稳定性冠心病患者血小板体积分布宽度与冠状动脉病变严重程度及长期预后的相关性  

Impact of platelet distribution width on the extent and long-term outcome of patients with stable coronary artery disease post percutaneous coronary intervention

作　　者：蒋萍[1] 宋莹[1] 许晶晶[1] 马元良[1] 唐晓芳[1] 姚懿[1] 姜琳[1] 王欢欢[1] 张雪[1] 刁晓琳 杨跃进[1] 高润霖[1] 乔树宾[1] 徐波[1] 袁晋青[1] Jiang Ping Song Ying Xu Jingjing Ma Yuanliang Tang Xiaofang Yao Yi Jiang Lin Wang Huanhuan Zhang Xue Diao Xiaolin Yang Yuejin Gao Runlin Qiao Shubin Xu Bo Yuan Jinqing(Department of Cardiology, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100037, China)

机构地区：[1]中国医学科学院北京协和医学院国家心脏病中心阜外医院心内科,100037

出　　处：《中华心血管病杂志》2017年第10期862-866,共5页Chinese Journal of Cardiology

基　　金：国家重点研发计划项目（2016YFC1301301）;国家自然科学基金（81470486）

摘　　要：目的研究评估血小板体积分布宽度（PDW）与行经皮冠状动脉介入治疗（PCI）的稳定性冠心病（SCAD）患者严重冠状动脉病变及长期预后的关系。方法本研究为前瞻性单中心观察性研究。连续纳入自2013年1至12月于阜外医院行PCI治疗的4 293例SCAD患者，空腹12 h后采血检测PDW，按PDW值三分位分为3组，即PDW≤11.4%组（1 402例）、11.4%〈PDW≤12.9%组（1 441例）和PDW〉12.9%组（1 450例），并随访2年。主要终点为主要不良心脑血管事件（MACCE），包括死亡、心原性死亡、心肌梗死（MI）、支架内血栓、血运重建（靶血管或靶病变血运重建）和卒中。采用多因素logistic回归分析PDW与严重冠状动脉病变的关系，多因素Cox回归分析PDW与预后的相关性。结果PDW≤11.4%组、11.4%〈PDW≤12.9%组和PDW〉12.9%组比较，糖尿病、体重指数、红细胞体积分布宽度、平均血小板体积（MPV）、血小板计数及糖化血红蛋白水平差异有统计学意义（P均〈0.05），但年龄、性别、肾小球滤过率等差异均无统计学意义（P均〉0.05）。不同PDW组之间，术后无再流、冠状动脉病变SYNTAX积分、严重冠状动脉病变差异均无统计学意义（P均〉0.05）。多变量logistic回归分析表明，PDW与SCAD患者严重冠状动脉病变无明显相关（OR＝0.994，95%CI 0.961～1.029，P＝0.73）。Cox回归分析表明，PDW是2年心原性死亡的独立危险因素（HR＝1.242，95%CI 1.031～1.497，P＝0.022），但PDW不是2年MACCE的危险因素（HR＝1.000，95%CI 0.952～1.050, P＝0.993）。结论PDW与PCI患者严重冠状动脉病变无明显相关性。PDW水平与SCAD患者心原性死亡存在独立的关联。ObjectiveTo evaluate the relationship between platelet distribution width（PDW） and the extent of coronary artery disease and 2-year outcome in patients received percutaneous coronary artery intervention（PCI） because of stable coronary artery disease（SCAD）.MethodsWe consecutively enrolled 4 293 patients who received PCI because of SCAD in Fuwai Hospital from Jan 2013 to Dec 2013, patients were followed up for 2 years. Patients were divided into three groups according to tertiles values of PDW as follows： PDW≤11.4%（1 402 patients）, 11.4%〈PDW≤12.9%（1 441 patients） and PDW〉12.9% （1 450 patients）. Major adverse cardiovascular and cerebrovascular events （MACCE） were defined as the occurrence of death, myocardial infarction, target vessel revascularization, intra stent thrombosis and stroke during follow-up. Multivariable logistic regression was used to evaluate the relationship between PDW and the extent of CAD. Multivariable Cox regression was used to evaluate the relationship between PDW and prognosis of SCAD patients.ResultsPDW was associated with diabetes mellitus, body mass index, red cell distribution width, mean platelet volume （MPV）, platelet counts and glycosylated haemoglobin （P〈0.05）, but not associated with age, sex, estimated glomerular filtration rate （P〉0.05）. PDW was not correlated with the extent of CAD（P=0.990）, SYNTAX score（P=0.721）, no-reflow phenomenon after PCI（P=0.978）. Multivariable logistic regression also showed no relationship between PDW and extent of CAD （OR=0.994, 95%CI 0.961-1.029, P=0.73）. PDW was found to be an independent risk factor of 2-year cardiac death （HR=1.242, 95%CI 1.031-1.497, P=0.022）, but was not an independent risk factor of all-cause death and MACCE.ConclusionsPDW is not related with the extent of coronary artery disease. PDW is an independent risk factor of 2-year cardiac death, but is not an independent risk factor of all-cause death and MACCE in this patient cohort.

关 键 词：冠状动脉疾病 血小板活化 血管成形术 

分 类 号：R541.4[医药卫生—心血管疾病]