不稳定型心绞痛患者不同血糖状态时血小板的检测及临床意义
Clinical implications of the platelet test results about unstable angina patients with different conditions of blood glucose

摘要：目的 研究不稳定型心绞痛患者不同血糖状态时血小板的变化及与相关生化指标、GRACE(global registry of acute coronary events)危险评分之间的关系。方法 入选诊断为不稳定型心绞痛的患者共82人，其中男性47人，女性35人，测定入院时的随机血糖值，根据血糖值的不同，分为正常血糖组(随机血糖<6.1mmol/L)和高血糖组(随机血糖≥6.1mmol/L)，比较两组的年龄、高血压、糖尿病、吸烟史、体质量指数(BMI)等临床指标。血生化检测指标包括糖化血红蛋白(HBA1C)、血糖、低密度脂蛋白胆固醇(LDL-C)、高密度脂蛋白胆固醇(HDL-C)、甘油三酯(TG)、脂蛋白A(LPA)、血清肌酐(CREA)、尿酸(UA)、超敏C反应蛋白(hsCRP)、B型脑钠肽(BNP)、肌酸激酶同工酶MB型(CKMB)、心肌肌钙蛋白I(CTNI)、D-二聚体(D-Dimers)。心功能检测指标为射血分数(EF，%)、GRACE评分。比较血小板相关检测结果血小板计数(PLT)、平均血小板体积(MPV)、血小板分布宽度(PDW)、大血小板比率(P-LCR)。分析MPV与hsCRP、D-Dimers及GRACE评分的相关性。结果 正常血糖(<6.1mmol/L)组和高血糖(≥6.1mmol/L)组比较，MPV、hsCRP、GRACE危险评分差异有明显统计学意义(P<0.05)，高血糖组MPV与hsCRP、D-Dimer、GRACE危险评分均有相关性(r=0.28、r=0.41、r=0.56，P<0.05)。结论 不稳定型心绞痛高血糖状态可能导致MPV增加、炎症标志物hsCRP的改变以及临床GRACE危险评分分值的增加。入院时的高血糖状态、MPV的异常预示着不稳定型心绞痛风险的增加。
ABSTRACT: Objective To study the platelet changes in patients with unstable angina with different blood glucose, and their related biochemical index changes, and their relationship with global registry of acute coronary events (GRACE) score. Methods For this clinical study, we enrolled 82 patients diagnosed with unstable angina, 47 of whom were male and 35 were female. Upon admission, their random blood glucose was tested. According to different blood glucose values, they were divided into normal blood glucose group (<6.1mmol/L) and high blood glucose (≥6.1mmol/L) group. The following clinical data were compared between the two groups: age, hypertension, diabetes, smoking history, and BMI. We detected EF (%), HBA1C, glucose, LDL-C, HDL-C, TG, LPA, CREA, UA, hsCRP, BNP, CKMB, CTNI, D-Dimer, and GRACE risk scores. We compared the platelet test results: PLT, P-LCR, PDW, and MPV. We also detected the relationship of MPV with hsCRP, D-Dimers and GRACE risk scores. Results MPV, hsCRP, and GRACE risk score differed significantly between normal blood glucose group and high blood glucose group (P<0.05). In the latter group, MPV had significant correlation with hsCRP, D-Dimers and GRACE risk score (r=0.28, r=0.41, r=0.56, P<0.05). Conclusion Hyperglycemia in patients with unstable angina causes the increase of MPV, change of the inflammatory marker hsCRP, and increase of clinical GRACE risk score. Abnormal MPV may predict the increased risk of unstable angina in patients with hyperglycemia upon hospitalization