平均血小板体积与血小板体积分布宽度联合对稳定性冠状动脉疾病远期预后的价值

目的:评估入院时平均血小板体积(MPV)及血小板体积分布宽度(PDW)联合对接受择期经皮冠状动脉介入治疗(PCI)的稳定性冠状动脉疾病患者远期预后的预测价值。方法:本研究共纳入4293例患者,根据MPV及PDW的中位数,将患者分为3组:低(MPV+PDW)组(n=2019);MPV+PDW异常组(即高MPV+低PDW或低MPV+高PDW,简称MPV+PDW异常组,n=333);高(MPV+PDW)组(n=1941)。应用多因素Cox回归分析比较不同组别与远期预后的相关性。结果:基线资料分析表明,与低(MPV+PDW)组患者相比,高(MPV+PDW)组患者合并糖尿病者更多,左心室射血分数(LVEF)和估算肾小球滤过率(eGFR)更低,糖化血红蛋白更高,使用β受体阻滞剂比例更低(P均<0.05)。与低(MPV+PDW)组比较,高(MPV+PDW)组患者心原性死亡率更高[17(0.9%)vs 5(0.2%),P=0.021],全因死亡发生率有升高趋势,但差异无统计学意义[25(1.3%)vs 16(0.8%),P=0.298]。Kaplan-Meier分析表明,高(MPV+PDW)组患者心原性死亡发生率显著高于其他组别(log-rank P=0.022)。多因素Cox回归分析表明,接受PCI的稳定性冠状动脉疾病患者中,高(MPV+PDW)组患者的2年心原性死亡的发生风险显著高于低(MPV+PDW)组患者(HR=3.497,95%CI:1.155~10.586,P=0.027)。结论:在接受择期PCI的稳定性冠状动脉疾病患者中,高MPV高PDW与远期预后不良相关。

Value of the Combination of Mean Platelet and Platelet Distribution Width in Predicting Long-term Prognosis of Patients With Stable Coronary Artery Disease Undergoing Percutaneous Coronary Intervention

Objectives:To evaluate the predictive value of combined mean platelet volume(MPV)and platelet distribution width(PDW)at admission for long-term prognosis in patients with stable coronary artery disease(CAD)who underwent elective percutaneous coronary intervention(PCI).Methods:A total of 4293 patients were enrolled in the study.Patients were divided into 3 groups according to the median of MPV and PDW:group 1(low MPV and low PDW,n=2019);group 2(high MPV,low PDW;or Low MPV,high PDW,n=333);Group 3(high MPV and high PDW,n=1941).Long-term prognosis was compared using Cox regression analysis among the 3 groups.Results:Baseline data analysis showed that prevalence of diabetes and glycated hemoglobin level were significantly higher,while left ventricular ejection fraction(LVEF)and estimated glomerular filtration rate(eGFR)were significantly lower in group 3 than in group 1(all P<0.05).In terms of prognosis analysis,cardiac mortality was significantly higher in group 3 than in group 1(17[0.9%]vs 5[0.2%],P=0.021).Kaplan-Meier analysis showed that the incidence of cardiac mortality was significantly higher in group 3 than in other 2 groups(log-rank P=0.022).Multivariate Cox regression analysis showed that the risk of 2-year cardiogenic death was significantly higher in group 3 than in group 1(HR=3.497,95%CI:1.155-10.586,P=0.027).Conclusions:In patients with stable CAD who underwent elective PCI,high MPV and high PDW are associated with poor long-term prognosis.