天津医药

天津医药 ›› 2019, Vol. 47 ›› Issue (12): 1248-1258.doi: 10.11958/20191374

• 临床研究 • 上一篇    下一篇

血小板反应指数与血小板聚集率的相关性及对非ST段抬高急性冠脉综合征的预后评价

张莹莹1△，郭绪昆1，郑君毅1，刘婷2，张莹2，马静2，刘寅1   

  1. 1天津市胸科医院心内科（邮编300222）；2天津市心血管病研究所
  • 收稿日期:2019-05-09 修回日期:2019-09-18 出版日期:2019-12-15 发布日期:2019-12-15
  • 通讯作者: 张莹莹 E-mail:1424413836@qq.com
  • 作者简介:张莹莹（1977），女，医学博士，副主任医师，主要从事心血管疾病临床及基础研究
  • 基金资助:
    天津市科技重大专项与工程项目

Correlation between platelet reactive index and platelet aggregation rate and prognostic evaluation of non-ST-segment elevation acute coronary syndrome

ZHANG Ying-ying1△, GUO Xu-kun1, ZHENG Jun-yi1, LIU Ting2, ZHANG Ying2, MA Jing2, LIU Yin1   

  1. 1 Department of Cardiology, Tianjin Chest Hospital, Tianjin 300222, China; 2 Tianjin Institute of Cardiovascular Disease
  • Received:2019-05-09 Revised:2019-09-18 Published:2019-12-15 Online:2019-12-15
  • Contact: Ying-Ying ZHANG E-mail:1424413836@qq.com
  • Supported by:
    Tianjin Major science and technology projects and engineering projects support

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摘要： 目的 探讨通过流式细胞术定量的血小板反应指数（PRI）和经典的血小板聚集率（PAG）的相关性，并评价 PRI及PAG与非ST段抬高急性冠脉综合征（NSTE-ACS）预后的关系。方法 连续纳入2016年10月—2017年1月天 津市胸科医院心内科收治的NSTE-ACS并接受冠状动脉介入治疗的患者231例，根据PRI中位数将患者分为2组，低 PRI组（PRI≤55%）116例和高PRI组（PRI>55%）115例，对比2组患者PAG水平、主要不良心血管事件（MACE）的发生 率、主要临床及生化指标。再根据PAG中位数将患者分为2组，低PAG组（PAG≤71%）112例和高PAG组（PAG>71%） 119例，对比2组患者PRI水平、MACE发生率、主要临床及生化指标。对PRI和PAG进行相关性分析和受试者工作特 征（ROC）曲线分析。全部患者随访2年，以全因死亡、支架内再狭窄、急性支架内血栓形成、再发急性心肌梗死为复 合终点事件，通过Cox回归分析评价PRI、PAG、肌钙蛋白（I TnI）等指标对MACE的预测能力。结果 以PRI中位数分 组，高PRI组PAG水平、MACE发生率均高于低PRI组（P＜0.01）。再根据PAG中位数分组，高PAG组PRI也高于低 PAG 组（P＜0.01），2 组间 MACE 发生率差异无统计学意义。相关性分析提示 PRI 与 PAG 呈正相关（r=0.318，P＜ 0.01）。以PAG为检验变量，PRI为状态变量的ROC曲线分析，曲线下面积（AUC）为0.873（95%CI：0.839~0.908，P＜ 0.01）。Cox 回归分析提示高 PRI 水平（HR=1.090，95%CI：1.038~1.146，P=0.001）及男性（HR=0.186，95%CI：0.053~ 0.659，P=0.009）患者更易发生不良心血管事件。结论 根据流式细胞术定量血管舒张刺激磷蛋白（VASP）磷酸化比 例计算的PRI和经典的光比浊法测定的PAG有相关性，对于NSTE-ACS患者，高PRI能预测不良心血管事件发生，较 传统的PAG检测更有意义。

关键词: 冠心病, 急性冠状动脉综合征, 血小板反应指数, 血小板聚集率, 血管舒张刺激磷蛋白

Abstract: Objective To investigate the correlation between platelet reactive index (PRI) quantified by flow cytometry and the classical platelet aggregation rate (PAG), and to evaluate the prognostic value of PRI/PAG in patients who suffered with non-ST-segment elevation acute coronary syndrome (NSTE-ACS). Methods From October 2016 to January 2017, 231 consecutive patients with NSTE-ACS admitted to the department of cardiology of Tianjin Chest Hospital and treated with percutaneous coronary intervention were enrolled. Patients were divided into two groups according to the PRI median, the low PRI group (PRI≤55%, n=116) and the high PRI group (PRI>55%, n=115). PAG levels, incidence of major adverse cardiovascular events (MACE), major clinical and biochemical indicators were compared between the two groups. According to the median of PAG level, patients were also divided into two groups, the low PAG group (PAG ≤71%, n=112) and the high PAG group (PAG>71%, n=119). The PRI level, the incidence of MACE, the major clinical and biochemical indexes were also compared between the two groups. Correlation analysis and receiver operating characteristic (ROC) curve were conducted between PRI and PAG. All patients were followed up for 2 years. Taking all-cause death, in-stent restenosis, acute in-stent thrombosis and recurrent acute myocardial infarction as the composite endpoint events, the predictive ability

of PRI, PAG, troponin I (TnI) and other indicators on MACE were evaluated by Cox regression analysis. Results Grouped
by the median of PRI
,
the PAG level and MACE incidence were significantly higher in the high PRI group than those in the
low PRI group
(
P＜0.
01
). Grouping by the median of PAG, the high PAG group also showed higher PRI than that of the other
group (
P＜0.01
). There was no significant difference in the incidence of MACE between the two groups
. Correlation analysis
indicated that PRI was positively correlated with PAG (correlation coefficient
r=0.318, P＜0.01). The ROC curve analysis
showed that the area under the curve (AUC) was 0.873 (95%
CI: 0.839-0.908, P＜0.01
),
with PAG as the test variable and
PRI as the state variable. Cox regression analysis manifested that higher level of PRI
(
HR
=
1.090, 95%CI: 1.038-1.146, P＜
0.01) and male gender patients
(
HR=0.186, 95%CI: 0.053-0.659, P =0.009) were more likely to have adverse cardiovascular
events.
Conclusion PRI calculated by the phosphorylation ratio of vasodilator stimulated phosphoprotein
(VASP)
according to the flow cytometry has a correlation with PAG. For patients with NSTE-ACS, high PRI can predict adverse
cardiovascular events
, which is more efficient than traditional PAG detection
.

Key words: coronary heart disease, acute coronary syndrome, platelet reactive index, platelet aggregation rate, vasodilator stimulated phosphoprotein

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