Objective To explore the correlation between platelet morphological indexes and coronary SYNTAX score in patients with acute coronary syndrome (ACS) complicated with diabetic nephropathy (DN).Methods Totally 190 patients diagnosed of ACS with DN from January 2012 to December 2015 in Beijing Anzhen Hospital,Capital Medical University were enrolled.All patients had platelet morphological indexes test[including mean platelet volume (MPV),platelet distribution width (PDW),platelet-large cell rate (P-LCR)] and coronary angiography examination.The SYNTAX score was calculated according to the result of coronary angiography;all patients were divided into low-score group(SYNTAX≤22 scores),mid-score group(SYNTAX 23-32 scores) and high-score group (SYNTAX ≥ 33 scores).Correlations of SYNTAX score with MPV,PDW and P-LCR were analyzed.Results There were respectively 101,50,39 cases in low-,mid-,high-score groups.MPV,PDW and P-LCR levels in high-score group were significantly higher than those in mid-,low-score groups [(12.6 ± 0.8)fL vs (11.6±0.6),(10.7±0.8)fL;(17.4 ±2.4)％ vs (14.6±1.6)％,(12.8 ±1.7)％;(45 ±6)％ vs (38±5) ％,(31 ± 7) ％] (P ＜ 0.05).Multivariate Logistic regression analysis showed that platelet morphological index was a risk factor of high SYNTAX score (odds ratio =6.154,95％ confidence interval:3.260-11.618,P =0.001).Spearman correlation analysis showed that MPV(r =0.723,P ＜ 0.001),PDW(r =0.708,P ＜ 0.001)and P-LCR(r =0.727,P ＜0.001) were positively correlated with SYNTAX score.Multinomial linear regression analysis showed that platelet morphological index(standardized coefficient:0.799,P ＜ 0.001) and urea(standardized coefficient:0.136,P =0.016) were independent influence factors of SYNTAX score.Conclusion Platelet morphological index is positively correlated with the severity of coronary lesion.%目的 探讨急性冠状动脉综合征合并糖尿病肾病患者血小板形态指标与冠状动脉SYNTAX评分之间的相关性.方法 纳入2012年1月至2015年12月于首都医科大学附属北京安贞医院诊断为急性冠状动脉综合征合并糖尿病肾病的患者190例.所有患者行血小板形态指标[包括平均血小板体积(MPV)、血小板分布宽度(PDW)、大血小板比率(P-LCR)]检测及冠状动脉造影检查,根据冠状动脉造影结果计算SYNTAX评分,将患者分为低评分组(≤22分)、中评分组(23～32分)及高评分组(≥33分).分析MPV、PDW、P-LCR与冠状动脉SYNTAX评分之间的相关性.结果 所有患者根据SYNTAX评分结果分为低评分组(101例)、中评分组(50例)及高评分组(39例).高评分组的MPV、PDW、P-LCR均明显高于中、低评分组[(12.6 ±0.8)fL比(11.6±0.6)、(10.7 ±0.8)fL,(17.4±2.4)％比(14.6±1.6)％、(12.8±1.7)％,(45±6)％比(38 ±5)％、(31±7)％],差异均有统计学意义(均P＜0.05).多因素Logistic回归分析结果提示血小板形态指标为高SYNTAX评分的危险因素(比值比=6.154,95％置信区间:3.260～ 11.618,P=0.001).Spearman相关分析结果显示MPV(r=0.723,P＜0.001)、PDW(r=0.708,P＜0.001)、P-LCR(r=0.727,P＜0.001)均与冠状动脉SYNTAX评分呈正相关.多元线性回归分析结果提示血小板形态指标和尿素是冠状动脉SYNTAX评分的独立影响因素,标准化回归系数依次为0.799(P ＜0.001)和0.136(P =0.016).结论 血小板形态指标与冠状动脉病变严重程度存在正相关性,对冠状动脉病变程度可能存在预测意义.
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