平均血小板体积对冠状动脉介入术后无再流的预测价值

Predictive Value of Mean Platelet Volume in No-Reflow Phenomenon after Percutaneous Coronary Intervention

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2:10.0fl<MPV≤10.8fl;组3:MPV>10.8fl);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 evaluate the predictive value of mean platelet volume（MPV）in no-re-flow phenomenon after percutaneous coronary intervention（PCI）in patients with unstable angina pectoris（UAP）.Methods A total of 4511 patients who received PCI for UAP in Fuwai Hospital of Chinese Academy of Medical Sciences from January 2013 to December 2013 were selected in this study.Venous blood samples were collected after 12 hours of fasting and the MPV was detec-ted in all patients.According to the MPV,patients were divided into three groups：group 1（≤10.0 fl）,group 2（10.0 fl10.8 fl）.The groups 1 and 2 were consid-ered as the low MPV group（n=2982）,and group 3 as the high MPV group（n=1529）.In addi-tion,according to thrombolysis in myocardial infarction（TIMI）grade after PCI,these patients were divided into no-reflow group（TIMI grade 0-1,n=112）and control group（TIMI grade 2-3, n=4399.Multivariable logistic regression was used to evaluate the relationship between MPV and no-flow phenomenon after PCI.Results Compared with control group,the MPV in no-reflow group significantly increased in no-reflow group（P =0.043）.However,there were no significant differences between the two groups in coronary artery disease severity,SYNTAX score,involved vessels,stent number and maximum stent diameter（P 〉0.05）.Compared with low MPV group, high MPV group showed obvious decrease in incidences of no-reflow（P =0.033）,diabetes（P 〈0.001）and smoking（P =0.01）,neutrophil/lymphocyte ratio（P =0.002）,glycosylated hemoglo-bin level（P 〈0.001）,and platelet count（P 〈0.001）.Logistic regression analysis showed that the 1fl increment of MPV was associated with a 1.227-fold increase in no-reflow risk（P =0.043）.Af-ter correction for confounding factors,the analysis showed that MPV was an independent risk fac-tor for no-reflow after PCI[OR （95%CI ）= 1.254（1.027-1.531）,P = 0.027].Conclusion The risk of no-reflow after PCI increases in patients with high MPV.After correction for multiple fac-tors,MPV is still an independent risk factor for no-reflow after PCI.