摘要目的 探讨接受冠状动脉旁路移植术(CABG)的冠心病患者平均血小板体积(MPV)与静脉桥血管再狭窄的关系,分析MPV预测CABG术后静脉桥血管再狭窄的临床意义. 方法 回顾性分析2009年9月至2014年9月就诊于天津市胸科医院,实施CABG治疗后3～5年再发可疑心肌缺血事件而入院治疗的患者354例.根据冠状动脉造影结果分为静脉桥血管狭窄(SVGD)组233例和静脉桥血管通畅(SVG)组121例.配对t检验分析不同因素与桥血管通畅性的关系.二元Iogistic回归分析MPV及其他因素对桥血管通畅性的影响.静脉桥血管狭窄＞50％被认为有意义且影响心肌供血. 结果 SVGD组患者MPV(10.2±1.5) fl较SVG组(9.6±1.5)fl高(P＜0.01).Logistic回归分析SVG组和SVGD组MPV值(OR=1.268,95％ CI:1.053～1.570,P=0.014)、年龄(OR=1.007,95％CI:1.038～1.117,P=0.000)、性别(OR=0.452,95％CI:0.250～0.816,P=0.008)、糖尿病(OR=2.319,95％CI:1.221～4.405,P=0.010)是静脉桥血管再狭窄的独立危险因素.Logistic回归分析非老年SVG组和SVGD组患者性别(OR=0.495,95％CI:0.251～0.976,P=0.042)、糖尿病(OR=2.237,95％CI:1.105～4.527,P=0.025)、MPV(OR=1.334,95％ CI:1.050～1.694,P=0.018)、纤维蛋白原定量(OR=1.654,95％ CI:1.020～2.682,P=0.041)是静脉桥血管狭窄的独立危险因素;Logistic回归分析老年SVG组和SVGD组患者年龄(OR=1.178,95％CI:1.116～1.244,P=1.178)为静脉桥血管狭窄的独立危险因素.MPV水平≥12 fl者狭窄率(92.6％,25/27)高于MPV水平处于＜12 fl者狭窄率(63.6％,208/327);ROC曲线结果显示,MPV曲线下面积为0.610,年龄、性别、糖尿病、维蛋白原定量曲线下面积分别为0.657、0.394、0.626、0.654,联合诊断曲线下面积为0.796,联合预测价值高于单独预测价值(P＜0.01). 结论 MPV水平是静脉桥血管狭窄的独立危险因素,与年龄、性别、糖尿病、维蛋白原联合预测价值更高.

abstractsObjective To investigate the relationship between mean platelet volume(MPV)and saphenous vein graft restenosis in patients receiving coronary artery bypass grafting(CABG),and to analyze the clinical significance of MPV in the prediction of restenosis after CABG.Methods A total of 354 patients admitted into Tianjin chest hospital from September 2009 to September 2014 with suspected myocardial ischemic events 3 to 5 years after CABG treatment was enrolled for a retrospective analysis.According to the coronary angiography(CAG)results,patients were divided into the vein bridge vascular lesion group(saphenous vein graft diseases,SVGD)(n=233)and the venous bridge vascular patency group(saphenous vein graft,SVG)(n=121).Paired t test was used to analyze the relationship between different factors and the bridge vascular patency.The binary logistic regression was used to analyze the effects of MPV and other factors on bridge vascular patency.Venous bridge stenosis ＞ 50％ was considered to be clinically significant and to damage myocardial blood supply.Results The MPV was higher in the SVGD group than the SVG group [(10.2±1.5)fl vs.(9.6±1.5)fl,P＜0.01].The logistic regression analysis showed that MPV(OR =1.268,95％CI:1.053-1.570,P=0.014),age(OR =1.007,95％CI:1.038-1.117,P=0.000),gender (OR=0.452,95％CI:0.250-0.816,P=0.008),diabetes mellitus(OR=2.319,95％CI:1.221-4.405,P =0.010)were the independent risk factors for venous bridge stenosis in the two groups,gender(OR=0.495,95％CI:0.251-0.976,P=0.042),diabetes mellitus(OR =2.237,95％CI:1.105-4.527,P =0.025),MPV(OR=1.334,95％CI;1.050 1.694,P=0.018),fibrinogen(OR=1.654,95％CI:1.020-2.682,P =0.041)were the independent risk factors for venous bridge stenosis in non-elderly patients,and age(OR =1.178,95％CI:1.116-1.244,P =1.178)was an independent risk factor for vein graft stenosis in elderly patients.The restenosis rate was higher in patients with MPV ≥ 12 fl(92.6％ or 25/27) than in the patients with MPV ＜ 12 fl(63.6％ or 208/327).The receiver operating characteristics(ROC) curve showed that the areas under the curve of MPV,age,gender,diabetes,fibrinogen were 0.610,0.657,0.394,0.626,0.654,respectively,and the area under the curve of joint diagnosis was 0.796,showing that joint prediction value was higher than any single prediction value(P＜0.01).Conclusions MPV level is an independent risk factor for vein graft stenosis,and has higher predictive value in combination with age,gender,diabetes and fibrinogen.