摘要目的:探讨稳定性冠心病（CAD）择期经皮冠状动脉介入治疗（PCI）的患者入院平均血小板体积（MPV）与2年不良心脑血管事件之间的关系，并进一步探讨该相关性在不同患者亚组中是否一致。方法:共纳入2013年全年于阜外医院行择期PCI治疗的4 293例稳定性CAD患者，按MPV值均分为两组：低MPV组（ n=2 219，MPV≤10.5 fL）和高MPV组（ n=2 074，MPV>10.5 fL）。使用Cox回归分析比较MPV与远期预后的相关性。 结果:与低MPV组患者相比，高MPV组患者合并糖尿病[30.4%（674/2 219）比34.5%（715/2 074）]、吸烟[53.3%（1 183/2 219）比57.0%（1 182/2 074）]、既往行冠状动脉旁路移植术（CABG）[4.0%（88/2 219）比5.4%（112/2 074）]的比例更高，左室射血分数（LVEF）（64±7比63±7）、肾小球滤过率（eGFR）（92±14比91±15）更低（均 P<0.05）。实验室检查方面，高MPV组患者糖化血红蛋白更高，血小板计数更低（均 P<0.05）。冠状动脉造影方面，两组术前SYNTAX积分、左主干/三支病变比例、置入支架类型、介入治疗成功率及支架总长度差异均无统计学意义（均 P>0.05）。预后方面，与低MPV组比较，高MPV组患者心源性死亡率更高[18（0.9%）比5（0.2%）， P=0.004]。Kaplan-Meier分析表明，与低MPV组相比，高MPV组心源性死亡显著高于低MPV组（Log-rank P=0.004）。多变量Cox回归分析表明，高MPV与稳定性CAD患者的2年心源性死亡独立相关（ HR 4.127，95 %CI 1.373~12.405， P=0.012）。受试者工作特征（ROC）分析同样显示，MPV在预测2年心源性死亡方面具有较好的诊断价值（ROC曲线下面积=0.624，95 %CI 0.511~0.738， P=0.04）。亚组分析发现，在糖尿病患者（ HR 2.090，95 %CI 1.217~3.589， P=0.008）及男性患者中（ HR 1.561，95 %CI 1.007~2.421， P=0.047），随MPV升高，心源性死亡发生率升高。 结论:接受择期PCI治疗的稳定性CAD患者中，高MPV与2年心源性死亡增加独立相关；该相关性在糖尿病及男性患者中更为显著。

abstractsObjective:To evaluate the relationship between admission mean platelet volume (MPV) and 2-year cardiac mortality in patients with stable coronary artery disease (CAD) undergoing elective percutaneous coronary intervention (PCI), and explored the consistence of this relationship in diabetes mellitus (DM) and non-DM subgroups.Method:A total of 4 293 patients who underwent PCI in Fuwai Hospital in 2013 were enrolled and divided into two groups according to MPV as follows: lower MPV ( n=2 219, MPV≤10.5fL) and higher MPV ( n=2 074, MPV>10.5fL). Result:Patients with high MPV had a higher rate of DM (30.4%(674/2 219) vs 34.5%(715/2 074)), smoking (53.3%(1 183/2219) vs 57.0%(1 182/2 074)), and previous coronary artery bypass grafting (CABG) (4.0%(88/2 219) vs 5.4%(112/2 074)), while left ventricular ejection fraction (LVEF) (64±7 vs 63±7), and glomerular filtration rate (eGFR) (92±14 vs 91±15) were lower compared with patients in the low MPV group (all P<0.05). In the laboratory examination, patients with high MPV had higher glycosylated hemoglobin, and lower platelet count (all P<0.05). In coronary angiography, there was no significant difference in SYNTAX scores, left main/three-vessel lesions, stent type, success rate of operation, and total stent length (all P>0.05). Compared with low MPV group, patients with high MPV had ahigher cardiac mortality [18 (0.9%) vs 5 (0.2%), P=0.004]. Kaplan-Meier analysis showed that compared to low MPV group, cardiac mortality in high MPV group was significantly higher (Log-rank P=0.004). Multivariate Cox regression analysis showed that high MPV was independently associated with 2-year cardiac mortality ( HR 4.127, 95 %CI 1.373 to 12.405, P=0.012). Receiver operating characteristic curve (ROC) analysis also showed that MPV had a good diagnostic value in predicting 2-year cardiac mortality (area under the curve=0.624, 95 %CI: 0.511-0.738, P=0.04). Subgroup analysis showed that in patients with DM ( HR 2.090, 95 %CI 1.217-3.589, P=0.008) and male ( HR 1.561, 95 %CI 1.007-2.421, P=0.047), MPV was significantly related with cardiac mortality. Conclusion:In patients with stable CAD who underwent elective PCI, high MPV was independently associated with an increase in 2-year cardiac mortality, especially in patients with DM and male gender.