血小板参数在早发冠心病冠脉病变中的临床意义及预测价值

The clinical significance and prevention value of platelet parameters in patients with premature coronary heart disease

目的 探讨血小板相关参数在早发冠心病患者冠状动脉病变中的变化及其临床预测价值。方法 选取2013年6月至2015年1月安徽医科大学第一附属医院心血管内科收治的306例疑诊冠心病患者作为研究对象,根据冠状动脉造影结果分为对照组即造影阴性者（62例）和早发冠心病组（年龄男≤55岁,女≤65岁,共244例）比较组间差异;将冠心病组按年龄划分为4组,比较不同年龄段冠心病与血小板相关参数之间的关系;再依据病变累及冠脉支数分为单支病变组、双支病变组及三支病变组,进一步回顾性分析其冠状动脉病变特性与血小板参数之间的相关性;依据西雅图心绞痛调查量表（SAQ）评估患者入院时和抗血小板治疗6个月后机体功能状态及生活质量。结果 （1）与对照组相比,冠心病组体质量指数（BMI）、血小板平均体积（MPV）升高,而血小板计数（PLC）降低,差异均有统计学意义（P〈0.05）。（2）不同年龄段患者比较发现50-65岁之间的患者PLC减低,MPV及血小板分布宽度（PDW）相比其他年龄段水平升高,差异有统计学意义（P〈0.05）。（3）多因素Logistic回归分析发现高体质量指数、血小板计数为早发冠心病的危险因素,而血小板参数与早发冠心病冠脉病变程度密切相关（P〈0.05）。（4）SAQ量表评估发现与冠心病入院时相比,出院抗血小板治疗6个月后各因子分及SAQ总分增加（P〈0.05）。结论 高体质量指数、血小板相关参数是早发冠心病患者的独立危险因素,血小板参数的定期监测对冠心病具有一定的预防意义。

Objective To explore the changes and prevention value of platelet parameters in patients with premature coronary heart disease （PCHD）.Methods 306 patients in the Department of Cardiology of the First Affiliated Hospital of Anhui Medical University with suspicious coronary heart disease were enrolled in from June 2013 to January 2015.Those patients were divided into control group which without coronary artery lesions（n =62）and premature group（male≤55 years old,female≤65 years old,n =244）,the difference was compared.According to the age,PCHD were divided into 4 groups and the correlation with platelet parameters was analyzed.then, PCHD group were subdivided into single branch disease,double vessel lesions and triple vessel lesions group.Its characteristics and re-lationship with platelet parameters were analyzed retrospectively.Finally,Seattle angina questionnaire（SAQ）was selected to assess the physical and mental status and quality of life.The assessment was performed on patients on admission and six months after enrollment. Results （1）Compared with the control group,patients with PCHD had higher body mass index（BMI）and mean platelet volume,lower platelet counts,which were statistically significant difference（P 〈0.05）.（2）According to the age,patients with PCHD showed that 50-65 years old had lower platelet counts,higher mean platelet volume and platelet distribution width（P 〈0.05）.（3）Multivariate Lo-gistic regression analysis indicated that higher BMI,platelet counts can be considered as risk factors for PCHD patients.Then platelet parameters is closely associated with severity of lesions in patients with PCHD （P 〈0.05）.（4）Compared with first on admission,after six months＇antiplatelet therapy was significant increase in scores of each items and total score of SAQ（P 〈0.05）.Conclusion High-er BMI,platelet parameters are independent risk factors for PCHD;hence monitoring of platelet parameters for PCHD has a certain pre-ventive significance.