作者：刘雪凯,张萌,辛勤,梁国威

单位：

1.100049 北京市，航天中心医院检验科　2.100049 北京市，航天中心医院心脏医学部

Units：

1.Department of Clinical Laboratory, Aerospace Center Hospital, Beijing 100049, China 2.Department of Cardiology, Aerospace Center Hospital, Beijing 100049, China Corresponding author: LIANG Guowei, E-mail: lgw721@126.com

关键词：

急性冠状动脉综合征; 双重抗血小板治疗; 经皮冠状动脉介入治疗; 缺血; 血小板; 血小板糖蛋白;

Keywords：

Acute coronary syndrome; Dual anti-platelet therapy; Percutaneous coronary intervention; Ischemia;Blood platelets; Platelet glycoprotein GP Ⅱ b- Ⅲ a complex; P-selectin; Forecasting

CLC：

DOI：

10.12114/j.issn.1008-5971.2021.00.288

Funds：

2016 年航天中心医院科研项目（YN201603）

摘要：

背景急性冠脉综合征(ACS)患者经皮冠状动脉介入术(PCI)后发生缺血性事件与血小板功能有关,而血小板糖蛋白Ⅱb/Ⅲa、P选择素可以反映血小板功能,且其对PCI后接受双重抗血小板治疗的ACS患者发生缺血性事件的预测价值尚不明确。目的 分析血小板糖蛋白Ⅱb/Ⅲa、P选择素对PCI后接受双重抗血小板治疗的ACS患者发生缺血性事件的预测价值。方法 选取2016年6月至2017年3月航天中心医院收治的PCI后接受双重抗血小板治疗的ACS患者141例为研究对象。收集患者一般资料,PCI后第3天检测患者血小板糖蛋白Ⅱb/Ⅲa、P选择素。分别于患者治疗后1、6、12、24个月对其进行电话随访,随访终点为患者发生缺血性事件,随访截止日期为2019-04-01。采用多因素Logistic回归分析探讨PCI后接受双重抗血小板治疗的ACS患者发生缺血性事件的影响因素;采用受试者工作特征(ROC)曲线分析血尿素氮(BUN)和血小板糖蛋白Ⅱb/Ⅲa、P选择素及其联合对PCI后接受双重抗血小板治疗的ACS患者发生缺血性事件的预测价值。结果 141例患者中,有3例后续诊断为癌症、14例失访,最终共纳入124例患者。随访结束时,共有25例患者发生了缺血性事件。发生缺血性事件患者年龄、BUN和血小板糖蛋白Ⅱb/Ⅲa、P选择素高于未发生缺血性事件患者(P <0.05)。多因素Logistic回归分析结果显示,BUN〔OR=1.233,95%CI(1.062,1.431)〕及血小板糖蛋白Ⅱb/Ⅲa〔OR=1.045,95%CI(1.008,1.084)〕、P选择素〔OR=1.031,95%CI(1.004,1.060)〕是PCI后接受双重抗血小板治疗的ACS患者发生缺血性事件的影响因素(P<0.05)。ROC曲线分析结果显示,BUN及血小板糖蛋白Ⅱb/Ⅲa、P选择素预测PCI后接受双重抗血小板治疗的ACS患者发生缺血性事件的曲线下面积(AUC)分别为0.622〔95%CI(0.474,0.770)〕、0.711〔95%CI (0.584,0.839)〕、0.608〔95%CI (0.475,0.741)〕,最佳截断值分别为6.850 mmol/L、21.1%、3.4%,灵敏度分别为0.444、0.857、0.762,特异度分别为0.816、0.581、0.488。BUN联合血小板糖蛋白Ⅱb/Ⅲa、BUN联合血小板P选择素和三者联合预测PCI后接受双重抗血小板治疗的ACS患者发生缺血性事件的AUC分别为0.806〔95%CI(0.719,0.894)〕、0.691〔95%CI(0.556,0.827)〕和0.819〔95%CI(0.737,0.902)〕,灵敏度分别为0.870、0.739和0.826,特异度分别为0.678、0.697和0.768。结论 血小板糖蛋白Ⅱb/Ⅲa、P选择素对PCI后接受双重抗血小板治疗的ACS患者发生缺血性事件有一定预测价值,且其与BUN联合的预测价值更高。

Abstract：

【Abstract】　Background Ischemic events after percutaneous coronary intervention (PCI) in patients with acutecoronary syndrome (ACS) are related to platelet function, while platelet glycoprotein Ⅱ b/ Ⅲ a and P-selectin can reflect plateletfunction, and their predictive value for ischemic events in ACS patients receiving dual anti-platelet therapy (DAPT) after PCIis not clear.Objective To evaluate the predictive value of platelet glycoproteinⅡ b/ Ⅲ a and P-selectin for ischemic eventsin ACS patients receiving DAPT after PCI.Methods A total of 141 ACS patients who received DAPT after PCI in AerospaceCenter Hospital from June 2016 to March 2017 were selected as the research objects. The general data of patients were collected,and platelet glycoprotein Ⅱ b/ Ⅲ a and P-selectin were detected on the third day after PCI. The patients were followed upby telephone at 1, 6, 12, and 24 months after treatment. The end of the follow-up was the occurrence of an ischemic event inthe patient, and the deadline for follow-up was 2019-04-01. Multivariate Logistic regression analysis was used to explore theinfluencing factors of ischemic events in ACS patients receiving DAPT after PCI. The receiver operating characteristic (ROC)curve was used to analyze the predictive value of blood urea nitrogen (BUN) , platelet glycoprotein Ⅱ b/ Ⅲ a, P-selectin andtheir combination on ischemic events in ACS patients receiving DAPT after PCI. Results Among the 141 patients, 3 weresubsequently diagnosed as cancer and 14 were lost to follow-up. Finally, a total of 124 patients were included. At the end offollow-up, a total of 25 patients had ischemic events. The age, BUN, platelet glycoproteinⅡ b/ Ⅲ a and P-selectin in patientswith ischemic events were higher than those in patients without ischemic events (P < 0.05) . The results of multivariate Logisticregression analysis showed that BUN [OR=1.233, 95%CI(1.062, 1.431) ] , platelet glycoprotein Ⅱ b/ Ⅲ a [OR=1.045, 95%CI(1.008, 1.084) ] and P-selectin [OR=1.031,95%CI (1.004, 1.060) ] were influencing factors of ischemic events in ACS patientsreceiving DAPT after PCI (P < 0.05) . ROC curve analysis results showed that the area under curve (AUC) of BUN, plateletglycoprotein Ⅱ b/ Ⅲ a and P-selectin for predicting ischemic events in ACS patients receiving DAPT after PCI was 0.622 [95%CI( 0.474, 0.770) ] , 0.711 [95%CI (0.584, 0.839) ] , 0.608 [95%CI (0.475, 0.741) ] , the best cut-off value was 6.850 mmol/L,21.1%, 3.4%, the sensitivity was 0.444, 0.857, 0.762, the specificity was 0.816, 0.581, 0.488, respectively. The AUC of BUNcombined with platelet glycoprotein Ⅱ b/ Ⅲ a, BUN combined with platelet P-selectin and the combination of these three factorsfor predicting ischemic events in ACS patients receiving DAPT after PCI was 0.806 [95%CI (0.719, 0.894) ] , 0.691 [95%CI (0.556,0.827) ] and 0.819 [95%CI (0.737, 0.902) ] , the sensitivity was 0.870, 0.739 and 0.826, and the specificity was 0.678, 0.697and 0.768, respectively.Conclusion Platelet glycoprotein Ⅱ b/ Ⅲ a and P-selectin have a certain predictive value for theoccurrence of ischemic events in ACS patients receiving DAPT after PCI, and their combined prediction value with BUN is higher.

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