血小板分布宽度联合休克指数对急性心肌梗死患者长期预后的预测价值
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摘要
目的探究血小板分布宽度(platelet distribution width,PDW)联合休克指数(shock index,SI)对急性心肌梗死患者长期预后的预测价值。方法选取2011年3月-2013年3月于本院就诊的急性心肌梗死患者1 094例,随访5年,根据是否发生终点事件,分为预后良好组(G组,n=894)和预后不良组(P组,n=174),通过Cox回归分析急性心肌梗死患者长期预后的影响因素,分析SI和PDW及两者联合评估急性心肌梗死患者长期预后的敏感度和特异度。结果平均随访时间(47.35±8.57)个月,失访26例(2.38%)。COX回归结果显示PDW(HR:1.53;95%CI:1.193～1.962)和SI(HR:1.47;95%CI:1.089～1.984)均是影响AMI预后的独立危险因素;PDW联合SI对AMI预后评估的AUC显著高于SI和PDW(AUC,0.947 vs 0.863和0.765),敏感度为75.5%,特异度为100%。结论 PDW联合SI预测AMI预后的敏感度高,值得临床推广使用。
Objective To investigate the value of platelet distribution width(PDW) combined with shock index(SI) in predicting prognosis of acute myocardial infarction(AMI). Methods A total of 1 094 patients with acute myocardial infarction admitted to our hospital from March 2011 to March 2013 were followed up for ?ve years. According to the endpoint events, they were divided into good prognosis group(G group, n=894) and poor prognosis group(P group, n=174). The in?uencing factors of long-term prognosis of patients with acute myocardial infarction were explored by Cox regression. The sensitivity and speci?city of SI and PWD and their combination in assessing long-term prognosis were analyzed. Results The mean follow-up time was(47.35±8.57) months. Twentysix(2.38%) patients were lost to follow up. Cox regression showed that both PDW(HR, 1.53; 95% CI, 1.193-1.962) and SI(HR,1.47; 95% CI, 1.089-1.984) were independent predictors for the prognosis of AMI. The sensitivity and speci?city of PDW combined with SI in evaluating prognosis of AMI were 75.5% and 100%, and AUC was signi?cantly higher than that of SI and PDW(AUC,0.947 vs 0.863 and 0.765). Conclusion PDW combined with SI has high sensitivity in predicting the prognosis of AMI, which is worthy of clinical application.
Objective To investigate the value of platelet distribution width(PDW) combined with shock index(SI) in predicting prognosis of acute myocardial infarction(AMI). Methods A total of 1 094 patients with acute myocardial infarction admitted to our hospital from March 2011 to March 2013 were followed up for ?ve years. According to the endpoint events, they were divided into good prognosis group(G group, n=894) and poor prognosis group(P group, n=174). The in?uencing factors of long-term prognosis of patients with acute myocardial infarction were explored by Cox regression. The sensitivity and speci?city of SI and PWD and their combination in assessing long-term prognosis were analyzed. Results The mean follow-up time was(47.35±8.57) months. Twentysix(2.38%) patients were lost to follow up. Cox regression showed that both PDW(HR, 1.53; 95% CI, 1.193-1.962) and SI(HR,1.47; 95% CI, 1.089-1.984) were independent predictors for the prognosis of AMI. The sensitivity and speci?city of PDW combined with SI in evaluating prognosis of AMI were 75.5% and 100%, and AUC was signi?cantly higher than that of SI and PDW(AUC,0.947 vs 0.863 and 0.765). Conclusion PDW combined with SI has high sensitivity in predicting the prognosis of AMI, which is worthy of clinical application.
引文
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14张妮,向定成,张金霞,等.吸烟对不同性别、年龄人群急性ST段抬高型心肌梗死发病风险的相关性研究[J].中国循环杂志,2016,31(9):858-861.
15 Menotti A,Lanti M.Coronary risk factors predicting early and late coronary deaths[J].Heart,2003,89(1):19-24.
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18杨帆,肖伟,楚小锋,等.红细胞分布宽度与静脉溶栓治疗急性心肌梗死疗效的相关性[J].解放军医学院学报,2015,36(4):329-332.
19 Spyridopoulos I,Noman A,Ahmed JM,et al.Shock-index as a novel predictor of long-term outcome following primary percutaneous coronary intervention[J].Eur Heart J Acute Cardiovasc Care,2015,4(3):270-277.
20 Cetin EHO,Cetin MS,Akdi A,et al.Response to the letter concerning the article:"Platelet distribution width and plateletcrit:novel biomarkers of ST elevation myocardial infarction in young patients"[J].Kardiol Pol,2018,76(1):228.
2 Betgem RP,de Waard GA,Nijveldt R,et al.Intramyocardial haemorrhage after acute myocardial infarction[J].Nat Rev Cardiol,2015,12(3):156-167.
3 Granger CB,Goldberg RJ,Dabbous O,et al.Predictors of hospital mortality in the global registry of acute coronary events[J].Arch Intern Med,2003,163(19):2345-2353.
4 Qin C,Zhang H,Gu J,et al.Dynamic monitoring of platelet activation and its role in post-dissection inflammation in a canine model of acute type A aortic dissection[J].J Cardiothorac Surg,2016,11(1):86.
5刘元税,宋维,张蕾蕾,等.休克指数和修正休克指数评估心脏骤停自主循环恢复患者的预后[J].中华急诊医学杂志,2014,23(10):1127-1131.
6中华医学会心血管病学分会,中华心血管病杂志编辑委员会.急性ST段抬高型心肌梗死诊断和治疗指南[J].中华心血管病杂志,2015,38(5):380-393.
7陈冬生,栾献亭,杨进刚,等.中国急性心肌梗死不同Kilip分级患者的临床特征、治疗和预后情况分析[J].中国循环杂志,2016,31(9):849-853.
8陈伟伟.中国心血管病报告2015[J].中华医学信息导报,2016,31(12):11.
9 Lloyd-Jones D,Adams RJ,Brown TM,et al.Executive summary:heart disease and stroke statistics--2010 update:a report from the American Heart Association[J].Circulation,2010,121(7):948-954.
10中华医学会心血管病学分会.心血管疾病防治指南和共识-2013[M].北京:人民卫生出版社,2013.
11 Paradela-Dobarro B,Raposeiras-Roubin S,Rodino-Janeiro BK,et al.Statins modulate feedback regulation mechanisms between advanced glycation end-products and C-reactive protein:evidence in patients with acute myocardial infarction[J].Eur J Pharm Sci,2013,49(4):512-518.
12宋克玉,吴旭平.降钙素原、C反应蛋白和白细胞联合检测在主动脉夹层和急性心肌梗死鉴别诊断中的意义[J].解放军医学院学报,2018,39(9):778-781.
13高晓津,杨进刚,杨跃进,等.中国急性心肌梗死患者不同年龄组心血管危险因素分析[J].中华医学杂志,2016,96(40):3251-3256.
14张妮,向定成,张金霞,等.吸烟对不同性别、年龄人群急性ST段抬高型心肌梗死发病风险的相关性研究[J].中国循环杂志,2016,31(9):858-861.
15 Menotti A,Lanti M.Coronary risk factors predicting early and late coronary deaths[J].Heart,2003,89(1):19-24.
16 Khosoosi Niaki MR,Hamid M,Farshidi F,et al.Evaluation of the role of opium addiction in acute myocardial infarction as a risk factor[J].Caspian J Intern Med,2013,4(1):585-589.
17汪雁博,傅向华,王学超,等.血小板分布宽度对急性心肌梗死冠状动脉介入治疗中无复流的预测价值[J].临床心血管病杂志,2012,28(5):338-341.
18杨帆,肖伟,楚小锋,等.红细胞分布宽度与静脉溶栓治疗急性心肌梗死疗效的相关性[J].解放军医学院学报,2015,36(4):329-332.
19 Spyridopoulos I,Noman A,Ahmed JM,et al.Shock-index as a novel predictor of long-term outcome following primary percutaneous coronary intervention[J].Eur Heart J Acute Cardiovasc Care,2015,4(3):270-277.
20 Cetin EHO,Cetin MS,Akdi A,et al.Response to the letter concerning the article:"Platelet distribution width and plateletcrit:novel biomarkers of ST elevation myocardial infarction in young patients"[J].Kardiol Pol,2018,76(1):228.