血小板平均体积与冠状动脉旁路移植术后静脉桥血管狭窄的关系探讨  

Investigation of relationship between mean platelet volume and saphenous vein graft restenosis after coronary artery bypass grafting

作　　者：张蕊[1] 宋衍秋 解存 刘珊 赵福梅 丛洪良[3] 武刚 Zhang Rui;Song Yanqiu;Xie Cun;Liu Shan;Zhao Fumei;Cong Hongliang;Wu Gang(Department of Cardiac Surgery,Tianjin Chest Hospital,Tianjin Medical University,Tianjin 300222,China;Tianjin Cardiovascular Diseases Institute,Tianjin 300222,China;Department of Cardiovascular Medicine,Tianjin Chest Hospital,Tianjin 300222,China)

机构地区：[1]天津医科大学胸科临床学院,天津市胸科医院心外科,300222 [2]天津市心血管病研究所,300222 [3]天津市胸科医院心内科,300222

出　　处：《中华老年医学杂志》2019年第5期508-512,共5页Chinese Journal of Geriatrics

基　　金：天津市科委课题(16ZXMJSY00140).

摘　　要：目的探讨接受冠状动脉旁路移植术(CABG)的冠心病患者平均血小板体积(MPV)与静脉桥血管再狭窄的关系,分析MPV预测CABG术后静脉桥血管再狭窄的临床意义。方法回顾性分析2009年9月至2014年9月就诊于天津市胸科医院,实施CABG治疗后3~5年再发可疑心肌缺血事件而入院治疗的患者354例。根据冠状动脉造影结果分为静脉桥血管狭窄(SVGD)组233例和静脉桥血管通畅(SVG)组121例。配对t检验分析不同因素与桥血管通畅性的关系。二元Logistic回归分析MPV及其他因素对桥血管通畅性的影响。静脉桥血管狭窄>50%被认为有意义且影响心肌供血。结果SVGD组患者MPV(10.2±1.5)fl较SVG组(9.6±1.5)fl高(P<0.01)。Logistic回归分析SVG组和SVGD组MPV值(OR=1.268,95%CI:1.053~1.570,P=0.014)、年龄(OR=1.007,95%CI:1.038~1.117,P=0.000)、性别(OR=0.452,95%CI:0.250~0.816,P=0.008)、糖尿病(OR=2.319,95%CI:1.221~4.405,P=0.010)是静脉桥血管再狭窄的独立危险因素。Logistic回归分析非老年SVG组和SVGD组患者性别(OR=0.495,95%CI:0.251~0.976,P=0.042)、糖尿病(OR=2.237,95%CI:1.105~4.527,P=0.025)、MPV(OR=1.334,95%CI:1.050~1.694,P=0.018)、纤维蛋白原定量(OR=1.654,95%CI:1.020~2.682,P=0.041)是静脉桥血管狭窄的独立危险因素;Logistic回归分析老年SVG组和SVGD组患者年龄(OR=1.178,95%CI:1.116~1.244,P=1.178)为静脉桥血管狭窄的独立危险因素。MPV水平≥12fl者狭窄率(92.6%,25/27)高于MPV水平处于<12fl者狭窄率(63.6%,208/327);ROC曲线结果显示,MPV曲线下面积为0.610,年龄、性别、糖尿病、维蛋白原定量曲线下面积分别为0.657、0.394、0.626、0.654,联合诊断曲线下面积为0.796,联合预测价值高于单独预测价值(P<0.01)。结论MPV水平是静脉桥血管狭窄的独立危险因素,与年龄、性别、糖尿病、维蛋白原联合预测价值更高。Objective To investigate the relationship between mean platelet volume(MPV)and saphenous vein graft restenosis in patients receiving coronary artery bypass grafting(CABG), and to analyze the clinical significance of MPV in the prediction of restenosis after CABG. Methods A total of 354 patients admitted into Tianjin chest hospital from September 2009 to September 2014 with suspected myocardial ischemic events 3 to 5 years after CABG treatment was enrolled for a retrospective analysis.According to the coronary angiography(CAG)results, patients were divided into the vein bridge vascular lesion group(saphenous vein graft diseases, SVGD)(n=233)and the venous bridge vascular patency group(saphenous vein graft, SVG)(n=121). Paired t test was used to analyze the relationship between different factors and the bridge vascular patency.The binary logistic regression was used to analyze the effects of MPV and other factors on bridge vascular patency.Venous bridge stenosis >50% was considered to be clinically significant and to damage myocardial blood supply. Results The MPV was higher in the SVGD group than the SVG group[(10.2±1.5)fl vs.(9.6±1.5)fl, P<0.01]. The logistic regression analysis showed that MPV(OR=1.268, 95%CI: 1.053-1.570, P=0.014), age(OR=1.007, 95%CI: 1.038-1.117, P=0.000), gender(OR=0.452, 95%CI: 0.250-0.816, P=0.008), diabetes mellitus(OR=2.319, 95%CI: 1.221-4.405, P=0.010)were the independent risk factors for venous bridge stenosis in the two groups, gender(OR=0.495, 95%CI: 0.251-0.976, P=0.042), diabetes mellitus(OR=2.237, 95%CI: 1.105-4.527, P=0.025), MPV(OR=1.334, 95%CI: 1.050-1.694, P=0.018), fibrinogen(OR=1.654, 95%CI: 1.020-2.682, P=0.041)were the independent risk factors for venous bridge stenosis in non-elderly patients, and age(OR=1.178, 95%CI: 1.116-1.244, P=1.178)was an independent risk factor for vein graft stenosis in elderly patients.The restenosis rate was higher in patients with MPV ≥ 12 fl(92.6% or 25/27)than in the patients with MPV < 12 fl(63.6% or 208/327). The receiver operating cha

关 键 词：血小板 心血管疾病 冠状动脉旁路移植 非体外循环 隐静脉 

分 类 号：R654.2[医药卫生—外科学]