冠状动脉粥样硬化性心脏病合并2型糖尿病患者经皮冠状动脉介入术后血小板高反应性与支架内再狭窄的关系

摘要

Objective To explore the correlation between high on-treatment platelet reactivity(HPR) and in-stent restenosis(ISR) in patients with coronary atherosclerotic heart disease (CHD) complicated with type 2 diabetes mellitus undergoing percutaneous coronary intervention (PCI).Methods Clinical data of 395 patients with CHD and type 2 diabetes who underwent PCI from January 2010 to December 2014 in Beijing Anzhen Hospital,Capital Medical University were retrospectively analyzed;51 patients had ISR (ISR group) and 344 patients were included in non-ISR group.Clinical baseline data,biochemical indicators and coronary angiography results were recorded.The predictive value of HPR for ISR was analyzed by receiver operating characteristic(ROC) curve.The relevance between HPR and ISR was analyzed by multivariate logistic regression.Results The maximum platelet aggregation rate (MPAR) and platelet distribution width in ISR group were significantly higher than those in non-ISR group[(55 ±17)％ vs (42 ±16)％,(13.7 ±2.4)％ vs (12.8 ±2.4)％] (P＜0.05).The area under ROC curve was 0.71 (95％ confidence interval:0.635-0.793,P ＜0.001) when MPAR ＞56.5％ was used as the diagnostic criteria of HPR.The sensitivity and specificity of HPR in predicting the occurrence of ISR were 53.0％ and 82.0％,respectively.Totally 93 patients(23.5％) had HPR;the HPR rate in ISR group was significantly higher than that in non-ISR group[52.9％ (27/51) vs 19.2％ (66/344)] (P ＜0.05).Logistic regression analysis showed that HPR was an independent risk factor of ISR(odds ratio =5.971,95％ confidence interval:2.900-12.292,P ＜ 0.001).Conclusion HPR is an independent predictor of ISR in CHD patients with type 2 diabetes.%目的 探讨冠状动脉粥样硬化性心脏病(冠心病)合并2型糖尿病患者经皮冠状动脉介入术后血小板高反应性(HPR)与支架内再狭窄(ISR)关系.方法 回顾性分析2010年1月至2014年12月于首都医科大学附属北京安贞医院行PCI术的395例冠心病合并2型糖尿病患者的临床资料.根据是否发生ISR,将患者分为非ISR组(344例)和ISR组(51例).记录所有患者基线资料、生化指标和造影情况,通过受试者工作特征(ROC)曲线分析HPR对于ISR的预测价值,采用Logistic多因素回归分析HPR与ISR的关系.结果 ISR组血小板最大聚集率(MPAR)明显高于非ISR组[(55±17)％比(42±16)％];血小板分布宽度明显高于非ISR组[(13.7±2.4)％比(12.8±2.4)％],差异均有统计学意义(均P＜0.05).通过ROC曲线分析,MPAR＞ 56.5％作为HPR诊断标准;ROC曲线下面积=0.71,95％置信区间:0.635～0.793,P＜0.001;HPR预测ISR敏感度为53.0％,特异度为82.0％.HPR患者共93例,占总数23.5％ (93/395),ISR组中HPR患者比例高于非ISR组[52.9％ (27/51)比19.2％ (66/344)],差异有统计学意义(P＜0.05).HPR患者发生ISR风险是非HPR患者的6倍(比值比=5.971,95％置信区间:2.900 ～ 12.292,P＜0.001).结论 HPR是冠心病合并2型糖尿病患者PCI术后ISR的独立危险因素.