论文部分内容阅读
目的评估平均血小板体积(MPV)与行经皮冠状动脉介入(PCI)的不稳定性心绞痛(UAP)患者术后冠状动脉TIMI无再流的相关性。方法选取2013年1—12月于中国医学科学院阜外医院行PCI治疗的4511例UAP患者。空腹12h采集静脉血检测MPV,根据MPV值使用三分位法将入选患者分为3组(组1:MPV≤10.0fl;组2:10.0fl10.8fl);将组1+组2归为低MPV组(n=2982),组3归为高MPV组(n=1529)。同时根据PCI术后冠状动脉TIMI血流将患者分为无再流组(TIMI 0-1级,n=112)与对照组(TIMI 2—3级,n=4399)。采用多因素Logistic回归分析评估MPV对PCI术后无再流的预测价值。结果无再流组MPV显著高于对照组(P=0.043)。与低MPV组相比,高MPV组无再流发生率(P=0.033)、糖尿病患病率(P<0.001)、吸烟率(P=0.01)、粒细胞/淋巴细胞比值(P=0.002)、糖化血红蛋白更高(P<0.001),血小板计数更低(P<0.001)。无再流组与对照组比较,冠状动脉病变严重程度、SYNTAX积分、受累血管、支架数目及最大支架直径差异均无统计学意义(P>0.05)。Logistic回归分析表明,MPV每升高1fl,PCI术后无再流的风险增高1.227倍(P=0.043);经校正混杂因素后,提示MPV是PCI术后无再流的独立危险因素[OR(95%CI)=1.254(1.027~1.531),P=0.027]。结论 MPV升高者,PCI术后无再流的风险明显增高;校正多因素后,MPV仍是PCI术后无再流的独立危险因素。
Objective To assess the association between mean platelet volume (MPV) and postoperative coronary TIMI without reflow in patients with unstable angina (UAP) undergoing percutaneous coronary intervention (PCI). Methods 4511 UAP patients undergoing PCI at Fu Wai Hospital of Chinese Academy of Medical Sciences from January 2013 to December 2013 were selected. Venous blood was collected 12 h after fasting for detection of MPV, and the patients were divided into 3 groups according to MPV value using the tertile method (group 1: MPV≤10.0fl; group 2: 10.0fl ), Group 1 + group 2 as low MPV group (n = 2982), group 3 as high MPV group (n = 1529). At the same time, the patients were divided into two groups according to the TIMI flow of PCI: TIMI level 0-1, n = 112 and control group (TIMI level 2-3, n = 4399). Multivariate Logistic regression analysis was used to evaluate the predictive value of MPV for no-reflow after PCI. Results MPV in no-reflow group was significantly higher than that in control group (P = 0.043). There were no recurrences (P = 0.033), diabetes prevalence (P <0.001), smoking (P = 0.01), neutrophil / lymphocyte ratio (P = 0.002) , Glycosylated hemoglobin was higher (P <0.001), and platelet count was lower (P <0.001). There was no significant difference in the severity of coronary artery disease, SYNTAX score, vessel involvement, number of stent and maximum stent diameter between no-reflow group and control group (P> 0.05). Logistic regression analysis showed that for each 1-MPV increase in MPV, the risk of no-reflow after PCI was 1.227 times higher (P = 0.043). After adjusting for confounding factors, it was suggested that MPV was an independent risk factor for no-reflow after PCI [OR 95% CI) = 1.254 (1.027-1.531), P = 0.027]. Conclusions There is a significantly higher risk of no-reflow after PCI in MPV patients. MPV is still an independent risk factor of no-reflow after PCI.