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1.
Butterworth RJ  Bath PM 《Platelets》1998,9(6):359-364
Platelets play a crucial role in the pathophysiology of atherothrombotic disease and are involved in the early thromboembolic phase of ischaemic stroke. Large platelets are known to be more active. We hypothesized that thrombomegaly would be limited to patients with cortical infarction as compared with patients with lacunar infarcts, and that it would be associated with functional outcome. Mean platelet volume (MPV) and platelet count (PC) were studied in 167 hospitalized patients with stroke within 48 h of symptom onset, and 65 age, gender and race matched controls. Stroke was clinically and radiologically sub-typed. MPV was significantly higher in patients with ischaemic stroke than the control group: mean (SD) 7.35 (1.05) vs 7.09 (0.74) fl, 2 P = 0.04; this difference could be explained by MPV being higher in patients with cortical stroke: 7.46 (1.00) fl, 2 P = 0.039, but not lacunar infarction: 7.14 (1.16) fl, 2 P = 1.0. No difference was seen in PC between ischaemic patients and controls: 231 (82) 10(9)/l vs 236 (54) 10(9)/l, 2 P = 0.63. MPV did not change at 3 months post-stroke in surviving patients with ischaemic stroke: 7.39 (1.03) fl vs 7.34 (0.97) fl, 2 P = 0.53. Patients who were dead or dependent at 3 months had a significantly higher baseline MPV and a tendency to a lower PC than those who returned to independence. MPV and PC were not altered in patients with primary intracerebral haemorrhage. No differences in red cell volume was observed. Platelet volume is elevated in acute ischaemic stroke, a finding that persists at 3 months post-stroke and is limited to patients with cortical infarction. Thrombomegaly is a risk factor for a poor outcome after ischaemic stroke.  相似文献   

2.
目的观察急性冠状动脉综合征(ACS)患者平均血小板体积(MPV)的变化及其相关因素。方法选取接受冠状动脉造影的ACS患者195例,慢性稳定型心绞痛(SA)患者48例和非冠心病对照73例。ACS包括非ST段抬高型ACS(NSTEACS)114例和ST段抬高型心肌梗死(STEMI)81例,又分为合并糖尿病患者66例和未合并糖尿病患者129例。测定MPV、血小板压积(PCT)等。结果与对照组[(9.59±1.40)fl]和SA组[(9.61±1.42)fl]比较,ACS组[(10.19±1.26)fl]、NSTEACS亚组[(10.12±1.35)fl]和STEMI亚组[(10.29±1.33)fl]的MPV均显著升高(均为P<0.01);与对照组(45.2%±49.9%)和SA组(49.6%±55.4%)比较,ACS组(33.1%±35.4%)及STEMI亚组(29.9%±29.8%)的PCT均显著降低(均为P<0.05);合并糖尿病亚组MPV显著高于未合并糖尿病亚组[(10.48±1.29)fl比(10.05±1.23)fl,P<0.05];多元回归分析显示,血清高敏C反应蛋白(hsCRP)和HDL-C是MPV的独立影响因素(r=0.209,-0.191,均为P<0.01)。结论ACS患者MPV显著升高,糖尿病、血清hsCRP水平和HDL-C与MPV的升高有密切关系。  相似文献   

3.

Purpose

This study aimed to determine changes in absolute and relative socioeconomic inequalities in hospital admissions for major cardiovascular causes among patients with diabetes in England.

Methods

We identified all patients with diabetes aged ≥45 years admitted to the hospital in England between 2004-2005 and 2014-2015 for acute myocardial infarction, stroke, percutaneous coronary intervention, or coronary artery bypass graft. We measured socioeconomic status using the Index of Multiple Deprivation. Diabetes-specific admission rates were calculated for each year by deprivation quintile. We assessed temporal changes using negative binomial regression models.

Results

Most admissions occurred among patients aged ≥65 years (71%) and men (63.3%). The number of admissions increased steadily from the least quintile to the most deprived quintile. Patients in the most deprived quintile had a 1.94-fold increased risk of acute myocardial infarction (95% confidence interval [CI], 1.79-2.10), 1.92-fold increased risk of stroke (95% CI, 1.78-2.07), 1.66-fold increased risk of coronary artery bypass graft (95% CI, 1.50-1.74), and 1.76-fold increased risk of percutaneous coronary intervention (95% CI, 1.64-1.89) compared with the least deprived group. Absolute differences in rates between the least and most deprived quintiles did not change significantly for acute myocardial infarction (P?=?.29) and were reduced for stroke, coronary artery bypass graft, and percutaneous coronary intervention (by 17.5, 15, and 11.8 per 100,000 patients with diabetes, respectively, P ≤ .01 for all).

Conclusions

Socioeconomic inequalities persist in diabetes-related hospital admissions for major cardiovascular events in England. Besides improved risk stratification strategies that consider socioeconomically defined needs, wide-reaching population-based policy interventions are required to reduce inequalities in diabetes outcomes.  相似文献   

4.
目的探讨红细胞分布宽度(RDW)、平均血小板体积(MPV)在早发冠心病人群中的分布特征及其与冠状动脉病变严重程度的关系,评价RDW、MPV对早发冠心病的诊断价值。方法收集因胸痛发作疑诊冠心病且男性55岁、女性65岁的患者407例,经冠状动脉造影(CAG)确诊早发冠心病组309例,余98例为正常对照组。比较2组及早发冠心病各疾病亚组间的RDW、MPV水平,分析RDW、MPV与冠状动脉病变严重程度(Gensini评分)的相关性及早发冠心病的独立危险因素。结果早发冠心病组RDW、MPV水平明显高于正常对照组(P0.05),RDW、MPV在急性心肌梗死(AMI)组、不稳定型心绞痛(UAP)组和稳定型心绞痛(SAP)组均高于正常对照组(P0.05)。早发冠心病组RDW、MPV与Gensini评分之间存在正相关(r分别为0.246、0.199,P0.05);多因素Logistic回归分析显示RDW(OR=3.373,95%CI:2.197~6.359,P0.001)和MPV(OR=1.353,95%CI:1.074~1.705,P=0.010)是早发冠心病的独立危险因素。R0C曲线分析发现,RDW诊断早发冠心病的界点值为12.25%(敏感性69%,特异性72%),MPV诊断早发冠心病的界点值为8.55 fl(敏感性91%,特异性37%)。结论 RDW、MPV与早发冠心病的临床类型及冠状动脉病变的严重程度有关,是早发冠心病的独立危险因素,为早发冠心病的诊断提供一定依据。  相似文献   

5.
目的 观察接受直接经皮冠状动脉介入( PPCI)治疗的ST段抬高型急性心肌梗死( STEMI)患者血小板体积的变化及与冠状动脉影像和血流的关系.方法 163例接受PPCI治疗的STEMI患者,入院时测定平均血小板体积(MPV)、大血小板比例(P-LCR)等血小板功能参数和血生化指标,阅读冠状动脉影像资料,评估梗死相关动脉( IRA)行PPCI前后的TIMI血流分级,计算IRA行PPCI后校正的TIMI血流帧数计数(CTFC).同期冠状动脉造影等确诊的107例稳定性心绞痛患者作为对照.结果 STEMI患者MPV和P-LCR显著高于稳定性心绞痛组[(10.30 ±0.82)fl比(9.89±0.98)fl,t =3.656,P =0.000; (27.24 ±6.43)%比(24.51±5.88)%,t=3.524,P =0.000]. STEMI患者各亚组间比较,MPV和P-LCR于多支病变亚组显著高于单支病变亚组[(10.40 ±0.85)fl比(10.04±0.69)fl,t=-2.558,P=0.011;(27.96±6.64)%比(25.40±5.52)%,t=-2.319,P=0.022].左前降支亚组显著高于回旋支亚组[( 10.42 ±0.86)fl比(9.98 ±0.62)fl,P<0.05; (28.07±6.63)%比(24.48±4.76)%,P<0.05].IRA无自发性开通亚组显著高于自发性开通亚组[(10.39±0.84)fl比( 10.04 ±0.69)fl,t=-2.460,P=0.015;(27.83±6.61)%比(25.64±5.70)%,t=- 2.082,P=0.040].IRA行PPCI后血流未达TIMI3级亚组显著高于达TIMI3级亚组[(10.68±1.02) fl比(10.22 ±0.76)fl,t =2.225,P =0.003; (30.42±7.84)%比(26.61±5.95)%,t=2.393,P=0.023].多元线性回归分析显示,MPV或P-LCR是IRA行PPCI后CTFC的独立影响因素(r=0.294,P=0.001;r =0.243,P=0.004).结论 STEMI患者血小板体积显著增加,血小板体积与冠状动脉病变及IRA行PPCI前后血流的受损程度有密切关系.  相似文献   

6.
Background: Acute coronary syndromes, characterized by the rupture of unstable plaque and the subsequent thrombotic process involving platelets, have been increasing in relative frequency. The central role of platelet activation has long been noticed in this pathophysiology; hence, many therapies have been directed against it. In this study, we have aimed to search prospectively the value of mean platelet volume (MPV), which is a simple and accurate measure of the functional status of platelets, in patients hospitalized with diagnosis of acute coronary syndromes (ACS). Materials and methods: A total of 216 consecutive patients (156 male, 60 female) hospitalized with the diagnosis of non-ST segment elevation (NSTE) ACS within the first 24 h of their chest pain were enrolled. One hundred and twenty patients, matched according to sex and age, with stable coronary heart disease (CHD) (85 male, 35 female) were enrolled as a control group. Patients were classified into two group: those with unstable angina (USAP, n = 105) and those with non-ST segment elevation myocardial infarction (NSTEMI, n = 111). Results: MPVs were 10.4 +/- 0.6 fL, 10 +/- 0.7 fL, 8.9 +/- 0.7 fL consecutively for NSTEMI, USAP and stable CHD with significant differences. Patients with ischemic attacks in the first day of hospitalization accompanied by >0.05 mV ST segment shift had significantly higher MPV compared to those without such attacks (P = 0.001). Multivariable logistic regression analysis yielded that MPV (P = 0.016), platelet count (P < 0.001), and the presence of >0.05 mV ST segment depression at admission (P = 0.002) were independent predictors of development of NSTEMI in patients presenting with NSTE ACS. Conclusion: In patients presenting with NSTE ACS, higher MPV, though there are overlaps among subgroups, indicates not only more risk of having NSTEMI but also ischemic complications.  相似文献   

7.
BACKGROUND: Long-term moderate or strenuous physical activity is associated with a considerable reduction in cardiovascular morbidity and mortality. However acute exercise leads to a transient activation of the thrombotic system. Healthy individuals can react this by increasing their fibrinolytic capacity acutely. However, patients with ischemic heart disease, lacking fibrinolytic potential, may be at considerable risk for acute ischemic events if exposed to heavy physical exertion. Platelet size has been shown to reflect platelet activity. The mean platelet volume (MPV) can reflect changes in either the level of platelet stimulation or rate of platelet production. DESIGN AND METHODS: We evaluated Treadmill exercise test (TMET) and compared MPV values (fl) before and after TMET in 63 consecutive patients who, then, underwent coronary angiography and found to have significant coronary artery disease in more than one coronary artery (>70% diameter stenosis in left anterior descending, right coronary or circumflex artery and >50% diameter stenosis in left main coronary artery). Sixty-three male patients were enrolled as a patient group with a mean age of 52.43 +/- 4.08 years and with strongly positive exercise test (> or =2 mm ST segment depression, horizontal or down-sloping). Thirty-five patients without significant coronary artery disease were selected as a control group with a mean age of 52.66 +/- 4.39 years having undergone TMET. RESULTS AND DISCUSSION: In the patient and control groups, mean MPV values before TMET were the same, 8.52 +/- 0.63 and 8.45 +/- 0.58 respectively. Following TMET within 30 minutes, mean MPV were 10.03 +/- 0.96 and 8.50 +/- 0.45 respectively ( p < 0.001). When pre and post-TMET MPV values were evaluated together, the patient group had a significant increase in the MPV ( p < 0.001), whereas, the control group had no significant increase in the MPV ( p = 0.379). It was concluded that exercise possibly makes patients with significant coronary artery disease, more susceptible to a thrombotic event through various routes, one of that is platelet activation that could be measured indirectly via MPV. Healthy subjects react this thrombotic process by increasing their fibrinolytic capacity acutely. Patients with ischemic heart disease, particularly those with significantly narrowed coronary arteries, known to lack fibrinolytic capacity and have high shear stress, on the other hand, might face ischemic events, including sudden death following acute exercise.  相似文献   

8.
We investigated the association of mean platelet volume (MPV) with culprit lesion severity and major cardiac outcomes (MCOs) in patients with acute coronary syndrome (ACS) with non-ST elevation (NSTE). This study included 344 patients with NSTE-ACS who had significant coronary stenosis at least 50%. They were divided into high MPV group (n = 109, upper tertile >9.9 fl) and low MPV group (n = 235, lower and mid tertile ≤ 9.9 fl) according to MPV values on admission. They were followed up for MCOs during 12 months. MCO consisted of the composite end-point of cardiac death, myocardial infarction (MI), recurrent angina or hospitalization. High MPV was independently associated with NSTE-MI [odds ratio (OR) 4.24, 95% confidence interval (CI) 2.52-7.15, P = 0.001] and severe culprit stenosis (≥ 80%) (OR 4.05, 95% CI 2.39-6.83, P = 0.001). MPV of 9.9 fl was predictive of severe culprit stenosis with a sensitivity of 73% and specificity of 77% (P < 0.001). At 12 months, MCO rate was higher in high MPV group than low MPV group (39 vs. 26%; P = 0.016). This difference resulted from death (6.4 vs. 2.1; P = 0.06) and recurrent angina (16.5 vs. 8.9%; P = 0.045). The MCO-free survival was worse in patients with high MPV than those with low MPV (61 vs. 74%; P = 0.01). In Cox regression analysis, high MPV remained an independent predictor of MCO (hazard ratio 1.52, 95% CI 1.01-2.29, P = 0.04) after adjusting for baseline characteristics. Elevated MPV was independently associated with NSTE-MI presentation and severity of culprit stenosis in NSTE-ACS patients. Moreover, MPV greater than 9.9 fl was predictive of a 12-month MCO.  相似文献   

9.
To determine whether coronary thrombi can be detected scintigraphically after acute myocardial infarction, 24 patients were studied with a new method employing indium-111-labeled platelets and technetium-99m-labeled red blood cells. Nine patients with suspected infarction were evaluated initially within 9 hours of the onset of symptoms and again 18 to 24 hours after onset. Eight patients with neurologic symptoms but without overt cardiac disease and seven patients with angina but without infarction served as unmatched control subjects. Foci of net indium accumulation were detected after image processing that incorporated subtraction of blood pool activity. Carotid and pulmonary artery reference regions, in which blood pool activity is high and active platelet deposition unlikely, were used to correct digitized cardiac scintigrams for indium-111 platelet activity in the blood pool. In patients with infarction, distinct foci of net indium accumulation were present in regions corresponding to the coronary artery supplying ischemic zones. This occurred in seven of eight patients at the time of the earliest evaluation (5.6 +/- 3.3 hours [mean +/- SD] after the onset of symptoms) and in eight of nine patients at the time of subsequent imaging (23.6 +/- 1.9 hours after onset). Only 1 of the 15 control patients exhibited a cardiac focus of net indium accumulation. The percent of indium excess (100 [total indium-111 activity-blood pool indium-111 activity]/blood pool indium-111 activity) within the cardiac region measured (+/- SD) 16.8 +/- 11.6% in all patients with myocardial infarction (19.1 +/- 11.2% in those with visually identified foci) compared with 0.4 +/- 4.3% in control patients (p less than 0.001). This method permits early detection and sequential assessment of coronary artery thrombi. It should permit improved characterization of the role of platelets in the pathogenesis of acute manifestations of coronary vascular disease and improved evaluation of interventions designed to prevent or lyse coronary thrombi.  相似文献   

10.
OBJECTIVE: Mean platelet volume (MPV), a marker for platelet reactivity, and white blood cell count (WBC-C), a marker for inflammation, have been shown to be predictive of unfavourable outcomes among survivors of ST elevation myocardial infarction (STEMI). The relationship of admission MPV and WBC-C with infarct-related artery (IRA) patency is not clear. We aimed to evaluate the value of admission MPV and WBC-C for the prediction of IRA patency, in patients with acute STEMI treated with primary percutaneous coronary intervention. METHODS: Blood samples were obtained on admission in 351 STEMI patients. The patients who had thrombolysis in myocardial infarction (TIMI) 3 flow in initial angiography constituted the IRA patent group and others having less than TIMI 3 flow constituted the IRA occluded group. RESULTS: In 16% of the patients, IRAs were found to be patent on initial angiography. Patients in the IRA occluded group had higher admission MPVs (9.3+/-1.2 vs. 8.6+/-1.3 fl, P<0.001) and higher WBC-C (13.3+/-4.8 vs. 11.0+/-2.9, P=0.002) compared with patients in the patent IRA group. In regression analysis, WBC-Cs [beta, 0.131; odds ratio (OR), 1.140; 95% confidence interval (CI), 1.043-1.245, P=0.004)] and MPV (beta, 0.519; OR, 1.680; 95% CI, 1.206-2.339, P=0.002) were found to be independent predictors of occluded IRA. The best cutoff value of MPV for predicting an occluded IRA was determined to be 8.55 fl with a sensitivity of 74% and a specificity of 60%. CONCLUSION: MPV and WBC-C at admission might be valuable in the prediction of IRA patency and in planning the need for adjunctive therapy to improve outcomes in patients with STEMI undergoing percutaneous coronary intervention.  相似文献   

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