血小板高反应性与稳定性心绞痛患者病变程度及围术期心肌梗死相关性分析

The correlation study of high platelet reactivity and the degree of the coronary artery lesions and the perioperative myocardial infarction in patients with stable angina

目的探讨血小板高反应性(HPR)与稳定性心绞痛患者冠状动脉病变程度的关系。方法选取自2016年1—6月在沈阳军区总医院接受经皮冠状动脉介入治疗(PCI)的915例稳定性心绞痛患者为研究对象。采用Verify Now P2Y12检测血小板反应性,以血小板反应单位(P2Y12反应单位)≥230为HPR,并将患者分为正常反应组(NPR组,n=467)与高反应性组(HPR组,n=448)。比较两组患者的冠状动脉狭窄程度、造影结果及支架置入情况、多支病变的相关危险因素,以及HPR与PCI围术期心肌梗死的相关性。结果与NPR组比较,HPR组患者冠状动脉的狭窄程度更重,冠状动脉病变数量、置入支架数量更多,两组比较,差异均有统计学意义(P<0.05)。多因素分析证实,进一步比较患者术后的心肌酶指标发现,HPR组患者围术期心肌梗死的发生率明显高于NPR组。HPR是稳定性心绞痛患者多支病变和围术期心肌梗死的独立危险因素。结论稳定性心绞痛患者中,HPR与冠状动脉病变程度及围术期心肌梗死存在相关性。术后应强化HPR患者的抗血小板治疗,及时复查心肌酶。

Objective To investigate the relationship between high platelet reactivity（ HPR） and the degree of the coronary artery lesions in patients with stable angina. Methods A retrospective study was performed on 915 cases of patients with stable angina who were admitted and underwent percutaneous coronary intervention from January to June 2016. Platelet reactivity was detected by the Verify Now P2 Y12,high platelet reactivity was identified by platelet response unit（ PRU） ≥230. Patients were divided into the normal reaction group（ NPR group,n = 467） and the high reactivity（ HPR group,n = 448）. The degree of coronary artery stenosis,angiographic results and stent implantation,the risk factors of multiple lesions were compared between the two groups,the correlation between HPR and PCI perioperative myocardial infarction in the two groups were analyzed. Results Compared with NPR group,coronary artery stenosis degree of HPR group was more severe,the number and coronary artery disease and the number of stent were even more,and the difference was statistically significant（ P〈0. 05）. Multiple factors analysis confirmed that HPR group of patients had a significantly higher incidence of perioperative myocardial infarction by detecting postoperative myocardial enzyme index; HPR was the independent risk factor of multivessel lesions and perioperative myocardial infarction in patients with stable angina. Conclusion High platelet reactivity and the degree of the coronary artery lesions and the perioperative myocardial infarction in patients with stable angina were correlated. The reinforced individualized antiplatelet treatment and routine detecting myocardial enzyme index for HPR patients in patients with stable angina are necessary.