血栓形成最大振幅和血小板参数与老年冠状动脉三支病变的相关性  

Correlation of maximum amplitude of thrombosis and platelet parameters with 3-vessel lesions of coronary artery in the elderly

作　　者：杨小云 徐晤 YANG Xiao-Yun;XU Wu(Center of Geriatrics,Lianyungang Clinical College of Xuzhou Medical University,Lianyungang 222006,Jiangsu Province,China;Department of Cardiology,Affiliated Hospital of Xuzhou Medical University,Xuzhou 221002,Jiangsu Province,China)

机构地区：[1]徐州医科大学连云港临床学院老年医学中心,江苏连云港222006 [2]徐州医科大学附属医院心血管内科,江苏徐州221002

出　　处：《中华老年多器官疾病杂志》2021年第10期770-775,共6页Chinese Journal of Multiple Organ Diseases in the Elderly

摘　　要：目的探讨血栓弹力图血栓形成最大振幅[TEG(MA)]、血小板参数与老年急性冠脉综合征(ACS)患者冠状动脉三支病变的相关性。方法选取2018年6月至2020年12月于徐州医科大学连云港临床学院心血管内科经冠状动脉造影确诊为ACS老年患者129例,按冠状动脉病变支数,分为单支组(34例),双支组(41例),三支组(54例),比较3组间TEG(MA)和血小板参数水平差异。采用SPSS 19.0统计软件进行数据分析。根据数据类型,多组间比较采用χ2检验、ANOVA方差分析或Kruskall-Wallis检验;2组间比较采用χ2检验或LSD检验。采用多元logistic回归分析冠状动脉三支病变的独立危险因素。结果老年ACS患者冠状动脉病变单支组TEG(MA)值低于双支组及三支组[(58.60±7.17)和(61.41±7.44)及(62.07±6.50)mm],差异均有统计学意义(均P<0.05);单支组平均血小板体积(MPV)低于双支组及三支组[(9.37±1.21)和(10.19±1.34)及(10.95±1.25)fL],双支组低于三支组,差均异有统计学意义(均P<0.05);多元logistic回归分析结果显示患者年龄、TEG(MA)、血小板平均体积(MPV)、血小板计数(PLT)、血小板压积(PCT)是冠状动脉病变三支病变的危险因素;通过受试者工作特征曲线分析,TEG(MA)联合MPV预测老年ACS患者冠状动脉三支病变的灵敏度和特异度分别为82.43%和67.18%。高MPV组(n=78)住院期间及出院3个月MACE事件发生率17.9%,全因死亡率2.6%;低MPV组(n=51)分别为7.8%,无死亡病例,差异均有统计学意义(P<0.05)。结论老年ACS患者入院时MPV与冠状动脉三支病变相关,为冠状动脉三支病变的独立危险因素,对冠状动脉三支病变有预测价值,且与住院期间及出院3个月MACE事件发生率较高相关;老年ACS患者入院时TEG(MA)与冠状动脉多支病变相关。Objective To investigate the correlations of thromboelastography(TEG)maximum amplitude(MA)and platelet parameters with the 3-vessel lesions in the elderly patients with acute coronary syndrome(ACS).Methods A total of 129 elderly patients with ACS confirmed by coronary angiography admitted in the Center of Geriatrics of Lianyungang Clinical College from June 2018 to December 2020 were enrolled in this study.According to the number of involved coronary artery lesions,they were divided into 1-(n=34),2-(n=41)and 3-vessel groups(n=54).The TEG(MA)and platelet parameters were compared among different groups.SPSS statistics 19.0 was used for statistical analysis.ANOVA analysis of variance,Chi-square test or Kruskall-Wallis test was applied for comparison among the groups,and Chi-square test or LSD test was employed for comparison between groups depending on date type.Multivariate logistic regression analysis was used to analyze the independent risk factors of 3-vessel disease.Results TEG(MA)level of the elderly patients in the 1-vessel group was significantly lower than that in the 2-and 3-vessel groups[(58.60±7.17)vs(61.41±7.44)and(62.07±6.50)mm,P<0.05].The mean platelet volume(MPV)level of the ACS elderly patients was in a decreasing order from the 1-vessel group to the 2-vessel group and then the 3-vessel group[(9.37±1.21),(10.19±1.34)and(10.95±1.25)fL,P<0.05].Multiple logistic regression analysis showed that age,TEG(MA),MPV,platelet count(PLT)and platelet hematocrit(PCT)were risk factors for 3-vessel lesions of coronary artery.Receiver operating characteristic curve analysis indicated that the sensitivity and specificity of TEG(MA)combined with MPV were 82.43% and 67.18%,respectively,in the prediction of 3-vessel lesions in the patients.In the high MPV group(n=78),the incidence of MACE was 17.9% and the all-cause mortality was 2.6% during hospital and in 3 months after discharge.While the incidence was 7.8%,and no death cases were found in the low MPV group(n=51),with statistical difference between the 2 groups

关 键 词：冠状动脉疾病 血栓弹力图血栓形成最大振幅 血小板参数 冠状动脉病变 

分 类 号：R543.3[医药卫生—心血管疾病]