平均血小板体积对回旋支病变的预测作用  

The value of mean platelet volume in predicting left circumflex artery as culprit vessel in patients with myocardial infarction

作　　者：牛少辉[1] 张丽华[1] 简立国[1] 沈桂彬[1] 顾国萍[1] 刘旭邦[1] 陈杰[1] 

机构地区：[1]郑州大学第二附属医院心内科,郑州450014

出　　处：《中华急诊医学杂志》2013年第7期716-720,共5页Chinese Journal of Emergency Medicine

摘　　要：目的探讨平均血小板体积（MPV）对急性非sT段抬高型心肌梗死（NSTEMI）患者回旋支病变的预测价值。方法连续收集2009年1月1日至2011年6月30日因NSTEMI入住郑州大学第二附属医院并且行冠状动脉造影检查的患者，入院时记录所有研究对象的临床资料，检测脑钠肽（BNP）、血常规、心肌损伤标志物等指标。入选患者全部接受冠状动脉造影检查，均有明确的梗死相关动脉。根据造影结果分为回旋支（LCX）病变组与非回旋支病变组。结果符合入选条件患者共184例，其中LCX病变患者68例，非LCX病变患者116例。LCX病变患者中既往行经皮冠状动脉介入治疗的患者的比例较低，人院时BNP水平较低，而吸烟患者比例和人院时MPV水平较高。其他主要临床特征和实验室检查指标差异无统计学意义。MPV预测回旋支病变的受试者工作特征曲线（ROC）下面积为0．75（95％CI：0．675-0．826），当MPV取9．15fL时，敏感度为83．8％，特异度为63．8％。多因素Logistic回归分析显示MPV是LCX病变的危险因素（OR=1．32，95％CI：1．031—1．688，P〈n05）。结论MPV是NSTEMI患者LCX病变的危险因素。Objective To evaluate the value of mean platelet volume （MPV） in identifying the location of infarct at left circumflex artery （LCX） in patients with non-ST-elevation myocardial infarction （NSTEMI）. Methods In this retrospective study, 184 consecutive patients with NSTEMI were eligible to be enrolled from January 1, 2009 to June 30, 2011 and laboratory examinations including platelet count, B-type natrinretic peptide （BNP）, troponins test （TnI）, C-reactive protein and serum creatinine （SCr） were done. The demographics and detailed history of patients were documented. In addition, left ventricular ejection fraction （LVEF） test and coronary angiography to determine the culprit vessel implicating in infarction were carried out in all enrolled patients. The patients were categorized into LCX group and N-LCX group according to culprit vessel. Results Of 184 patients, 68 patients were in LCX group and 116 patients had left anterior descending artery （LAD） lesion or right coronary artery （RCA） lesion. High percent of LCX infarction were found in patients with high MPV level and low BNP level, and in smokers. And lower proportion of those patients had previous percutaneous coronary artery intervention. The results showed that MPV was larger in patients with LCX infarction than that in patients with LAD or RCA. Receiver operating characteristic curve showed the area under curve was 0. 75 （95% CI： 0. 675-0. 826）. An optimized cut off point at 9. 15 fL of MPV showed 83. 8% sensitivity and 63. 8% specificity for prediction of LCX infarction. Multivariate analysis also showed that MPV was the only independent predictor of a LCX infarction in patients with NSTEMI [ OR = 1.32, （95% CI： 1.031-1.688）, P 〈 0. 05 t. Conclusions MPV was the only independent factor associated with LCX infarction in patients with NSTEMI.

关 键 词：平均血小板体积 心肌梗死 梗死相关动脉 回旋支 

分 类 号：R542.22[医药卫生—心血管疾病]