平均血小板体积与血小板计数比值和白细胞计数与 ST 段抬高型心肌梗死患者择期经皮冠状动脉腔内支架植入术后住院病死率的相关性研究  

Association between Ratio of Mean Platelet Volume to Platelet Count and White Blood Cell Count and In- hospital Mortality of ST- segment Elevation Myocardial Infarction with Selective Percutaneous Coronary Intervention

作　　者：王春明[1] 李东泽[1] 杨毅宁[1,2,3] 马依彤[1,2] 李晓梅[1] 潘硕[1] 陈铀[1] 

机构地区：[1]新疆医科大学第一附属医院心脏中心冠心病一科,新疆乌鲁木齐市830054 [2]新疆医科大学新疆心血管病研究重点实验室 [3]新疆医科大学临床医学研究院

出　　处：《中国全科医学》2015年第3期269-273,共5页Chinese General Practice

基　　金：国家自然科学基金资助项目(81160042);教育部新世纪优秀人才支持计划(NCET-11-1074)

摘　　要：目的探讨平均血小板体积(MPV)与血小板计数(PLT)比值(MPV/PLT)和白细胞计数(WBC)对ST段抬高型心肌梗死(STEMI)晚期血运重建经皮冠状动脉腔内支架植入(PCI)术后患者住院死亡的预测价值。方法回顾性分析2009年11月—2013年8月在新疆医科大学第一附属医院住院的STEMI患者660例,其中死亡88例(死亡组),生存572例(生存组)。收集一般资料、血压、左心室射血分数(LVEF)及冠状动脉狭窄情况;采用ROC曲线判断入院时MPV/PLT及WBC预测住院死亡的临床最佳截点;采用Logistic回归分析STEMI晚期血运重建PCI术后住院死亡的影响因素。结果死亡组患者MPV/PLT〔0.052(0.037)〕高于生存组〔0.045(0.022),u=-4.629,P<0.001〕;死亡组患者WBC〔12.25(9.30)×109/L〕高于生存组〔8.22(4.49)×109/L,u=-8.561,P<0.001〕。采用ROC判断STEMI晚期血运重建PCI术后患者住院死亡的MPV/PLT、WBC临床最佳截点分别为0.047、9.28×109/L。MPV/PLT>和≤0.047的晚期血运重建PCI术后患者病死率分别为19.2%(60/313)和8.1%(28/347),差异有统计学意义(χ2=17.547,P<0.001);WBC>和≤9.28×109/L的晚期血运重建PCI术后患者病死率分别为22.6%(64/283)和6.4%(24/377),差异有统计学意义(χ2=36.935,P<0.001)。Logistic回归分析结果显示,MPV/PLT〔OR=2.665,95%CI(1.632,4.351),P=0.027〕和WBC〔OR=4.258,95%CI(2.572,7.049),P=0.015〕为STEMI晚期血运重建PCI术后患者住院死亡的独立影响因素。结论 MPV/PLT>0.047和WBC>9.28×109/L均为STEMI患者晚期血运重建PCI术后住院死亡独立危险因素,并且对STEMI患者晚期血运重建PCI术后住院死亡有较高的预测价值。Objective To study the association between ratio（ MPV/ PLT）of mean platelet volume（ MPV）to platelet count（PLT）and white blood cell count（ WBC）and in - hospital mortality of ST - segment elevation myocardial infarction（STEMI）with selective percutaneous coronary intervention（ PCI）. Methods 660 STEMI patients admitted to the First Affiliated Hospital of Xinjiang Medical University from November 2009 to August 2013 were retrospectively analyzed. Among the patients,88 of them died,572 of them survived. The clinical data of the patients were collected,including general information,blood pressure,left ventricular ejection fraction（LVEF） and coronary artery stenosis. The best clinical cut - off values of MPV/ PLT and WBC for in - hospital mortality were found by ROC curve. The influencing factors for the in - hospital mortality of advanced STEMI after PCI were analyzed by Logistic regression analysis. Results The MPV/ PLT ratio〔0. 052 （0. 037）vs. 0. 045（0. 022）,u = - 4. 629,P ﹤ 0. 001〕and WBC〔12. 25（9. 30）× 10^9 / L vs. 8. 22（4. 49） ×10^9 / L,u= - 8. 561,P ﹤ 0. 001〕of the dead patients were higher than the survivors with statistically significant differences. The cut - off values of MPV/ PLT ratio and WBC were 0. 047 and 9. 28 ×10^9 / L,respectively. The mortality of patients with more than and less than the cut - off values of MPV/ PC ratio were 19. 2% （60 / 313）and 8. 1% （28 / 347）respectively with statistically significant differences（χ2 = 17. 547,P ﹤ 0. 001）. The mortality of patients with more than and less than the cut - off values of WBC were 22. 6% （64 / 283 ） and 6. 4% （ 24 / 377 ） with statistically significant differences（ χ2 = 36. 935,P ﹤ 0. 001 ） . Logistic regression analysis showed that MPV/ PLT ratio〔OR = 2. 665,95% CI（1. 632,4. 351）,P = 0. 027〕and WBC〔OR = 4. 258, 95% CI（2. 572,7. 049）,P = 0. 015〕were independent risk factors for the in - hospital mortality of advanced STEMI patients with PCI. Conclus

关 键 词：心肌梗死 血小板计数 白细胞计数 血管成形术 经腔 经皮冠状动脉 医院死亡率 

分 类 号：R542.22[医药卫生—心血管疾病]