冠心病合并2型糖尿病患者血小板分布宽度与支架内再狭窄的相关性研究

Correlation between platelet distribution width and in-stent restenosis after percutaneous coronary intervention for patients with coronary heart disease and diabetes mellitus

目的:探讨冠心病合并2型糖尿病患者经皮冠状动脉介入术(PCI)后,血小板分布宽度与支架内再狭窄(ISR)间的相关性。方法:连续入选2012年1月至2013年12月,在北京安贞医院行PCI术的冠心病合并2型糖尿病患者共5 232例,对其进行3年的随访,其中438例在我院完成了第二次冠状动脉造影检查,且符合本研究的纳入和排除标准,进行统计分析。基线资料按血小板分布宽度(PDW)四分位分组,应用单因素分析进行组间比较,应用受试者工作特征曲线(ROC)得出预测ISR事件的最佳PDW值,并作为高PDW的定义标准。进行多因素Logistic回归分析PDW对发生ISR风险的影响。结果:438例患者中59例发生ISR,发生率13.5%。PDW高四分位组(定义为PDW≥13.65f L)患者ISR发生风险显著高于低四分位组,线性相关分析发现PDW与ISR密切相关(r=0.647,95%CI:0.535~0.750,P<0.0001)。多因素Logistic回归分析显示,PDW每升高1个单位,ISR发生风险增加约30%(OR=1.289,95%CI:1.110~1.498,P=0.001),高PDW患者ISR发生风险是低PDW的4倍(OR=4.241,95%CI:1.879~9.572,P=0.001)。结论:对于冠心病合并2型糖尿病患者PCI术后,血小板分布宽度与发生ISR之间存在相关性,可作为临床预测冠状动脉ISR的指标之一。

Objective： This study was to investigate the correlation between platelet distribution width（ PDW） and stent restenosis after percutaneous coronary intervention（ PCI） in patients with coronary heart disease（ CHD） and type 2 diabetes mellitus. Methods： A total of 5232 patients with diabetes and CHD who underwent coronary DES implantation in Beijing Anzhen Hospital in China were consecutively enrolled from January 2012 to December 2013,followed up for 3 years. Of these,438 patients who underwent the second angiography and met the inclusion and exclusion criteria were included. Baseline data were grouped according to PDW quartiles,and univariate analysis was applied to compare between groups. Receiver operating characteristic curve（ ROC） was used to get the best PDW value for predicting ISR events,and to define the standard of high PDW. Results： 59 out of the 438 patients had ISR,and the incidence was 13. 5%. Patients from the High PDW quartiles（ PDW≥13. 65 fl） had significantly higher risk of ISR than patients from the low PDW quartiles.Linear correlation analysis showed a strong link between PDW and ISR（ r = 0. 647,95% CI： 0. 535-0. 750,P 〈 0. 0001）. Multivariate regression analysis showed that the risk of ISR increased by 30% with one unit increased in PDW（ OR = 1. 289,95% CI： 1. 110-1. 498,P = 0. 001）. Conclusion： PDW was associated with ISR for CHD and type 2 diabetes mellitus patients who underwent PCI. PDW could be used as an independent predictor of ISR.