MPV和AR与非ST段抬高ACS患者不良预后的相关性

Association of Mean Platelet Volume and Aspirin Resistance with Poor Prognosis in Non-ST-Segment Elevated Acute Coronary Syndromes

目的探讨平均血小板体积(MPV)和阿司匹林抵抗(AR)与非ST段抬高的急性冠脉综合征(ACS)患者不良心血管事件发生的相关性。方法 197例非ST段抬高的ACS患者,每日口服阿司匹林100 mg>4周,检测由ADP诱导的血小板聚集率(PAG)和Sysmex XT-1800i检测的MPV,根据PAG和MPV将患者分为4组:①MPV正常不伴阿司匹林抵抗组(对照组);②MPV正常伴阿司匹林抵抗组;③MPV升高不伴阿司匹林抵抗组;④MPV升高伴阿司匹林抵抗组,随访观察4组主要不良事件(心源性死亡、心肌梗死、血运重建)发生的比率并进行比较。结果在197例非ST段抬高的ACS患者中,4组不良事件发生率分别为12.0%、18.6%、23.4%和62.5%,其中组4(MPV升高伴阿司匹林抵抗组)与组1(对照组)比较,不良事件发生比率明显增高(62.5%vs 12.0%,P<0.0001)。结论 MPV升高和AR与非ST段抬高的ACS患者不良心血管事件的发生呈正相关,它是非ST段抬高的ACS患者的重要危险因素和独立预测因子。

Objective To investigate aspirin resistance and mean platelet volume（MPV） in patients with non-ST-segment elevation acute coronary syndromes related adverse clinical cardiovascular events. Methods 197 patients with non-ST-segment elevation acute coronary syndromes took aspirin 100 mg/d for more than four weeks. Platelet aggregation function （PAG） was induced with adenosins disphosphate（ADP） and mean platelet volume was detected with Sysmex XT-1800i. The patients with acute coronary syndromes were divided into MPV normal aspirin-sensitive group, MPV normal aspirin-resistance group, MPV increased aspirin-sensitive group and MPV increased aspirin-resistance group by PAG and MPV. The primary outcome was the composite of cardiovascular death, myocardial infarction, unstable angina. The incidence of adverse clinical events in four groups was compared. Results Among 197 patients with non-ST-segment elevation acute coronary syndromes, the rations of adverse events in four groups were 12.0%, 18.6% ,23.4% ,62.5% , respectively. The patients with MPV increased aspirin-resistance were at increased risk of adverse clinical events compared with patients with MPV normal aspirin-sensitive （62.5% vs 12.0%, P 〈 0. 0001 ）. Conclusion Mean platelet volume increased and aspirin resistance was positively correlated with cardiovascular events in patients with non-ST-segment elevation acute coronary syndrome and were important risk factors and independent predictors.