart rate, fibrinogen, D-dimer, right ventricular diameter, and pulmonary artery pressure with pulmonary embolism patients.3 Platelet distribution width>18% was independent risks of massive pulmonary embolism or submassive pulmonary embolism. |
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