Kin Kyoko, Iwamoto Toshihiko, Takasaki Masaru
Department of Geriatric Medicine, Tokyo Medical University.
Nihon Ronen Igakkai Zasshi. 2002 Jul;39(4):419-26. doi: 10.3143/geriatrics.39.419.
This study was conducted to clarify the relationship between the outcome of various diseases in elderly patients and platelet function. The outcome in 347 consecutive patients aged 60 or older, who were treated without antiplatelet drugs on registration, was retrospectively studied after platelet aggregability tests. The mean age was 77.5 years (161 men and 186 women). The grading curve (GC) type, as an index of platelet aggregability, was determined spectrophotometrically with an aggregometer and adenosine-5'-diphosphate as an agonist. They were classified into three groups according to GC type: Group I with a GC type of -2 or -1 (n = 40), group II with a GC type of 0 or +1 (n = 208), and group III with a GC type of +2 or +3 (n = 99). The mean follow-up period was 3.9 years. There were 3 deaths in group I, 33 in group II, and 30 in group III. Mean annual mortality rate was 2.1% in group I, 4.0% in group II, and 7.5% in group III. Among causes of death, vascular events was seen in 15 patients of group III, although the most common cause of death was pneumonia in the three groups. The annual mortality rates due to vascular events were 0.7% in group I, 0.6% in group II, and 4.2% in group III, indicating a significantly higher mortality rate in group III. Antiplatelet therapy was performed in approximately 15% of each group during their clinical course, and, when they were excluded for survival analyses, annual mortality rate was also higher in group III than in groups I and II. Cox proportional hazards models for vascular death yielded a hazard ratio of 2.3 and 2.2 in the increased GC type and diabetes, respectively. These findings indicated that elderly patients with accelerated aggregability had higher mortality rates due to vascular events. Therefore, accelerated aggregability in the elderly suggested not only the progress of arteriosclerosis, but indications of antiplatelet therapy to prevent vascular events.
本研究旨在阐明老年患者各种疾病的预后与血小板功能之间的关系。对347例60岁及以上连续登记且未接受抗血小板药物治疗的患者，在进行血小板聚集试验后进行回顾性研究。平均年龄为77.5岁（男性161例，女性186例）。作为血小板聚集性指标的分级曲线（GC）类型，使用聚集仪和5'-二磷酸腺苷作为激动剂，通过分光光度法测定。根据GC类型将他们分为三组：I组GC类型为-2或-1（n = 40），II组GC类型为0或+1（n = 208），III组GC类型为+2或+3（n = 99）。平均随访期为3.9年。I组有3例死亡，II组有33例，III组有30例。I组的年平均死亡率为2.1%，II组为4.0%，III组为7.5%。在死亡原因中，III组有15例患者出现血管事件，尽管三组中最常见的死亡原因是肺炎。I组、II组和III组因血管事件导致的年死亡率分别为0.7%、0.6%和4.2%，表明III组的死亡率显著更高。在每组的临床过程中，约15%的患者接受了抗血小板治疗，在进行生存分析将这些患者排除后，III组的年死亡率也高于I组和II组。血管性死亡的Cox比例风险模型显示，GC类型增加和糖尿病导致的风险比分别为2.3和2.2。这些发现表明，血小板聚集性加速的老年患者因血管事件导致的死亡率更高。因此，老年人血小板聚集性加速不仅提示动脉硬化进展，还提示抗血小板治疗以预防血管事件的指征。
