网织血小板与早发冠心病PCI术后远期预后的相关性
Reticulated platelets are associated with long-term outcomes of premature coronary artery disease following percutaneous coronary intervention

摘要：目的 探讨网织血小板(reticulated platelets, RPs)与早发冠状动脉疾病(premature coronary artery disease, PCAD)经皮冠状动脉介入术(percutaneous coronary intervention, PCI)后远期预后的相关性。方法 共纳入300例PCAD患者(冠心病发病年龄男性<45岁，女性<55岁)及冠脉造影正常者250例为对照组。用双标记流式细胞仪对全血进行检测获得RPs百分比(RPs%)。随访24月时，评估RPs与远期主要不良心脏血管事件(major adverse cardiac event, MACE)及冠脉支架内再狭窄(in-stent restenosis, ISR)的相关性。结果 随访24月共发生MACE 20例(占6.7%)。PCAD组与对照组的吸烟、糖尿病、家族史、心力衰竭史差异均有统计学意义；PCAD组RPs显著高于对照组，差异有统计学意义(P<0.05)。RPs>10%组ISR的发生率与RPs 6%～8%组的差异有统计学意义(P<0.05)。Cox比例风险回归分析RPs>10%是预测心脏不良事件的一个独立变量(HR=2.58，95%可信区间：1.12～5.35，P<0.01)。Kaplan-Meier事件生存率曲线显示，RPs>10%组的心血管事件发生率高于RPs<10%组。 结论 RPs是预测PCAD行PCI术后远期预后的独立分子标志物。RPs>10%与PCAD患者PCI术后ISR相关，且MACE发生率高。
ABSTRACT: Objective?? To investigate the assocaition between reticulated platelets (RPs) and long-term outcomes of premature coronary artery disease (PCAD) patients after percutaneous coronary intervention (PCI). Methods? ?We recruited 300 PCAD patients (males aged <45 years and females aged <55 years at the onset of coronary artery disease) and 250 controls with normal coronary angiographic results. RPs percentage was assessed using a direct, whole blood, dual-labeling flow cytometric method. We evaluated the association of RPs with long-term major adverse cardiac events (MACE) after 24-month follow-up and coronary in-stent restenosis (ISR). Results?? There were 20 cardiac events (6.7%) during the 24-month follow-up. PCAD and control groups differed significantly in smoking, diabetes, family history, and history of heart failure. RPs were significantly higher in PCAD group than in control group (P<0.05). The incidence of ISR in RPs>10% group was significantly different from that in RPs 6%-8% group (P<0.05). Cox proportional hazard regression analysis of RPs>10% was an independent variable in predicting MACE (HR=2.58, 95% CI: 1.12-5.35, P<0.01). Kaplan-Meier event survival curve showed that the incidence of cardiovascular events in RPs>10% group was higher than that in RPs <10% group. Conclusion? ?RPs are an independent molecular marker for predicting the long-term outcomes in PCAD after PCI. RPs>10% are associated with ISR in patients with PCAD after PCI, and the incidence of MACE is increased