血浆炎症指标对糖尿病患者冠脉支架术后再狭窄预测分析
Predictive Analysis of Plasma Inflammatory Indicators on Restenosis after Coronary Stenting in Diabetes Patients
DOI: 10.12677/acm.2024.14123226, PDF, HTML, XML,   
作者: 夏学雯:内蒙古医科大学研究生院,内蒙古 呼和浩特;高 雯*:内蒙古巴彦淖尔市医院心血管内科,内蒙古 巴彦淖尔
关键词: 冠状动脉支架术后再狭窄2型糖尿病血细胞参数冠心病血小板Restenosis after Coronary Artery Stenting Type 2 Diabetes Blood Cell Parameters Coronary Heart Disease Platelet
摘要: 经皮冠状动脉介入治疗(PCI)作为冠心病(CHD)的重要治疗方法,尽管药物洗脱支架取得了重大进展,但支架内再狭窄(ISR)仍然是PCI后具有挑战性的临床问题,其中炎症反应和血小板的激活至关重要,而糖尿病病程长短是否会影响体内炎症表达,临床尚无确切说明,因此,本文旨在讨论血浆炎症指标对糖尿病患者冠脉支架术后再狭窄的预测作用,为糖尿病患者冠脉支架术后管理和治疗策略提供科学依据。
Abstract: Percutaneous coronary intervention (PCI) is an important treatment method for coronary heart disease (CHD). Although drug-eluting stents have made significant progress, in stent restenosis (ISR) is still a challenging clinical problem after PCI. Inflammatory response and platelet activation are crucial, and whether the duration of diabetes will affect the expression of inflammation in vivo has not yet been clearly explained in clinical practice. Therefore, this article aims to discuss the predictive effect of plasma inflammatory indicators on the restenosis of diabetes patients after coronary stenting, and provide scientific basis for the management and treatment strategies of diabetes patients after coronary stenting.
文章引用:夏学雯, 高雯. 血浆炎症指标对糖尿病患者冠脉支架术后再狭窄预测分析[J]. 临床医学进展, 2024, 14(12): 1358-1364. https://doi.org/10.12677/acm.2024.14123226

1. 前言

冠状动脉粥样硬化性心脏病(CHD)的发病率逐年上升,是一种严重影响人类生命健康的慢性疾病[1]。而经皮冠状动脉介入治疗(PCI)是CHD的重要治疗方法[2],在过去的几十年里,尽管这些设备的生物相容性有了显着改善,但在多达10%~20%的情况下,它们容易出现短期或长期故障。因此,PCI术后ISR的防治仍是我们目前需要解决的问题[3]

ISR是指在支架植入后原发性冠状动脉病变的再狭窄,范围约为在支架内和/或支架近端和远端五毫米段的冠状动脉管腔再狭窄直径 ≥ 50% [4]。ISR多发生于PCI术后的六个月内,以复发性心绞痛为特点,但也可引起心肌梗死。近年来,随着药物洗脱支架(DES)技术逐渐替代裸金属支架(BMS),ISR的发生率明显地降低[5]。而在DES植入后ISR发生率仍为3%~20% [6],这是一个重大的临床挑战,且目前没有完善的治疗方案。因此,ISR的防治仍是心血管领域的一个值得探索的难题[7]

支架内再狭窄是一个多因素过程,具有复杂且不完全了解的病理生理学,其中炎症反应和血小板的激活至关重要。糖尿病患者体内激素及环境改变可引起炎性标志物升高,T2DM患者的血浆胰升糖素的水平升高且餐后的胰岛素的水平下降。离体灌注肝脏的研究显示,在类固醇激素和胰岛素同时作用的情况下,胰升糖素是炎症标志物产生的关键因素。炎症反应与多种因素相关,包括早期血管损伤、新生内膜增生和管腔损伤等,支架的植入损伤血管内膜并作为异物引起一种非特异性的炎症反应,在临床实践中,血细胞参数被广泛应用且易于获得,在研究炎症反应与ISR之间的关系中提供了重要价值[8]

炎症标志物在许多慢性疾病中可能会增加,例如糖尿病(DM)、高血压(HT)、肥胖、心血管疾病和癌症[9]。众多研究数据表明,糖尿病患者伴随着高水平的炎症标记物,糖尿病的发病及发展与多种炎症指标相关。例如:较高程度的红细胞分布宽度与更严重的糖尿病慢性肾脏病的显著相关;血小板/淋巴细胞计数比值对糖尿病视网膜病变的发生有临床诊断价值,可作为2型糖尿病随访指标;外周白细胞计数对2型糖尿病并发周围神经病变具有早期诊断价值。所以,糖尿病也可以被当作一种低度炎症性疾病。持续而广泛的炎症加速2型糖尿病相关的并发症和死亡率,糖尿病病程长短是否会影响体内炎症表达,不同病程的糖尿病患者术后再狭窄的严重程度是否存在不同,这些问题我们仍不得而知。

因此,本研究旨在探究血浆炎症指标对糖尿病患者冠脉支架术后再狭窄的预测作用。通过对糖尿病患者病程长短进行分类,分析不同病程糖尿病患者之间血浆炎症指标水平的差异,进一步了解炎症与冠脉支架术后再狭窄的关系,探索可能的生理代谢机制,增加对冠脉支架术后再狭窄发病机制的理解,并评估其与再狭窄风险之间的关联性。为糖尿病患者冠脉支架术后管理和治疗策略提供科学依据。

2. 糖尿病冠心病患者体内血浆炎症指标

糖尿病(DM)是一种多系统疾病,由于糖代谢受损,炎症和内皮功能障碍加重。高血糖会诱导细胞免疫激活并触发促炎性细胞因子的产生,2型糖尿病患者体内的红细胞分布宽度(RDW)、白细胞/中性粒细胞–淋巴细胞比率(NLR)、血小板–淋巴细胞比率(PLR)、淋巴细胞、嗜酸性粒细胞、血小板分布宽度(PDW)、单核细胞–淋巴细胞比率(MLR)、分叶中性粒细胞、绝对淋巴细胞等指标水平存在明显差异[10],而这些血细胞参数影响冠心病的发展进程及冠脉支架术后再狭窄的发生,对冠脉支架术后再狭窄的预测具有很高价值。

2.1. 红细胞分布宽度(RDW)

T2DM冠心病患者的红细胞分布宽度(RDW)较高,RDW可能是慢性炎症的结果,它会阻碍红细胞的生成,降低红细胞(RBC)的变形能力和半衰期,在活性氧过量的情况下,更高的脂蛋白氧化会加剧炎症和心血管并发症[11]。氧化应激增加导致更高的红细胞凋亡率,从而影响红细胞的变形能力并威胁微循环[12]。2型糖尿病中过量的葡萄糖会增加粘度并损害红细胞的流动性。葡萄糖粘附于红细胞会引发更多凝集,从而对红细胞产生更大的摩擦,导致红细胞损伤和碎片产生,进而导致沉积和血管斑块,动脉粥样硬化引起的炎症状态会因红细胞生成不足而引发RDW水平升高,从而产生未成熟和较大的红细胞并减慢红细胞清除速度,加速冠状动脉粥样硬化的进程[13]。已有研究表明,基线RDW与随访时支架内再狭窄密切相关,基线RDW较高且间接胆红素和糖尿病的患者发生ISR的风险较高,应特别注意PCI前RDW较高的患者,因为他们将来发生ISR的可能性更大[14]

2.2. 白细胞计数

白细胞计数是炎症反应的标志物,具有机体的免疫、防御、阻止病原微生物渗入的功能,根据白细胞形态不同,可分为中性粒细胞、噬碱性粒细胞、嗜酸性粒细胞、单核细胞和淋巴细胞5类[15]。中性粒细胞和白细胞增加,淋巴细胞计数减少是炎症期间的最常表现,糖尿病合并冠心病患者体内的白细胞计数明显增加,白细胞计数升高与糖尿病血糖水平不稳定显著相关,白细胞增多会因其粘度更高、直径更大和体积更大而破坏毛细血管,导致内皮细胞受损[16],白细胞总数增加是冠状动脉粥样硬化的危险因素,因为吞噬细胞,尤其是巨噬细胞和中性粒细胞,很可能导致动脉粥样硬化的进展和组织退化[17],而淋巴细胞反应了皮质醇的生理应激,提示预后不良,白细胞计数越高,重大不良心血管事件(MACE)发生率越高,一项研究表明,在支架植入后10~15分钟内,可在支架损伤的冠状动脉节段水平检测到白细胞募集,分类和回归树(CART)分析显示,白细胞计数是决定急性冠脉综合征(ACS)患者MACE风险增加的测量指标之一[18]

2.3. 中性粒细胞计数和中性粒细胞/淋巴细胞(NLR)

中性粒细胞增多和中性粒细胞/淋巴细胞(NLR)升高与糖代谢状态相关,较高的NLR和高血糖会增加糖尿病并发症的进展,并导致更严重和复杂的冠状动脉病变。中性粒细胞活化增加导致动脉粥样硬化斑块不稳定,血小板活化和P-选择素表达增加,从而引发血栓形成,NLR高的患者有可能出现更多软斑块,研究表明,糖尿病合并ISR患者的NLR平均水平高于糖尿病非ISR,NLR是2型糖尿病患者成功植入DES后ISR的一个强大而独立的预测因子,而且ACS 在高血糖反应中产生的促炎细胞因子和儿茶酚胺会减少淋巴细胞的产生和组织分布,导致淋巴细胞凋亡,患者淋巴细胞计数低反映了皮质醇的生理压力,提示预后较差[19],中性粒细胞作为一种关键因素,作用于急性冠状动脉的内皮损伤和血小板的聚集过程中,淋巴细胞则体现免疫调节反应。

虽然中性粒细胞或淋巴细胞计数可以作为一种炎症标志物,但其组合(即NLR)对比其单体作为炎症标志物更加可靠。因此,NLR作为全身炎症的高效的生物标志物,被当作一种预测因子,常用于心血管疾病(尤其是CAD)的预测中[20] [21]

2.4. 血小板/淋巴细胞比(PLR)

血小板数值的升高影响不良心血管事件的发生率,低数值的淋巴细胞计数可直接影响到冠心病患者的发病率和死亡率[22]。由于血小板是一种急性期反应物,受到全身的感染、炎症、出血和肿瘤的刺激,有助于增加血凝块形成和增强炎症反应,血小板在ISR和新生内膜增生中发挥着重要作用。经皮冠状动脉介入的过程导致毛细血管内皮细胞破裂和斑块破坏,进而引起内皮下组织因子和胶原蛋白的大量分泌、炎症介质和趋化因子的大量产生,最后引起血小板细胞活化和聚集生成栓塞,而血小板源性生长因子则在血小板细胞活化过程中产生,引起肌细胞增殖和迁移,加速ISR进程[23],多种因素激活了血小板细胞并导致晚期支架内血栓发生、支架动脉粥样硬化、内皮愈合延缓、支架脱落和血管内侵蚀,激活的血小板可以与中性粒细胞相结合,致使血管壁引发炎症,进而促使动脉粥样硬化[24]。血小板数值的升高可能表示潜藏的炎症和血栓状态。降低的淋巴细胞计数体现了一种无法抑制的炎症状态。

T2糖尿病ACS中的PLR明显较高,糖尿病患者PLR升高与HbA1c呈显著正相关。高血糖诱导更多的血小板活化和血小板免疫细胞聚集,促进炎症细胞因子和趋化因子的释放,加速糖尿病患者冠心病的进展,高血糖会改变血小板的水平和糖基化模式,较高的糖基化水平导致T2DM合并冠心病患者血小板反应性增加,血栓形成风险增加[25]。在ACS或CAD患者中,PLR反映了更高的斑块负担并与动脉粥样硬化严重程度相关,高PLR值是稳定或不稳定心绞痛患者ISR的独立预测因素,血小板与淋巴细胞的比值即PLR经研究表明,成为一种炎症标志物,比起独个血小板或者淋巴细胞计数作为炎症标志物更加可信[26]

2.5. 单核细胞–淋巴细胞比率(MLR)

单核细胞与淋巴细胞比率(MLR)作为一种新型的炎症标志物,已被证明是三支病变中长期死亡率和不良心血管事件的独立预测因素,MLR与冠脉病变严重程度及冠状动脉慢血流显著相关,能更好地反映冠状动脉病变,CAD患者单核细胞计数的增加,这可能是由于动脉粥样硬化期间的炎症反应所致,应激导致的类固醇水平升高和炎症增加则会使淋巴细胞的产生减少而凋亡增加[27],循环单核细胞和驻留血管巨噬细胞是第一批被募集到早期动脉粥样硬化斑块的白细胞,在炎症和感染反应中在动脉粥样硬化发展中起着重要作用。募集的单核细胞是组织巨噬细胞更新的重要系统来源,单核细胞和单核细胞衍生的巨噬细胞参与了冠状动脉斑块的发生、发展和破裂,淋巴细胞减少可加重斑块负荷,加速冠状动脉粥样硬化的形成,也会导致急性斑块破裂[28]。然而目前对于MLR对冠心病患者PCI术后ISR的发生的相关性研究较少,仍需要更多的前瞻性试验来进一步证明MLR在IRS患者中的预后价值。

2.6. 平均血小板体积(MPV)与血小板分布宽度(PDW)

MPV反映了血小板大小和活性[29]。高MPV代表血小板群未成熟或网织,这些未成熟或网织血小板比起成熟血小板更加活泼,抵抗血小板治疗反应方面更差劲[30] [31]。较大的血小板通常更加粘稠,并且经过分泌促血栓因子及血管活性因子并表明较高水准的粘附因子而更易于聚积,有研究表明,2型糖尿病患者对照非糖尿病的MPV值显著增加,MPV值升高是缺血性血管事件、复发性心肌梗死或CAD死亡的独立预测因子[32]-[34]。Choi等人证明,高NLR和高MPV的组合独立预测了PCI后发生重大不良心血管事件(心源性猝死、非致命性心肌梗死和支架内血栓的产生)的风险。Dai等人评估了MPV作为颈动脉血管成形术和支架内再狭窄的预测因子的作用,初期再狭窄与手术前的MPV的数值较高相关联,此类患者可能需要加强抗血小板治疗[35]

血小板分布宽度(PDW)是呈现血小板因体积大小变异性的参数,是一种血小板激活标志[36],RDW水平增高与2型糖尿病或其并发症密切相关,也可能是糖尿病控制进一步恶化的表现。PDW增加表明血小板同质性高和血小板大小差异,与CAD的严重程度和预后有关[37] [38]。炎症反应导致循环血小板在某些特征上存在的差异,血小板激活可能改变其形态,进而作用PDW。PDW作为一种独立预测因子,在CAD糖尿病病人植入DES后ISR预测起到关键作用。通过多变量解析察觉到,PDW和MPV与ISR紧密相联。每当PDW数值增长1个基数时,伴随着ISR风险就会增长大致30%左右。

3. 结论

ISR涉及血小板与激活白细胞之间的相互促进与抑制,炎症反应参与早期血管损伤、新生内膜增生、管腔狭窄,而血糖代谢异常可能引发炎症指标水平异常,糖尿病患者普遍伴有炎性指标增高,长期反复的高血糖,会导致心肌细胞代谢障碍及血管内皮功能障碍,加剧支架内动脉硬化斑块承载压力,同期,也会对支架外冠状动脉斑块的形成有推进作用,加重血栓形成的概率,而目前对于不同病程糖尿病患者体内炎症指标是否存在差异研究甚少,在临床实践中,血细胞参数作为简单、应用广泛、价格低廉且易于获取的研究对象,如白细胞计数、中性粒细胞计数、中性粒细胞/淋巴细胞(NLR)、红细胞分布宽度、血小板/淋巴细胞比(PLR)等,已被佐证对ISR具有预测价值,我们应该更加重视血细胞参数的预测作用,通过研究糖尿病病程长短是否对其存在影响,实施早期预防策略,降低ISR发生,避免一部分严重的不良心血管事件。

NOTES

*通讯作者。

参考文献

[1] Van Camp, G. (2014) Cardiovascular Disease Prevention. Acta Clinica Belgica, 69, 407-411.
https://doi.org/10.1179/2295333714y.0000000069
[2] Serruys, P.W., Kutryk, M.J.B. and Ong, A.T.L. (2006) Coronary-Artery Stents. New England Journal of Medicine, 354, 483-495.
https://doi.org/10.1056/nejmra051091
[3] Gori, T. (2022) Restenosis after Coronary Stent Implantation: Cellular Mechanisms and Potential of Endothelial Progenitor Cells (A Short Guide for the Interventional Cardiologist). Cells, 11, Article 2094.
https://doi.org/10.3390/cells11132094
[4] Byrne, R.A., Joner, M. and Kastrati, A. (2015) Stent Thrombosis and Restenosis: What Have We Learned and Where Are We Going? The Andreas Grüntzig Lecture ESC 2014. European Heart Journal, 36, 3320-3331.
https://doi.org/10.1093/eurheartj/ehv511
[5] Ullrich, H., Olschewski, M., Münzel, T. and Gori, T. (2021) Coronary In-Stent Restenosis: Predictors and Treatment. Deutsches Ärzteblatt international, 118, 637-644.
https://doi.org/10.3238/arztebl.m2021.0254
[6] He, W., Xu, C., Wang, X., Lei, J., Qiu, Q., Hu, Y., et al. (2021) Development and Validation of a Risk Prediction Nomogram for In-Stent Restenosis in Patients Undergoing Percutaneous Coronary Intervention. BMC Cardiovascular Disorders, 21, Article No. 435.
https://doi.org/10.1186/s12872-021-02255-4
[7] Alfonso, F., Byrne, R.A., Rivero, F. and Kastrati, A. (2014) Current Treatment of In-Stent Restenosis. Journal of the American College of Cardiology, 63, 2659-2673.
https://doi.org/10.1016/j.jacc.2014.02.545
[8] Xi, H., Liu, J., Xu, T., Li, Z., Mou, X., Jin, Y., et al. (2023) Risk Investigation of In-Stent Restenosis after Initial Implantation of Intracoronary Drug-Eluting Stent in Patients with Coronary Heart Disease. Frontiers in Cardiovascular Medicine, 10, Article 1117915.
https://doi.org/10.3389/fcvm.2023.1117915
[9] Chambers, S.E.J., Pathak, V., Pedrini, E., Soret, L., Gendron, N., Guerin, C.L., et al. (2021) Current Concepts on Endothelial Stem Cells Definition, Location, and Markers. Stem Cells Translational Medicine, 10, S54-S61.
https://doi.org/10.1002/sctm.21-0022
[10] Kucukseymen, S. (2017) Inflammation Effects on Stent Restenosis. Angiology, 68, 741.
https://doi.org/10.1177/0003319717701659
[11] Amalia, M., Saputri, F.C., Sauriasari, R. and Widyantoro, B. (2023) Complete Blood Count, Lipid Profiles, and Inflammatory Markers Associated with Atherosclerotic Cardiovascular Disease in Patients with Diabetes. F1000Research, 12, Article 1470.
https://doi.org/10.12688/f1000research.131867.1
[12] Alamri, B.N., Bahabri, A., Aldereihim, A.A., et al. (2019) Hyperglycemia Effect on Red Blood Cells Indices. European Review for Medical & Pharmacological Sciences, 23, 2139-2150.
https://doi.org/10.26355/eurrev_201903_17259
[13] Poznyak, A., Grechko, A.V., Poggio, P., Myasoedova, V.A., Alfieri, V. and Orekhov, A.N. (2020) The Diabetes Mellitus-Atherosclerosis Connection: The Role of Lipid and Glucose Metabolism and Chronic Inflammation. International Journal of Molecular Sciences, 21, Article 1835.
https://doi.org/10.3390/ijms21051835
[14] Mortaş, T., Arikan Durmaz, Ş., Sezen, Ş.C. and Savranlar, Y. (2021) Assessment of Erythrocyte Morphology in Patients with Type 2 Diabetes Mellitus: A Pilot Study of Electron Microscopy-Based Analysis in Relation to Healthy Controls. Turkish Journal of Medical Sciences, 51, 2534-2542.
https://doi.org/10.3906/sag-2103-336
[15] Geng, N., Su, G., Wang, S., Zou, D., Pang, W. and Sun, Y. (2019) High Red Blood Cell Distribution Width Is Closely Associated with In-Stent Restenosis in Patients with Unstable Angina Pectoris. BMC Cardiovascular Disorders, 19, Article No. 175.
https://doi.org/10.1186/s12872-019-1159-3
[16] Xiong, K., Xu, C., Shou, X. and Dong, M. (2023) Relation of Red Cell Distribution Width to Glucose Metabolism and Adverse Long-Term Prognosis in Patients with Acute Coronary Syndrome. Diabetes, Metabolic Syndrome and Obesity, 16, 61-70.
https://doi.org/10.2147/dmso.s395923
[17] Kawabe, A., Yasu, T., Morimoto, T., Tokushige, A., Momomura, S., Sakakura, K., et al. (2021) WBC Count Predicts Heart Failure in Diabetes and Coronary Artery Disease Patients: A Retrospective Cohort Study. ESC Heart Failure, 8, 3748-3759.
https://doi.org/10.1002/ehf2.13513
[18] Narjis, M., Noreen, M., Safi, S.Z., Ilahi, N.E., Alomar, S.Y. and Alkhuriji, A.F. (2021) Cross Talk between Complete Blood Count and Progression of Type II Diabetes Mellitus. Journal of King Saud UniversityScience, 33, Article 101492.
https://doi.org/10.1016/j.jksus.2021.101492
[19] Balta, S., Celik, T., Mikhailidis, D.P., Ozturk, C., Demirkol, S., Aparci, M., et al. (2015) The Relation between Atherosclerosis and the Neutrophil-Lymphocyte Ratio. Clinical and Applied Thrombosis/Hemostasis, 22, 405-411.
https://doi.org/10.1177/1076029615569568
[20] Chen, J., Chen, M., Li, S., Guo, Y., Zhu, C., Xu, R., et al. (2014) Usefulness of the Neutrophil-to-Lymphocyte Ratio in Predicting the Severity of Coronary Artery Disease: A Gensini Score Assessment. Journal of Atherosclerosis and Thrombosis, 21, 1271-1282.
https://doi.org/10.5551/jat.25940
[21] Duffy, B.K., Gurm, H.S., Rajagopal, V., Gupta, R., Ellis, S.G. and Bhatt, D.L. (2006) Usefulness of an Elevated Neutrophil to Lymphocyte Ratio in Predicting Long-Term Mortality after Percutaneous Coronary Intervention. The American Journal of Cardiology, 97, 993-996.
https://doi.org/10.1016/j.amjcard.2005.10.034
[22] Zouridakis, E.G., Garcia-Moll, X. and Kaski, J.C. (2000) Usefulness of the Blood Lymphocyte Count in Predicting Recurrent Instability and Death in Patients with Unstable Angina Pectoris. The American Journal of Cardiology, 86, 449-451.
https://doi.org/10.1016/s0002-9149(00)00963-2
[23] Yi, N., Chen, S., Ma, A., Chen, P., Yao, B., Liang, T., et al. (2012) Tunicamycin Inhibits PDGF‐BB‐Induced Proliferation and Migration of Vascular Smooth Muscle Cells through Induction of HO‐1. The Anatomical Record, 295, 1462-1472.
https://doi.org/10.1002/ar.22539
[24] Huczek, Z., Filipiak, K.J., Kochman, J., Michalak, M., Roik, M., Piatkowski, R., et al. (2010) Baseline Platelet Size Is Increased in Patients with Acute Coronary Syndromes Developing Early Stent Thrombosis and Predicts Future Residual Platelet Reactivity. A Case-Control Study. Thrombosis Research, 125, 406-412.
https://doi.org/10.1016/j.thromres.2009.09.003
[25] Li, L., Qu, C., Wu, X., Dai, J., Lu, Y., Gong, Y., et al. (2017) Patterns and Levels of Platelet Glycosylation in Patients with Coronary Heart Disease and Type 2 Diabetes Mellitus. Journal of Thrombosis and Thrombolysis, 45, 56-65.
https://doi.org/10.1007/s11239-017-1573-2
[26] Li, C., Shen, Y., Xu, R., Dai, Y., Chang, S., Lu, H., et al. (2018) Evaluation of Preprocedural Laboratory Parameters as Predictors of Drug-Eluting Stent Restenosis in Coronary Chronic Total Occlusion Lesions. Angiology, 70, 272-278.
https://doi.org/10.1177/0003319717752245
[27] Shumilah, A.M., Othman, A.M. and Al-Madhagi, A.K. (2021) Accuracy of Neutrophil to Lymphocyte and Monocyte to Lymphocyte Ratios as New Inflammatory Markers in Acute Coronary Syndrome. BMC Cardiovascular Disorders, 21, Article No. 422.
https://doi.org/10.1186/s12872-021-02236-7
[28] Song, F.H., Zheng, Y.Y., Tang, J.N., et al. (2021) A Correlation between Monocyte to Lymphocyte Ratio and Long-Term Prognosis in Patients with Coronary Artery Disease after PCI. Clinical and Applied Thrombosis/Hemostasis, 27.
https://doi.org/10.1177/1076029621999717
[29] Unal, E.U., Ozen, A., Kocabeyoglu, S., Durukan, A.B., Tak, S., Songur, M., et al. (2013) Mean Platelet Volume May Predict Early Clinical Outcome after Coronary Artery Bypass Grafting. Journal of Cardiothoracic Surgery, 8, Article No. 91.
https://doi.org/10.1186/1749-8090-8-91
[30] Guthikonda, S., Lev, E.I., Patel, R., Delao, T., Bergeron, A.L., Dong, J.‐F., et al. (2007) Reticulated Platelets and Uninhibited COX‐1 and COX‐2 Decrease the Antiplatelet Effects of Aspirin. Journal of Thrombosis and Haemostasis, 5, 490-496.
https://doi.org/10.1111/j.1538-7836.2007.02387.x
[31] Guthikonda, S., Alviar, C.L., Vaduganathan, M., Arikan, M., Tellez, A., DeLao, T., et al. (2008) Role of Reticulated Platelets and Platelet Size Heterogeneity on Platelet Activity after Dual Antiplatelet Therapy with Aspirin and Clopidogrel in Patients with Stable Coronary Artery Disease. Journal of the American College of Cardiology, 52, 743-749.
https://doi.org/10.1016/j.jacc.2008.05.031
[32] Choi, D., Kang, S. and Song, H. (2016) Mean Platelet Volume: A Potential Biomarker of the Risk and Prognosis of Heart Disease. The Korean Journal of Internal Medicine, 31, 1009-1017.
https://doi.org/10.3904/kjim.2016.078
[33] Rechciński, T., Jasińska, A., Foryś, J., Krzemińska-Pakuła, M., Wierzbowska-Drabik, K., Plewka, M., et al. (2013) Prognostic Value of Platelet Indices after Acute Myocardial Infarction Treated with Primary Percutaneous Coronary Intervention. Cardiology Journal, 20, 491-498.
https://doi.org/10.5603/cj.2013.0134
[34] Sansanayudh, N., Anothaisintawee, T., Muntham, D., McEvoy, M., Attia, J. and AmmarinThakkinstian, (2014) Mean Platelet Volume and Coronary Artery Disease: A Systematic Review and Meta-Analysis. International Journal of Cardiology, 175, 433-440.
https://doi.org/10.1016/j.ijcard.2014.06.028
[35] Yang, A., Pizzulli, L. and Lüderitz, B. (2006) Mean Platelet Volume as Marker of Restenosis after Percutaneous Transluminal Coronary Angioplasty in Patients with Stable and Unstable Angina Pectoris. Thrombosis Research, 117, 371-377.
https://doi.org/10.1016/j.thromres.2005.04.004
[36] Chai, D., Yang, X., Wang, A., et al. (2022) Usefulness of Platelet Distribution Width and Fibrinogen in Predicting In-Stent Restenosis with Stable Angina and Type 2 Patients with Diabetes Mellitus. Frontiers in Cardiovascular Medicine, 9, Article 710804.
https://doi.org/10.3389/fcvm.2022.710804
[37] Bekler, A., Ozkan, M.T.A., Tenekecioglu, E., Gazi, E., Yener, A.U., Temiz, A., et al. (2014) Increased Platelet Distribution Width Is Associated with Severity of Coronary Artery Disease in Patients with Acute Coronary Syndrome. Angiology, 66, 638-643.
https://doi.org/10.1177/0003319714545779
[38] Liu, R., Gao, F., Huo, J. and Yi, Q. (2011) Study on the Relationship between Mean Platelet Volume and Platelet Distribution Width with Coronary Artery Lesion in Children with Kawasaki Disease. Platelets, 23, 11-16.
https://doi.org/10.3109/09537104.2011.586073