不同水平平均血小板容积对STEMI患者PCI术后心脏不良事件及预后的影响观察  

Effect of different levels of mean platelet volume on adverse cardiac events and prognosis in patients with ST-segment elevation myocardial infarction af-ter percutaneous coronary intervention

作　　者：邹宁[1] 王娜[2] 王皓 季春鹏[3] ZOU Ning;WANG Na;WANG Hao;JI Chunpeng(Department of Neurology,the Second Hospital of Qinhuangdao,Qinhuangdao Hebei 066600,China;Department of Cardiology,the Second Hospital of Qinhuangdao,Qinhuangdao Hebei 066600,China;Department of Cardiology,Tangshan Kailuan General Hospital,Tangshan Hebei 063000,China)

机构地区：[1]秦皇岛市第二医院神经内科,河北秦皇岛066600 [2]秦皇岛市第二医院心内三科,河北秦皇岛066600 [3]唐山市开滦总医院心内科,河北唐山063000

出　　处：《新疆医科大学学报》2021年第10期1154-1158,共5页Journal of Xinjiang Medical University

基　　金：河北省2021年度医学科学研究课题(20210746);秦皇岛市科学技术研究与发展计划(201902A085)。

摘　　要：目的研究不同水平平均血小板容积对急性ST段抬高型心肌梗死(ST-elevation myocaidi-al infraction,STEMI)患者经皮冠状动脉介入(Percutaneous coronary intervention,PCI)术后发生心脏不良事件及预后的影响。方法选取在秦皇岛市第二医院心内科2018年10月-2020年1月收治的120例STEMI患者为研究对象,所有患者PCI手术前静脉采血,根据平均血小板容积(Mean platelet vol-ume,MPV)水平分为:高MPV组、中MPV组和低MPV组,每组随机选取40例患者参与本研究。在术前对各组患者给予阿司匹林肠溶片300 mg和替格瑞洛片180mg进行抗凝治疗,术后次日每早空腹口服阿司匹林肠溶片(100 mg/次)和替格瑞洛片(90mg/次),每晚口服替格瑞洛片(90mg/次),服用1年时间。测定各组患者PCI术后MPV的水平,分析MPV水平与PCI术后不良心脏事件的相关性,并进行危险因素分析,各组患者术后随访1年进行生存曲线分析。结果与术前比较,高MPV组PCI术后MPV水平降低(P<0.05),中MPV组和低MPV组MPV水平术后与术前无明显差异(P>0.05)。与中MPV组和低MPV组比较,高MPV组的病变血管支数更多、梗死相关血管开通时间更长、无复流患者所占比例更高,差异均具有统计学意义(P<0.01),与低MPV组比较,中MPV组病变血管支数更多、梗死相关血管开通时间更长、无复流患者所占比例更高,差异均具有统计学意义(P<0.01)。3组患者随访1年后,与中MPV组和低MPV组比较,高MPV组的心源性死亡、心源性休克、非致死性心肌梗死、室颤、室速、卒中等不良事件发生率更高(P<0.05)。相关性分析显示,高容积MPV与病变血管支数、梗死相关血管开通时长及无复流数呈正相关(r=0.821、0.876、0.583,P<0.05)。高MPV组1年死亡曲线显著低于中MPV组和低MPV组。结论MPV水平的增加有可能引起PCI术后心脏不良事件且患者预后较差,MPV预测STEMI术后PCI心脏不良事件价值较高,值得在临床推广。Objective To study the effect of different levels of mean platelet volume on adverse cardiac events and prognosis in patients with ST-segment elevation myocardial infarction(STEMI)after percutaneous coronary intervention(PCI).Methods 120 patients with STEMI admitted to The Second Hospital of Qinhuangdao from October 2018 to Janu⁃ary 2020 were selected.All patients were collected venous blood before PCI.According to the mean platelet volume(MPV)level,they were randomly divided into three groups:high MPV group(n=40),medium MPV group(n=40)and low MPV group(n=40).Before operation,patients in each group were given aspirin enteric-coated tablets 300 mg and tigritol tablets 180 mg for anticoagulant treatment.The next day after operation,aspirin enteric-coated tablets(100 mg/time)and tigritol tablets(90 mg/time)were orally taken every morning and tigritol tablets(90 mg/time)every night for 1 year.MPV levels were compared,the correlation between MPV and adverse cardiac events after PCI was ana⁃lyzed,and the risk factors were analyzed.All patients were followed up for 1 year to plot Kaplan-Meier curve.Results Compared with the preoperative,the MPV level in high MPV group decreased after PCI(P<0.05),and there was no significant difference in the MPV level between medium MPV group and the low MPV group(P>0.05).Compared with medium MPV group and low MPV group,the number of diseased vessels in high MPV group was more,the opening time of infarct related vessels was longer,and the proportion of patients without reflow was higher(P<0.01).Com⁃pared with low MPV group,the number of diseased vessels in medium MPV group was more,the opening time of in⁃farct related vessels was longer,and the proportion of patients without reflow was higher(P<0.01).After 1-year fol⁃low-up,compared with medium MPV group and low MPV group,the incidence of non-fatal myocardial infarction,car⁃diac death,ventricular tachycardia,ventricular fibrillation,stroke and cardiogenic shock in high volume MPV group was higher(P<0.05).Univariate correlati

关 键 词：平均血小板容积 STEMI PCI术后 心脏不良事件 预测价值 

分 类 号：R558[医药卫生—血液循环系统疾病]