急性心肌梗死PCI术后近期MACE的危险因素及血小板功能参数的预测作用  

Risk factors of MACE and the predictive effect of platelet function parameters in the near future after PCI in patients with acute myocardial infarction

作　　者：闫洁[1] 袁森[2] YAN Jie;YUAN Sen(Department of Geriatrics,Xi'an North Hospital,Xi'an,Shaanxi 710043,China;Department of Cardiovascular Medicine,Xi'an North Hospital,Xi'an,Shaanxi 710043,China)

机构地区：[1]西安市北方医院老年病科,陕西省西安市710043 [2]西安市北方医院心血管内科,陕西省西安市710043

出　　处：《中国动脉硬化杂志》2020年第12期1065-1072,共8页Chinese Journal of Arteriosclerosis

基　　金：陕西省西安市科学技术计划项目(2020yb70)。

摘　　要：目的探讨急性心肌梗死患者经皮冠状动脉介入治疗(PCI)术后近期主要不良心血管事件(MACE)的危险因素及血小板功能参数对其的预测作用。方法回顾性分析行PCI手术的184例急性心肌梗死患者的临床病历资料,均于术前、术后3天及术后14天行血小板功能检测。根据术后6月内MACE发生情况将所有患者分为发生MACE组与未发生MACE组,对比两组术后血小板功能相关指标水平,并采用Logistic回归分析法分析PCI术后血小板功能(术后3天与基线变化量用Δ表示,术后14天与基线的变化量用Δ′表示)对急性心肌梗死PCI术后发生MACE的影响,另使用受试者工作特征(ROC)曲线评估血小板功能对患者PCI术后近期MACE发生的预测价值。结果术后3天及14天的血小板α颗粒膜糖蛋白(CD62P)、血小板膜糖蛋白GpⅡb/Ⅲa复合物(PAC-1)、血小板最大聚集率及平均血小板体积(MPV)/血小板计数(P)均低于术前,术后14天均低于术后3天,差异均有统计学意义(P<0.05);经Logistic回归分析发现,老年、多个部位梗死、病变支数≥2支、左心室射血分数(LVEF)<50%、高血压、糖尿病、高脂血症、PCI术后慢/无复流、PCI术后CD62P、术后PAC-1、术后血小板最大聚集率、术后MPV/P比值均是急性心肌梗死PCI术后近期MACE发生的危险因素(P<0.05);经ROC分析,ΔCD62P、ΔPAC-1、Δ血小板最大聚集率、ΔMPV/P单项及联合预测近期MACE发生的AUC分别为0.731、0.737、0.759、0.751、0.871;(ΔCD62P)′、(ΔPAC-1)′、(Δ血小板最大聚集率)′、(ΔMPV/P)′单项及联合预测近期MACE发生的AUC分别为0.756、0.763、0.774、0.749、0.865。结论急性心肌梗死PCI术后血小板功能活性增强以及合并高血压、糖尿病、高脂血症以及PCI术后慢/无复流等均可增加术后近期MACE的发生风险,且术后血小板功能参数对术后近期发生MACE具有一定的预测价值。Aim To investigate the risk factors of recent main adverse cardiovascular events(MACE) in patients with acute myocardial infarction(AMI) after percutaneous coronary intervention(PCI) and the predictive effect of platelet function parameters. Methods The clinical data of 184 patients with AMI who underwent PCI were retrospectively analyzed, and the platelet function were detected in the disease group before, 3 d after and 14 d after operation. All patients were divided into the occurrence group and the non-occurrence group according to the occurrence of MACE within 6 months after operation, and the levels of platelet function related indicators were compared between the two groups, then the influences of platelet function after PCI(the change of 3 d after operation and baseline expressed with Δ, and the change of 14 d after operation and baseline expressed with Δ′) on MACE after PCI in patients with AMI were analyzed by Logistic regression analysis method,and receiver operating characteristic(ROC) curve was used to evaluate the predictive value of platelet function on the occurrence of MACE in patients after PCI. Results The platelet α granular membrane glycoprotein(CD62 P), platelet membrane glycoprotein GpⅡb/Ⅲa complex(PAC-1), maximum platelet aggregation rate, mean platelet volume(MPV)/platelet count(P) at 3 d after PCI and 14 d after PCI were higher than those before PCI, which were higher at 14 d after PCI than those at 3 d after PCI, and differences were statistically significant(P<0.05). Logistic regression analysis showed that the elderly, multiple site infarction, lesion branches≥2 branches, left ventricular ejection fraction(LVEF)<50%, hypertension, diabetes mellitus, hyperlipidemia, slow/no reflow after PCI, CD62 P after PCI, PAC-1 after PCI, the maximum platelet aggregation rate after PCI, MPV/P after PCI were risk factors for the occurrence of MACE in patients with AMI after PCI(P<0.05). According to ROC analysis, the AUC of ΔCD62 P,ΔPAC-1,Δmaximum platelet aggregation rate and ΔMPV/P s

关 键 词：急性心肌梗死 经皮冠状动脉介入治疗 血小板功能 主要不良心血管事件 

分 类 号：R542.2[医药卫生—心血管疾病]