血小板反应指数与血小板聚集率的相关性及对非ST段抬高急性冠脉综合征的预后评价

Correlation between platelet reactive index and platelet aggregation rate and prognostic evaluation of non-ST-segment elevation acute coronary syndrome

目的探讨通过流式细胞术定量的血小板反应指数(PRI)和经典的血小板聚集率(PAG)的相关性,并评价PRI及PAG与非ST段抬高急性冠脉综合征(NSTE-ACS)预后的关系。方法连续纳入2016年10月-2017年1月天津市胸科医院心内科收治的NSTE-ACS并接受冠状动脉介入治疗的患者231例,根据PRI中位数将患者分为2组,低PRI组(PRI≤55%)116例和高PRI组(PRI>55%)115例,对比2组患者PAG水平、主要不良心血管事件(MACE)的发生率、主要临床及生化指标。再根据PAG中位数将患者分为2组,低PAG组(PAG≤71%)112例和高PAG组(PAG>71%)119例,对比2组患者PRI水平、MACE发生率、主要临床及生化指标。对PRI和PAG进行相关性分析和受试者工作特征(ROC)曲线分析。全部患者随访2年,以全因死亡、支架内再狭窄、急性支架内血栓形成、再发急性心肌梗死为复合终点事件,通过Cox回归分析评价PRI、PAG、肌钙蛋白I(TnI)等指标对MACE的预测能力。结果以PRI中位数分组,高PRI组PAG水平、MACE发生率均高于低PRI组(P<0.01)。再根据PAG中位数分组,高PAG组PRI也高于低PAG组(P<0.01),2组间MACE发生率差异无统计学意义。相关性分析提示PRI与PAG呈正相关(r=0.318,P<0.01)。以PAG为检验变量,PRI为状态变量的ROC曲线分析,曲线下面积(AUC)为0.873(95%CI:0.839~0.908,P<0.01)。Cox回归分析提示高PRI水平(HR=1.090,95%CI:1.038~1.146,P=0.001)及男性(HR=0.186,95%CI:0.053~0.659,P=0.009)患者更易发生不良心血管事件。结论根据流式细胞术定量血管舒张刺激磷蛋白(VASP)磷酸化比例计算的PRI和经典的光比浊法测定的PAG有相关性,对于NSTE-ACS患者,高PRI能预测不良心血管事件发生,较传统的PAG检测更有意义。

Objective To investigate the correlation between platelet reactive index(PRI) quantified by flow cytometry and the classical platelet aggregation rate(PAG),and to evaluate the prognostic value of PRI/PAG in patients who suffered with non-ST-segment elevation acute coronary syndrome(NSTE-ACS).Methods From October 2016 to January 2017,231 consecutive patients with NSTE-ACS admitted to the department of cardiology of Tianjin Chest Hospital and treated with percutaneous coronary intervention were enrolled.Patients were divided into two groups according to the PRI median,the low PRI group(PRI≤55%,n=116) and the high PRI group(PRI>55%,n=115).PAG levels,incidence of major adverse cardiovascular events(MACE),major clinical and biochemical indicators were compared between the two groups.According to the median of PAG level,patients were also divided into two groups,the low PAG group(PAG≤71%,n=112) and the high PAG group(PAG>71%,n=119).The PRI level,the incidence of MACE,the major clinical and biochemical indexes were also compared between the two groups.Correlation analysis and receiver operating characteristic(ROC) curve were conducted between PRI and PAG.All patients were followed up for 2 years.Taking all-cause death,in-stent restenosis,acute in-stent thrombosis and recurrent acute myocardial infarction as the composite endpoint events,the predictive ability of PRI,PAG,troponin Ⅰ(TnI) and other indicators on MACE were evaluated by Cox regression analysis.Results Grouped by the median of PRI,the PAG level and MACE incidence were significantly higher in the high PRI group than those in the low PRI group(P <0.01).Grouping by the median of PAG,the high PAG group also showed higher PRI than that of the other group(P <0.01).There was no significant difference in the incidence of MACE between the two groups.Correlation analysis indicated that PRI was positively correlated with PAG(correlation coefficient r=0.318,P <0.01).The ROC curve analysis showed that the area under the curve(AUC) was 0.873(95%CI:0.839-0.908,P <0.01),with PAG as the test variable and PRI as the state variable.Cox regression analysis manifested that higher level of PRI 1.090,95%CI:1.038-1.146,P <0.01) and male gender patients(HR=0.186,95%CI:0.053-0.659,P=0.009) were more likely to have adverse cardiovascular events.Conclusion PRI calculated by the phosphorylation ratio of vasodilator stimulated phosphoprotein(VASP)according to the flow cytometry has a correlation with PAG.For patients with NSTE-ACS,high PRI can predict adverse cardiovascular events,which is more efficient than traditional PAG detection.