平均血小板体积与冠状动脉搭桥术后桥管病变的相关分析
发布时间：2018-08-11 21:32
【摘要】：目的:研究接受冠状动脉旁路移植术(Coronary Atery Bypass Graft,CABG)的冠心病(CHD)患者的平均血小板体积(Mean Platelet Vomlume,MPV)与其桥血管病变的关系,探讨移植桥血管病变的危险因素。分析患者行CABG术前和术后的临床指标变化,探究变化因素与桥血管通畅性的关系,以指导患者CABG术后长期的药物治疗。在合并2型糖尿病、心力衰竭、心律失常三种不同情况的冠心病患者中,分析MPV对桥血管通畅性的影响。旨在探索MPV以及其联合其他因素预测桥血管远期通畅率的价值。方法:依照入选标准,回顾性分析2008年01月01日至2014年9月30日就诊于天津市胸科医院,既往经冠脉造影(Coronary Angiography,CAG)确诊为严重冠状动脉病变,于我院或其他医院实施CABG治疗,本次再发可疑心肌缺血事件而入院治疗的患者514例。其中CABG术前、术后病历搜集信息均完整者164例患者。收集2014年01月01日至2015年01月01日就诊于天津市胸科医院行CAG证实冠脉正常者194例作为对照组。根据桥血管是否狭窄将桥血管组分成桥血管通畅组和桥血管病变组。此外,分别根据患者是否具有2型糖尿病、是否具有收缩性心力衰竭、是否具有心律失常,将桥血管组分成糖尿病亚组、心功能不全亚组、心律失常亚组三个组别。入组患者均于入院时收集一般临床资料、既往病史(高血压病史、糖尿病病史)、个人史(吸烟史、饮酒史)、搭桥时间、心肌梗死病史、家族史;采集入院第一次空腹静脉血检测结果,记录超声心动图和胸片结果。根据Syntax评分评价冠状动脉血管的严重程度。结果:(1)比较桥血管组与对照组,高龄、糖尿病病史、NYHA分级Ⅱ级、射血分数(ejection fraction,EF)50%和心胸比例50%是严重冠状动脉病变的冠心病患者接受CABG术的易感因素(均p0.05)。(2)CABG术后桥血管发生病变的独立危险因素是MPV值(OR 1.550,95%OR 1.248~1.926)、LP(α)值(OR6.218,95%OR 1.624~23.810)和静脉桥支数(OR 2.131,95%OR 1.427~3.181),HDL水平(OR 0.179,95%OR 0.057~0.560)是患者桥血管通畅的保护因素(均p0.05)。(3)对比cabg术前、术后的临床资料,桥血管通畅组中,红细胞压积(hct)、红细胞平均体积(mcv)、红细胞分布宽度(rdw)、血糖(glu)、载脂蛋白(apro-a1)、ef均有变化。hct、mcv、apro-a1水平术后较术前降低,rdw、glu、ef水平较术前增加(均p0.05)。在桥血管病变组红细胞计数(redbloodcell,rbc)、hct、血小板计数(platelet,plt)、mpv、总胆固醇(totalcholesterin,tc)、低密度脂蛋白(low-densitylipoprotein,ldl)、ef有变化,rbc、hct水平术后较术前降低,plt、mpv、tc、ldl、ef水平较术前增加(均p0.05)。(4)在桥血管组中,高水平mpv组的桥血管狭窄率明显高于低、中水平mpv组(均p0.05)。相比搭桥早期复查者(搭桥术后时间12个月)的桥血管狭窄率明显高于中晚期者(搭桥术后时间≥12个月)(p0.05),其中plt水平较早期复查者升高,但是两组之间的差异无统计学意义,同时,mpv与pdw无统计学差异(均p0.05)。(5)在2型糖尿病亚组中,共220例患者,桥血管病变组中mpv范围处于12fl以上的患者人数多于桥血管通畅组(p0.05),但是两组之间的其他血小板参数(plt、pdw、pct水平)无统计学意义。心功能不全亚组中共98例患者,桥血管病变组mpv水平高于桥血管通畅组(p0.05)。心律失常亚组中共84例患者,其中房颤患者32例,右束支传导阻滞患者30例,室性早搏患者12例,窦缓患者10例。桥血管通畅组与病变组中的血小板参数之间的差异无统计学意义(均p0.05)。(6)对桥血管病变组患者分别应用mpv水平、lp(α)水平、静脉桥支数和hdl水平进行桥血管预后的预测,绘制受试者工作特征曲线(roc曲线),其下面积(areaunderthecurve,auc)分别为0.657,95%ci(0.586~0.727);0.618,95%ci(0.544~0.692);0.628,95%ci(0.552~0.705);0.606,95%ci(0.529~0.692)。mpv最佳截点是10.45,敏感性为0.497,95%ci(0.472~0.522),特异性为0.757,95%ci(0.719~0.795);lp(α)最佳截点是0.175,敏感性为0.717,95%ci(0.681~0.753),特异性为0.500,95%ci(0.475~0.525);静脉桥最佳截点是1.500,敏感性为0.845,95%ci(0.803~0.887),特异性为0.686,95%ci(0.652~0.720);hdl最佳截点是1.085,敏感性为0.620,95%ci(0.589~0.651),特异性为0.614,95%ci(0.583~0.645);结合mpv值、lp(α)值、静脉桥支数和hdl值二元logistic回归系数。拟合联合诊断方程=0.439×mpv+1.827×lp(α)+0.757×(静脉桥支数)-1.718×hdl-3.565,应用联合诊断的roc曲线下面积高于mpv、lp(α)值、静脉桥支数和hdl,为0.770(95%ci0.706~0.833),具有统计学意义(p0.05)。其在最佳截点的0.881,敏感性为0.706,95%CI(0.671~0.741),特异性为0.714,(0.678~0.750)。结论:高龄、2型糖尿病病史、NYHA分级Ⅱ级、射血分数(ejection fraction,EF)50%、心胸比例50%的具有严重冠状动脉病变的患者更倾向于通过CABG以达到血运重建,改善心肌供血的目的。桥血管发生病变的独立危险因素是MPV水平、LP(α)水平和静脉桥血管支数,HDL水平是桥血管通畅性的保护因素。通过CABG术开通血管后,患者的心脏泵功能可以得到改善。CABG术后仍需抗血小板和调脂治疗。无论2型糖尿病亚组还是心功能不全,MPV值的变化均与桥血管病变有关。对桥血管病变组患者应用MPV值、LP(α)值、静脉桥支数和HDL值四者联合预测,具有辨识度。其在最佳截点的0.881,敏感性为0.706,特异性为0.714。
[Abstract]:Objective: To study the relationship between mean platelet volume (MPV) and graft vascular lesions in patients with coronary heart disease (CHD) undergoing coronary artery bypass grafting (CABG), and to explore the risk factors of graft vascular lesions. The relationship between MPV and patency of bridging vessels was analyzed in patients with coronary heart disease (CHD) complicated with type 2 diabetes mellitus, heart failure and arrhythmia. According to the enrollment criteria, 514 patients who had been admitted to Tianjin Thoracic Hospital from January 1, 2008 to September 30, 2014 were retrospectively analyzed. They were diagnosed as severe coronary artery disease by coronary angiography (CAG). They were treated with CABG in our hospital or other hospitals. Of them, 514 patients were admitted to the hospital for treatment of recurrent suspicious myocardial ischemic events. A total of 164 patients were enrolled in the study. 194 patients with normal coronary artery confirmed by CAG in Tianjin Thoracic Hospital from January 01, 2014 to January 01, 2015 were enrolled as control group. The bridge vessels were divided into two groups according to whether the bridge vessels were stenosed: the patency group and the lesion group. Patients with type 2 diabetes mellitus, with or without systolic heart failure, with or without arrhythmia were divided into three groups: diabetes subgroup, cardiac insufficiency subgroup and arrhythmia subgroup. Bypass time, history of myocardial infarction, family history, fasting venous blood test results, echocardiographic and chest radiographic results were recorded. F) 50% and 50% of cardiothoracic ratio were susceptible factors to CABG. (2) MPV (OR 1.550,95% OR 1.248-1.926), LP (alpha) value (OR 6.218,95% OR 1.624-23.810) and the number of venous bridges (OR 2.131,95% OR 1.427-3.181), HDL level (OR 0. 179,95% OR 0.057-0.560 was the protective factor for patency of bridging vessels (all p0.05). (3) Compared with the clinical data before and after cabg, the levels of hematocrit (hct), mean volume of red blood cells (mcv), red blood cell distribution width (rdw), blood glucose (glu), apolipoprotein (apro-a1), EF in the group with patency of bridging vessels decreased after operation. The levels of red blood cell (rbc), hct, platelet, mpv, total cholesterol (tc), low-density lipoprotein (ldl), ef, RBC and HCT were lower than those before operation, and the levels of plt, mpv, tc, ldl, EF were lower than those before operation. (4) the stenosis rate of high-level MPV group was significantly higher than that of low-level MPV group (all p0.05). the stenosis rate of bridging vessels was significantly higher in the high-level MPV group than in the medium-level MPV group (all p0.05). There was no significant difference between the two groups. Meanwhile, there was no significant difference between MPV and PDW (p0.05). (5) In type 2 diabetes mellitus subgroup, 220 patients, the number of patients whose MPV range was above 12 FL in bridge vascular disease group was more than that in bridge vascular patency group (p0.05), but other platelet parameters (plt, pdw, PCT level) between the two groups were not statistically significant. Significance. There were 98 patients in the subgroup of cardiac insufficiency, and the MPV level in the group of bridge vascular disease was higher than that in the group of bridge vascular patency (p0.05). There were 84 patients in the subgroup of arrhythmia, including 32 patients with atrial fibrillation, 30 patients with right bundle branch block, 12 patients with ventricular premature beats and 10 patients with sinus bradycardia. There was no significant difference between the two groups (p0.05). (6) the prognosis of patients with bridge vascular disease were predicted by MPV level, LP (a) level, the number of venous bridge branches and HDL level, and the receiver operating characteristic curve (roc curve) was drawn. the area under the curve (auc) were 0.657, 95% CI (0.586-0.727), 0.618, 95% CI (0.544-0.692) respectively. 0.628,95% CI (0.552-0.705); 0.606,95% CI (0.529-0.692); 0.606,95% CI (0.529-0.692). The best cut-off point of MPV was 10.45, the sensitivity was 0.497,95% CI (0.497,95% CI (0.472-0.522), specificwas 0.757,95% CI (0.757,95% CI (0.719-0.795); LP (a) was 0.175, 0.175, 0.717, 95% CI (0.717, 95% CI (0.681-0.681-0.753), specificwas 0.500, 95% CI The cut-off point is 1.500 and the sensitivity is 0.845,9. 5% CI (0.803-0.887), specificity is 0.686,95% CI (0.652-0.720); the best cut-off point of HDL is 1.085, sensitivity is 0.620, 95% CI (0.589-0.651), specificity is 0.614, 95% CI (0.583-0.645); combined with MPV value, LP (a) value, venous bridge number and HDL value binary logistic regression coefficient. The area under the ROC curve of combined diagnosis was higher than mpv, LP (a), the number of venous bridges and hdl, 0.770 (95% CI 0.706-0.833), which was statistically significant (p0.05). the best cut-off point was 0.881, the sensitivity was 0.706, 95% CI (0.671-0.741), the specificity was 0.714 (0.678-0.750). conclusion: the elderly, the history of type 2 diabetes mellitus, the NYHA classification Level II, ejection fraction (EF) 50%, and cardiothoracic 50% of patients with severe coronary artery disease were more likely to achieve revascularization and improve myocardial blood supply through CABG. Protective factors. Cardiac pump function can be improved after CABG. Antiplatelet and lipid-lowering therapy are still needed after CABG. The changes of MPV are related to pontine vascular disease in both type 2 diabetes mellitus subgroup and cardiac insufficiency. The joint prediction has the identification. Its sensitivity is 0.706 and specificity is 0.714 at the best cut-off point of 0.881.
【学位授予单位】：天津医科大学
【学位级别】：硕士
【学位授予年份】：2015
【分类号】：R654.2
本文编号：2178293
[Abstract]:Objective: To study the relationship between mean platelet volume (MPV) and graft vascular lesions in patients with coronary heart disease (CHD) undergoing coronary artery bypass grafting (CABG), and to explore the risk factors of graft vascular lesions. The relationship between MPV and patency of bridging vessels was analyzed in patients with coronary heart disease (CHD) complicated with type 2 diabetes mellitus, heart failure and arrhythmia. According to the enrollment criteria, 514 patients who had been admitted to Tianjin Thoracic Hospital from January 1, 2008 to September 30, 2014 were retrospectively analyzed. They were diagnosed as severe coronary artery disease by coronary angiography (CAG). They were treated with CABG in our hospital or other hospitals. Of them, 514 patients were admitted to the hospital for treatment of recurrent suspicious myocardial ischemic events. A total of 164 patients were enrolled in the study. 194 patients with normal coronary artery confirmed by CAG in Tianjin Thoracic Hospital from January 01, 2014 to January 01, 2015 were enrolled as control group. The bridge vessels were divided into two groups according to whether the bridge vessels were stenosed: the patency group and the lesion group. Patients with type 2 diabetes mellitus, with or without systolic heart failure, with or without arrhythmia were divided into three groups: diabetes subgroup, cardiac insufficiency subgroup and arrhythmia subgroup. Bypass time, history of myocardial infarction, family history, fasting venous blood test results, echocardiographic and chest radiographic results were recorded. F) 50% and 50% of cardiothoracic ratio were susceptible factors to CABG. (2) MPV (OR 1.550,95% OR 1.248-1.926), LP (alpha) value (OR 6.218,95% OR 1.624-23.810) and the number of venous bridges (OR 2.131,95% OR 1.427-3.181), HDL level (OR 0. 179,95% OR 0.057-0.560 was the protective factor for patency of bridging vessels (all p0.05). (3) Compared with the clinical data before and after cabg, the levels of hematocrit (hct), mean volume of red blood cells (mcv), red blood cell distribution width (rdw), blood glucose (glu), apolipoprotein (apro-a1), EF in the group with patency of bridging vessels decreased after operation. The levels of red blood cell (rbc), hct, platelet, mpv, total cholesterol (tc), low-density lipoprotein (ldl), ef, RBC and HCT were lower than those before operation, and the levels of plt, mpv, tc, ldl, EF were lower than those before operation. (4) the stenosis rate of high-level MPV group was significantly higher than that of low-level MPV group (all p0.05). the stenosis rate of bridging vessels was significantly higher in the high-level MPV group than in the medium-level MPV group (all p0.05). There was no significant difference between the two groups. Meanwhile, there was no significant difference between MPV and PDW (p0.05). (5) In type 2 diabetes mellitus subgroup, 220 patients, the number of patients whose MPV range was above 12 FL in bridge vascular disease group was more than that in bridge vascular patency group (p0.05), but other platelet parameters (plt, pdw, PCT level) between the two groups were not statistically significant. Significance. There were 98 patients in the subgroup of cardiac insufficiency, and the MPV level in the group of bridge vascular disease was higher than that in the group of bridge vascular patency (p0.05). There were 84 patients in the subgroup of arrhythmia, including 32 patients with atrial fibrillation, 30 patients with right bundle branch block, 12 patients with ventricular premature beats and 10 patients with sinus bradycardia. There was no significant difference between the two groups (p0.05). (6) the prognosis of patients with bridge vascular disease were predicted by MPV level, LP (a) level, the number of venous bridge branches and HDL level, and the receiver operating characteristic curve (roc curve) was drawn. the area under the curve (auc) were 0.657, 95% CI (0.586-0.727), 0.618, 95% CI (0.544-0.692) respectively. 0.628,95% CI (0.552-0.705); 0.606,95% CI (0.529-0.692); 0.606,95% CI (0.529-0.692). The best cut-off point of MPV was 10.45, the sensitivity was 0.497,95% CI (0.497,95% CI (0.472-0.522), specificwas 0.757,95% CI (0.757,95% CI (0.719-0.795); LP (a) was 0.175, 0.175, 0.717, 95% CI (0.717, 95% CI (0.681-0.681-0.753), specificwas 0.500, 95% CI The cut-off point is 1.500 and the sensitivity is 0.845,9. 5% CI (0.803-0.887), specificity is 0.686,95% CI (0.652-0.720); the best cut-off point of HDL is 1.085, sensitivity is 0.620, 95% CI (0.589-0.651), specificity is 0.614, 95% CI (0.583-0.645); combined with MPV value, LP (a) value, venous bridge number and HDL value binary logistic regression coefficient. The area under the ROC curve of combined diagnosis was higher than mpv, LP (a), the number of venous bridges and hdl, 0.770 (95% CI 0.706-0.833), which was statistically significant (p0.05). the best cut-off point was 0.881, the sensitivity was 0.706, 95% CI (0.671-0.741), the specificity was 0.714 (0.678-0.750). conclusion: the elderly, the history of type 2 diabetes mellitus, the NYHA classification Level II, ejection fraction (EF) 50%, and cardiothoracic 50% of patients with severe coronary artery disease were more likely to achieve revascularization and improve myocardial blood supply through CABG. Protective factors. Cardiac pump function can be improved after CABG. Antiplatelet and lipid-lowering therapy are still needed after CABG. The changes of MPV are related to pontine vascular disease in both type 2 diabetes mellitus subgroup and cardiac insufficiency. The joint prediction has the identification. Its sensitivity is 0.706 and specificity is 0.714 at the best cut-off point of 0.881.
【学位授予单位】：天津医科大学
【学位级别】：硕士
【学位授予年份】：2015
【分类号】：R654.2
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