稳定性冠心病患者平均血小板体积对经皮冠状动脉介入术远期预后的价值  

Long-term prognostic value of mean platelet volume in patients with stable coronary artery disease undergoing elective 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] 王欢欢[1] 杨跃进[1] 高润霖[1] 乔树宾[1] 徐波[1] 袁晋青[1] 张茵[1] Jiang Ping;Song Ying;Xu Jingjing;Ma Yuanliang;Tang Xiaofang;Yao Yi;Wang Huanhuan;Yang Yuejin;Gao Runlin;Qiao Shubin;Xu Bo;Yuan Jinqing;Zhang Yin(Department of Cardiology,Fuwai Hospital and Cardiovascular Institute,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,北京100037

出　　处：《中华医学杂志》2020年第9期679-684,共6页National Medical Journal of China

基　　金：国家重点研发计划资助(2016YFC1301301);国家自然科学基金(81770365)。

摘　　要：目的探讨稳定性冠心病(CAD)择期经皮冠状动脉介入治疗(PCI)的患者入院平均血小板体积(MPV)与2年不良心脑血管事件之间的关系,并进一步探讨该相关性在不同患者亚组中是否一致。方法共纳入2013年全年于阜外医院行择期PCI治疗的4293例稳定性CAD患者,按MPV值均分为两组:低MPV组(n=2219,MPV≤10.5 fL)和高MPV组(n=2074,MPV>10.5 fL)。使用Cox回归分析比较MPV与远期预后的相关性。结果与低MPV组患者相比,高MPV组患者合并糖尿病[30.4%(674/2219)比34.5%(715/2074)]、吸烟[53.3%(1183/2219)比57.0%(1182/2074)]、既往行冠状动脉旁路移植术(CABG)[4.0%(88/2219)比5.4%(112/2074)]的比例更高,左室射血分数(LVEF)(64±7比63±7)、肾小球滤过率(eGFR)(92±14比91±15)更低(均P<0.05)。实验室检查方面,高MPV组患者糖化血红蛋白更高,血小板计数更低(均P<0.05)。冠状动脉造影方面,两组术前SYNTAX积分、左主干/三支病变比例、置入支架类型、介入治疗成功率及支架总长度差异均无统计学意义(均P>0.05)。预后方面,与低MPV组比较,高MPV组患者心源性死亡率更高[18(0.9%)比5(0.2%),P=0.004]。Kaplan-Meier分析表明,与低MPV组相比,高MPV组心源性死亡显著高于低MPV组(Log-rank P=0.004)。多变量Cox回归分析表明,高MPV与稳定性CAD患者的2年心源性死亡独立相关(HR 4.127,95%CI 1.373~12.405,P=0.012)。受试者工作特征(ROC)分析同样显示,MPV在预测2年心源性死亡方面具有较好的诊断价值(ROC曲线下面积=0.624,95%CI 0.511~0.738,P=0.04)。亚组分析发现,在糖尿病患者(HR 2.090,95%CI 1.217~3.589,P=0.008)及男性患者中(HR 1.561,95%CI 1.007~2.421,P=0.047),随MPV升高,心源性死亡发生率升高。结论接受择期PCI治疗的稳定性CAD患者中,高MPV与2年心源性死亡增加独立相关;该相关性在糖尿病及男性患者中更为显著。Objective To evaluate the relationship between admission mean platelet volume(MPV)and 2-year cardiac mortality in patients with stable coronary artery disease(CAD)undergoing elective percutaneous coronary intervention(PCI),and explored the consistence of this relationship in diabetes mellitus(DM)and non-DM subgroups.Method A total of 4293 patients who underwent PCI in Fuwai Hospital in 2013 were enrolled and divided into two groups according to MPV as follows:lower MPV(n=2219,MPV≤10.5fL)and higher MPV(n=2074,MPV>10.5fL).Result Patients with high MPV had a higher rate of DM(30.4%(674/2219)vs 34.5%(715/2074)),smoking(53.3%(1183/2219)vs 57.0%(1182/2074)),and previous coronary artery bypass grafting(CABG)(4.0%(88/2219)vs 5.4%(112/2074)),while left ventricular ejection fraction(LVEF)(64±7 vs 63±7),and glomerular filtration rate(eGFR)(92±14 vs 91±15)were lower compared with patients in the low MPV group(all P<0.05).In the laboratory examination,patients with high MPV had higher glycosylated hemoglobin,and lower platelet count(all P<0.05).In coronary angiography,there was no significant difference in SYNTAX scores,left main/three-vessel lesions,stent type,success rate of operation,and total stent length(all P>0.05).Compared with low MPV group,patients with high MPV had ahigher cardiac mortality[18(0.9%)vs 5(0.2%),P=0.004].Kaplan-Meier analysis showed that compared to low MPV group,cardiac mortality in high MPV group was significantly higher(Log-rank P=0.004).Multivariate Cox regression analysis showed that high MPV was independently associated with 2-year cardiac mortality(HR 4.127,95%CI 1.373 to 12.405,P=0.012).Receiver operating characteristic curve(ROC)analysis also showed that MPV had a good diagnostic value in predicting 2-year cardiac mortality(area under the curve=0.624,95%CI:0.511-0.738,P=0.04).Subgroup analysis showed that in patients with DM(HR 2.090,95%CI 1.217-3.589,P=0.008)and male(HR 1.561,95%CI 1.007-2.421,P=0.047),MPV was significantly related with cardiac mortality.Conclusion In patients with stab

关 键 词：平均血小板体积 冠状动脉心脏病 心源性死亡 经皮冠状动脉介入治疗 

分 类 号：R541[医药卫生—心血管疾病]