Department of General Internal Medicine, Inselspital, CH-3010 Bern, Switzerland.
Platelets. 2009 Dec;20(8):566-74. doi: 10.3109/09537100903295922.
Elevated platelet count might reflect increased inflammation as an etiological factor for venous thromboembolism (VTE). Poor sleep, fatigue, and exhaustion are all associated with inflammation and are also common sequelae of chronic psychological stress that previously predicted increased risk of VTE. We hypothesized that platelet count would be high in patients with VTE who sleep poorly and who are fatigued and exhausted. We investigated 205 patients scheduled for thrombophilia work-up > or =3 months after an objectively diagnosed venous thromboembolic event. They completed the Jenkins Sleep Questionnaire to rate subjective sleep quality and the short forms of the Multidimensional Fatigue Symptom Inventory and Maastricht Vital Exhaustion Questionnaire. Platelet count was determined by a mechanical Coulter counter. Analyses controlled for age, sex, body mass index, time since the index event, and medication. After taking into account these covariates, poorer sleep quality (p = 0.001; DeltaR(2)= 0.046), high fatigue (p = 0.008; DeltaR(2)= 0.032), and vital exhaustion (p = 0.050; DeltaR(2)= 0.017) were all associated with elevated platelet count. In addition, high level of fatigue mediated the relationship between poor sleep quality and elevated platelet count (p = 0.046). Poor sleep quality, high levels of fatigue, and vital exhaustion were identified as correlates of an elevated platelet count in patients with a previous episode of VTE. Given the emerging role of inflammatory processes in VTE, the findings suggest a mechanism through which behavioral and chronic psychological stressors might contribute to incident and recurrent venous thrombotic events.
血小板计数升高可能反映出炎症作为静脉血栓栓塞症（VTE）的病因。睡眠不佳、疲劳和疲惫都与炎症有关，也是慢性心理压力的常见后遗症，而慢性心理压力此前曾预测 VTE 的风险增加。我们假设 VTE 患者的血小板计数会升高，这些患者睡眠不佳，且感到疲劳和疲惫。我们调查了 205 名患者，他们在客观诊断出静脉血栓栓塞事件后>或=3 个月接受了血栓形成倾向检查。他们完成了詹金斯睡眠问卷，以评估主观睡眠质量，以及多维疲劳症状量表和马斯特里赫特活力衰竭问卷的简短形式。血小板计数由机械库尔特计数器确定。分析控制了年龄、性别、体重指数、从指数事件发生到现在的时间以及药物治疗。在考虑了这些协变量后，睡眠质量较差（p=0.001；DeltaR(2)=0.046）、疲劳程度高（p=0.008；DeltaR(2)=0.032）和活力衰竭（p=0.050；DeltaR(2)=0.017）都与血小板计数升高有关。此外，高疲劳水平介导了睡眠质量差与血小板计数升高之间的关系（p=0.046）。在以前发生过 VTE 的患者中，睡眠质量差、高疲劳水平和活力衰竭被确定为血小板计数升高的相关因素。鉴于炎症过程在 VTE 中的作用不断增强，这些发现表明，行为和慢性心理压力源可能通过某种机制导致静脉血栓栓塞事件的发生和复发。
