Тромбоцитарное звено гемостаза у полиморбидных пациентов с острым коронарным синдромом и COVID-19

Введение. Тромбоциты играют ключевую роль в возникновении артериального тромбоза, а влияние SARS-CoV-2 на тромбоциты способствует повышенному риску тромбообразования. 

Цель. Оценить тромбоцитарное звено гемостаза, а также полиморбидность у пациентов с острым коронарным синдромом и COVID-19 на момент госпитализации.

Материалы и методы. Исследование «случай – контроль»; 96 пар пациентов с острым коронарным синдромом (ОКС), сопоставимых по полу, возрасту и диагнозу «ОКС». Группу 1 составили пациенты с ОКС и COVID-19, группу 2 – пациенты с ОКС без COVID-19. Показатели крови исследовали на гематологических анализаторах Mindray BC-5150 (China) и ABX Micros-60 (France), результаты которых были сопоставимы. Статистическая обработка выполнялась в среде Statistica 13.0. Работа одобрена локальным этическим комитетом ФГБОУ ВО УГМУ Минздрава России протоколом №9 от 22.10.2021.

Результаты. Уровень тромбоцитов (PLT) в группе 1 составил 242 (178÷299) х 109/л, в группе 2 – 236 (199÷291) х 109/л, p = 0,927. Средний объем тромбоцитов (MPV) в группе 1 составил 10,0 (9,3÷11,5) фл, в группе 2 – 8,0 (7,6÷8,8) фл, p < 0,001. Ширина распределения тромбоцитов (PDW) в группе 1 составила 16,2 (15,9÷16,4), в группе 2 – 15,7 (14,7÷16,7), p < 0,001. Тромбокрит (PCT) в группе 1 составил 0,24 (0,18÷0,30)%, в группе 2 – 0,19 (0,16÷0,24)%, p < 0,001. Отношение абсолютного количества тромбоцитов к абсолютному количеству лимфоцитов (PLR) в группе 1 составило 159,4 (109,5÷232,9), в группе 2 – 118,4 (88,2÷158,1), p < 0,001. Индекс полиморбидности Charlson в группе 1 составил 5 (4÷6) баллов, в группе 2 – 4 (4÷6) балла, p = 0,047.

Выводы. Более высокие значения MPV, PDW, PCT при равном уровне PLT, больший уровень PLR на момент поступления в стационар и большая полиморбидность могут свидетельствовать о более выраженной активации тромбоцитов за счет воспаления, выраженной иммуносупрессии и сопутствующих заболеваний у пациентов с COVID-19.

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