基线血小板-白细胞聚集体水平对NSTE-ACS患者近期预后的预测价值  

Predictive value of admission platelet-leukocyte-aggregate to the short-term major adverse cardiac events in patients with non-ST-segment elevation acute coronary syndrome

作　　者：李晓明[1] 王舒莹[2] 刘震岳[2] 张建民[2] 王平[2] 

机构地区：[1]承德医学院附属医院检验科,河北承德067000 [2]承德医学院附属医院输血科,河北承德067000

出　　处：《中国现代医学杂志》2014年第6期38-42,共5页China Journal of Modern Medicine

摘　　要：目的探讨基线血小板-白细胞聚集体（PLA）水平对非ST段抬高型急性冠状动脉综合征（NSTE-ACS）患者近期主要不良心脏事件（MACE）的预测价值。方法共纳入114例患者,其中NSTE-ACS组72例,对照（CTL）组42例,分析比较两组患者相关临床资料;采用全球急性冠状动脉事件注册（GRACE）评分将NST-ACS患者分为低危组和高危组,比较两组PLA、血小板-单核细胞聚集体（PMA）、血小板-中性粒细胞聚集体（PNA）及血小板-淋巴细胞聚集体（PlyA）水平,并对PLA、PMA、PNA及PlyA水平与GRACE评分分数进行Spearman相关性检验;对NST-ACS组患者近期（出院后8个月内）MACE进行随访,使用受试者工作特征（ROC）曲线评价基线PLA水平对NST-ACS患者近期MACE的预测价值。结果与CTL组相比,NST-ACS组PLA、PMA、PNA及PLyA均升高（P〈0.01）;高危组NSTE-ACS患者PLA、PMA、PNA及PLyA均较低危组明显升高（均P〈0.01）;NST-ACS患者GRACE评分分数与基线PLA、PMA、PNA及PlyA水平均成正相关（r值分别为0.597、0.634、0.487、0.435,P〈0.01）;经随访,共有13.89%的NSTE-ACS患者发生了近期MACE;入院时PLA水平预测NSTE-ACS组出院后8个月内MACE的ROC曲线下面积为0.753（95%CI：0.737~0.779,P〈0.01）。结论基线PLA水平升高可能预示NSTE-ACS患者的不稳定状态;基线PLA水平不但可用于NSTE-ACS患者的早期快速危险分层,还可对NSTE-ACS患者近期MACE进行预测。[Objective] To determine the predictive value of admission platelet-leukocyte-aggregate （PLA） to the major adverse cardiac events （MACE） in patients with non-ST-segment elevation acute coronary syndrome （NSTE- ACS）. [Methods] According to the clinical diagnosis, the 114 hospitalized patients were divided into two groups： the NSTE-ACS group （n =72） and the control （CTL） group （n =72）, the clinical data of the two groups were collected and analyzed. Further, the NST-ACS group were further divided into low-risk （LR） group （n =22） and high-risk （HR） group （n =50） according to the global registry of acute coronary events （GRACE） scores. The platelet-mono- cyte-aggregate （PMA）, the platelet-neutrophile-aggregate （PNA） and the platelet- lymphocyte-aggregate （PlyA） were compared in the LR group and HR group. Moreover, the correlations of PLA, PMA, PNA and PlyA to the GRACE scores were also evaluated, and the receiver operating characteristic （ROC） curve was used to assess the predictive value of PLA to the short-term MACE of patients with the NSTE-ACS. [Results] Compared to the CTL group, the PLA, PMA, PNA and PlyA were significantly higher in the NSTE-ACS group （all P 〈0.01）; the PLA, PMA, PNA and PlyA were also marked higher in the high-risk group than in the low-risk group （all P 〈0.01）; the spearman correla- tion analysis showed that the GRACE scores was positively correlated with PLA, PMA, PNA and PlyA （r =0.617, 0.634, 0.527, 0.492, respectively, all P 〈0.01）; during the follow up, the MACE occurred in 13.89% （10/72） NST- ACS patients; the ROC curve showed the area under curve （AUC） of on admission PLA was 0.753 （P 〈0.01, 95%CI： 0.737-0.779） to predict the short-term risk of MACE. [ Conclusions ] The PLA of admission is a significant predictor for the short-term MACE in patients with NSTE-ACS.

关 键 词：冠状动脉疾病 血小板-白细胞聚集体 血小板活化 预后 

分 类 号：R543.3[医药卫生—心血管疾病]