平均血小板体积在不稳定型心绞痛患者冠状动脉愈合斑块中的预测价值

Predictive value of mean platelet volume in coronary artery healed plaque in patients with unstable angina pectoris

目的 观察不稳定型心绞痛(UAP)患者平均血小板体积(MPV)的水平变化,并探讨其对冠状动脉罪犯血管处愈合斑块的预测价值。方法 选取2020年1月~2023年1月于新疆医科大学第一附属医院心脏中心行冠状动脉造影(CAG)与造影后即刻对冠状动脉罪犯血管行光学相关断层成像扫描(OCT)的UAP患者110例。根据OCT图像斑块特征,将患者分为愈合斑块组(50例)和非愈合斑块组(60例)。比较两组患者临床资料及生化指标,应用多因素logistic回归分析愈合斑块的独立危险因素,采用受试者工作特征(ROC)曲线分析MPV水平变化对愈合斑块的预测价值。结果 愈合斑块组尿酸、MPV、血小板分布宽度(PDW)、病变长度[(361.20±91.34)mmol/L比(325.73±75.70)mmol/L、(10.71±0.81)fL比(9.95±0.86)fL、(11.88±1.84)%比(11.14±17.01)%、11.38(8,15)mm比8.98(8,10)mm]高于非愈合斑块组(P<0.05),白蛋白、高密度脂蛋白水平[(42.23±3.09)g/L比(43.94±3.55)g/L、(0.91±0.25)mmol/L比(1.01±0.21)mmol/L]低于非愈合斑块组(P<0.05)。OCT斑块特征分析得出,愈合斑块组巨噬细胞分级更高、钙化小结比例[(50.0)%比(30.0)%、(22.0)%比(5.0)%]高于非愈合斑块组(P<0.05)。Spearman相关性分析显示,MPV与易损斑块(TCFA)呈正相关性(r=0.680,P<0.001)。多因素logistic回归分析结果显示,MPV、白蛋白是UAP患者罪犯血管处愈合斑块的独立预测因素。ROC曲线分析显示,当MPV=10.05 fL时对愈合斑块的诊断效能较高,用于预测愈合斑块发生的曲线下面积为0.751(95%CI 0.659~0.842,P<0.001)。结论 在UAP患者的冠状动脉罪犯血管处,愈合斑块与斑块易损性相关,MPV水平变化对愈合斑块具有较高的诊断价值。

Objective To investigate the changes in the level of mean platelet volume(MPV)in patients with unstable angina pectoris(UAP)and its predictive value for healed plaques at coronary culprit vessels.Methods A total of 110 patients with UAP who underwent coronary angiography(CAG)and optical coherence tomography(OCT)of the coronary culprit vessels immediately after CAG in the First Affiliated Hospital of Xinjiang Medical University from January 2020 to January 2023 were included.According to the plaque characteristics of the OCT images,the patients were divided into healed plaque groups(50 cases)and non-healed plaque group(60 cases).The clinical data and biochemical indexes of the two groups were compared.Independent risk factors of healed plaques were analyed by multivariate logistic regression,and the predictive value of changes in MPV levels on healed plaque analysed using receiver operating characteristic(ROC)curves.Results In the healed plaque group,Uric acid,MPV,platelet distribution width(PDW),and lesion length[(361.20±91.34)mmol/L vs.(325.73±75.70)mmol/L,(10.71±0.81)fL vs.(9.95±0.86)fL,(11.88±1.84)%vs.(11.14±17.01)%,11.38(8,15)mm vs.8.98(8,10)mm]was higher than the non-healing plaque group(P<0.05),and albumin and HDL levels[(42.23±3.09)g/L vs.(43.94±3.55)g/L,(0.91±0.25)mmol/L vs.(1.01±0.21)mmol/L]were lower than the nonhealed plaque group.In the healed plaque group,macrophage grading and the proportion of calcified nodules[(50.0)%vs.(30.0)%and(22.0)%vs.(5.0)%]were higher than in the non-healed plaque group(P<0.05)on OCT plaque characterization.Correlation analysis showed that MPV positively correlated with vulnerable plaque(TCFA)(r=0.680,P<0.001).Multivariate logistic regression analysis showed that MPV and albumin were the influencing factors for healed plaque at the coronary culprit vessel in UAP patients.ROC curves analysis showed a higher diagnostic efficacy for healed plaque when MPV=10.05 fL and the area under the curve(AUC)for MPV for predicting the occurrence of healed plaque was 0.751(95%CI 0.659-0.842,P<0.001).Conclusions Healed plaque correlates with plaque vulnerability at the coronary culprit vessel in patients with UAP,and the changes in MPV levels have a higher predictive value for healed plaque.