血小板与淋巴细胞比值对新疆STEMI患者直接PCI术后无复流及短期预后的预测价值  

Predictive value of PLR in STEMI patients with no reflow and short-term prognosis after PPCI

作　　者：伊尔夏提·吐逊江 哈斯达尔·米地里别克 何鹏义[1] 刘志强[1] 杨玉春[1] 张雷[1] 努尔比亚·阿斯哈尔 木胡牙提[1] YIERXIATI Tuxunjiang;HASIDAER Midilibieke;HE Pengyi;LIU Zhiqiang;YANG Yuchun;ZHANG Lei;NVERBIYA Asier;MUHUYATI(The First Affiliated Hospital of Xinjiang Medical University,Urumqi,Xinjiang,830054,China)

机构地区：[1]新疆医科大学第一附属医院,乌鲁木齐830054

出　　处：《临床心血管病杂志》2020年第4期341-346,共6页Journal of Clinical Cardiology

基　　金：国家自然科学基金项目(No:81560062)。

摘　　要：目的:评估新型预测因子血小板/淋巴细胞比值(PLR)对直接经皮冠状动脉介入治疗(PPCI)的ST段抬高型心肌梗死(STEMI)患者术后无复流及院内心血管不良事件(MACE)的价值。方法:纳入159例从2015-04-01-2017-12-30新疆医科大学第一附属医院收治的发病12h内,并行PPCI的STEMI患者,根据术后血流情况分为正常血流组(TIMI 3级,120例)和无复流组(TIMI≤2级,39例),比较两组临床资料,通过Logistic多因素回归分析STEMI患者PPCI术后无复流的独立危险因素,绘制ROC曲线评价PLR对无复流的预测价值。再进一步比较两组术后院内MACE差异,从而评价PLR与MACE的相关性。结果:STEMI患者术后心肌无有效再灌注达39例(24.5%)。无复流组Gensini评分高,且空腹血糖、血小板计数、吸栓导管使用、IABP植入及PLR高于正常血流组(P<0.05)。经多因素Logistic回归分析,PLR是术后心肌无复流的独立预测因子(OR=6.443,95%CI:2.793~14.862,P<0.001)。通过ROC曲线分析出当PLR>158.58时,曲线下面积为0.697(P<0.001,95%CI:0.599~0.796)对无复流敏感度为71.8%,特异度为70.0%。对两组术后MACE事件分析得出,无复流组住院期间心力衰竭发生率高于正常血流组(P<0.05)。结论:术前高PLR可能是STEMI患者术后心肌无复流的独立预测因素。Objective:To evaluate the role of a new predictor,platelet/lymphocyte ratio(PLR),in ST-segment Elevation Myocardial Infarction(STEMI)patients with no reflow and major adverse cardiovascular events(MACE)after primary percutaneous coronary intervention(PPCI).Method:This study enrolled 159patients with STEMI from April 1st 2015to December 30th 2017,in the First Affiliated Hospital of Xinjiang Medical University.According to their postoperative TIMI flow grades,there were 120patients in normal group and 39patients in control(non-reflow)group.Independent risk factor of non-reflow in STEMI patients after PPCI was determined by multivariate Logistic regression analysis,and the predictive value of PLR for non-reflow was evaluated by ROC curve.Furthermore,the occurrence of MACE between two groups was compared in order to investigate their correlation.Result:Invalid myocardial reperfusion was occurred in 39patients with STEMI(24.5%)after PPCI.Compared with the normal group,Gensini score,fasting blood glucose,thrombus aspiration,IABP,platelet count and PLR were significantly higher in non-reflow group(all P<0.05).Multivariate Logistic regression analysis revealed that PLR was an independent risk factor for the occurrence of non-reflow(OR=6.443,95%CI:2.793-14.862,P<0.001).ROC curve analysis showed that PLR level was greater than 158.58,and the area under the curve was 0.697(P<0.001,95%CI:0.599-0.796),which indicates sensitivity and specificity for non-reflow after PPCI were 71.8%and 70.0%,respectively.The comparison of MACE among two groups after PPCI showed that the incidence of heart failure in non-reflow group was higher than that of normal group during their hospital stay.Conclusion:PLR can be used as an independent risk factor for STEMI patients with no reflow after PPCI.

关 键 词：血小板/淋巴细胞比值 心肌无复流 ST段抬高型心肌梗死 

分 类 号：R542.2[医药卫生—心血管疾病]