MPVLR对急性ST段抬高型心肌梗死患者直接PCI术后无复流的预测价值
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摘要
目的探讨平均血小板体积/淋巴细胞比率(MPVLR)对急性ST段抬高型心肌梗死(STEMI)患者直接PCI术后有无复流的预测价值。方法选择2015年1月至2017年12月期间山西医科大学第二医院收治的因急性STEMI住院并于发病12 h内行直接PCI的患者304例。收集入选患者的基线资料及术前血常规参数计算得出血小板/淋巴细胞比率(PLR)、平均血小板体积/淋巴细胞比率(MPVLR)。按PCI术中冠状动脉有无复流分为正常血流组及无复流组,Logistic回归分析其危险因素。结果单因素分析显示,无复流组淋巴细胞计数明显低于正常血流组(P<0.05);无复流组平均血小板体积、PLR、MPVLR、高敏C反应蛋白、术中使用替罗非班、发病到球囊扩张时间、病变长度显著高于正常血流组(P<0.05)。多因素分析显示,PLR、MPVLR及发病到球囊扩张时间是预测急性STEMI患者直接PCI术后无复流的独立危险因素。PLR、MPVLR对应的ROC曲线下面积分别为0.766、0.795,预测的敏感性分别为73.8%、88.7%,特异性分别为69.1%、64.1%。结论 MPVLR能够有效预测急性STEMI患者直接PCI术后无复流的发生,其作为血常规常见指标的计算值,获取方便,值得推广。
Aim To investigate the predictive value of mean platelet volume/lymphocyte ratio(MPVLR) in patients with acute ST-segment elevation myocardial infarction(STEMI) after primary percutaneous coronary intervention(p PCI).Methods From January 2015 to December 2017,a total of 304 patients who underwent p PCI,admitted within 12 hours from symptom onset,were enrolled and divided into two groups based on no-reflow.The platelet/lymphocyte ratio(PLR) and the MPVLR were calculated by collecting baseline data of patients enrolled and preoperative blood parameters.Logistic regression was used to analyze the risk factors.Results In univariate analysis,the lymphocyte count in the no-reflow group was significantly lower than that in the normal-reflow group(P<0.05);Mean platelet volume,PLR,MPVLR,high-sensitive C-reactive protein(hs-CRP),tirofiban in operation,pain-to-balloon time,and average stent length in the no-reflow group were significantly higher than those in the normal-reflow group(P<0.05).In multivariate analysis,PLR,MPVLR,and pain-to-balloon time were independent predictors of no-reflow after p PCI in patients with acute STEMI.The area under the ROC curves for PLR and MPVLR were 0.766 and 0.795,respectively.The sensitivity was73.8% and 88.7%,and the specificity was 69.1% and 64.1%,respectively.Conclusions MPVLR can effectively predict the occurrence of no-reflow after p PCI in patients with acute STEMI.As a calculated value of common indicators from blood routine examination,MPVLR is easy to get and deserved to be generalized.
Aim To investigate the predictive value of mean platelet volume/lymphocyte ratio(MPVLR) in patients with acute ST-segment elevation myocardial infarction(STEMI) after primary percutaneous coronary intervention(p PCI).Methods From January 2015 to December 2017,a total of 304 patients who underwent p PCI,admitted within 12 hours from symptom onset,were enrolled and divided into two groups based on no-reflow.The platelet/lymphocyte ratio(PLR) and the MPVLR were calculated by collecting baseline data of patients enrolled and preoperative blood parameters.Logistic regression was used to analyze the risk factors.Results In univariate analysis,the lymphocyte count in the no-reflow group was significantly lower than that in the normal-reflow group(P<0.05);Mean platelet volume,PLR,MPVLR,high-sensitive C-reactive protein(hs-CRP),tirofiban in operation,pain-to-balloon time,and average stent length in the no-reflow group were significantly higher than those in the normal-reflow group(P<0.05).In multivariate analysis,PLR,MPVLR,and pain-to-balloon time were independent predictors of no-reflow after p PCI in patients with acute STEMI.The area under the ROC curves for PLR and MPVLR were 0.766 and 0.795,respectively.The sensitivity was73.8% and 88.7%,and the specificity was 69.1% and 64.1%,respectively.Conclusions MPVLR can effectively predict the occurrence of no-reflow after p PCI in patients with acute STEMI.As a calculated value of common indicators from blood routine examination,MPVLR is easy to get and deserved to be generalized.
引文
[1]颜红兵,向定成,刘红梅,等.ST段抬高型急性心肌梗死院前溶栓治疗中国专家共识[J].中国介入心脏病学杂志,2018,26(4):181-190.
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[4]Akpek M,Kaya MG,Lam YY,et al.Relation of neutrophil/lymphocyte ratio to coronary flow to in-hospital major adverse cardiac events in patients with ST-elevated myocardial infarction undergoing primary coronary intervention[J].Am J Cardiol,2012,110(5):621-627.
[5]Eeckhout E,Kern MJ.The coronary no-reflow phenomenon:a review of mechanisms and therapies[J].Eur Heart J,2001,22(9):729-739.
[6]Kurtul A,Yarlioglues M,Murat SN,et al.Usefulness of the platelet-to-lymphocyte ratio in predicting angiographic reflow after primary percutaneous coronary intervention in patients with acute ST-segment elevation myocardial infarction[J].Am J Cardiol,2014,114(3):342-347.
[7]Vakili H,Shirazi M,Charkhkar M,et al.Correlation of platelet-to-lymphocyte ratio and neutrophil-to-lymphocyte ratio with thrombolysis in myocardial infarction frame count in ST-segment elevation myocardial infarction[J].Eur JClin Invest,2017,47(4):322-327.
[8]Martin JF,Trowbridge EA,Salmon G,et al.The biological significance of platelet volume:its relationship to bleeding time,platelet thromboxane B2 production and megakaryocyte nuclear DNA concentration[J].Thromb Res,1983,32(5):443-460.
[9]Giles H,Smith RE,Martin JF.Platelet glycoproteinⅡb-Ⅲa and size are increased in acute myocardial infarction[J].Eur J Clin Invest,1994,24(1):69-72.
[10]Kurtul A,Acikgoz SK.Usefulness of mean platelet volumeto-lymphocyte ratio for predicting angiographic no-reflow and short-term prognosis after primary percutaneous coronary intervention in patients with ST-segment elevation myocardial infarction[J].Am J Cardiol,2017,120(4):534-541.
[11]Niccoli G,Burzotta F,Galiuto L,et al.Myocardial no-reflow in humans[J].J Am Coll Cardiol,2009,54(4):281-292.
[12]杨溶海,梁建光,汪学军.血小板-淋巴细胞比率预测非ST段抬高型急性心肌梗死患者左心室收缩功能障碍的准确性[J].中国动脉硬化杂志,2015,23(8):802-806.
[13]李少辉,王海昌,张英梅,等.血小板与淋巴细胞比率对急性ST段抬高型心肌梗死患者PCI术后无复流的预测价值[J].现代生物医学进展,2016,16(17):3268-3271.
[14]Thompson CB,Eaton KA,Princiotta SM,et al.Size dependent platelet subpopulations:relationship of platelet volume to ultrastructure,enzymatic activity,and function[J].Br J Haematol,1982,50(3):509-519.
[15]May AE,Langer H,Seizer P,et al.Platelet-leukocyte interactions in inflammation and atherothrombosis[J].Semin Thromb Hemost,2007,33(2):123-127.
[16]巩洁,任晖,高天林,等.冠心病患者血清尿酸与平均血小板体积的关系及二者对心血管事件的预测价值[J].中国动脉硬化杂志,2016,24(8):821-824.
[17]Forteza MJ,Trapero I,Hervas A,et al.Apoptosis and mobilization of lymphocytes to cardiac tissue is associated with myocardial infarction in a reperfused porcine model and infarct size in post-PCI patients[J].Oxid Med Cell Longev,2018,2018:1975167.
[18]Hudzik B,Szkodziński J,Lekston A,et al.Mean platelet volume-to-lymphocyte ratio:a novel marker of poor shortand long-term prognosis in patients with diabetes mellitus and acute myocardial infarction[J].J Diabetes Complications,2016,30(6):1097-1102.
[2]Harrison RW,Aggarwal A,Ou FS,et al.Incidence and outcomes of no-reflow phenomenon during percutaneous coronary intervention among patients with acute myocardial infarction[J].Am J Cardiol,2013,111(2):178-184.
[3]Jaffe R,Dick A,Strauss BH.Prevention and treatment of microvascular obstruction-related myocardial injury and coronary no-reflow following percutaneous coronary intervention:a systematic approach[J].JACC Cardiovasc Interv,2010,3(7):695-704.
[4]Akpek M,Kaya MG,Lam YY,et al.Relation of neutrophil/lymphocyte ratio to coronary flow to in-hospital major adverse cardiac events in patients with ST-elevated myocardial infarction undergoing primary coronary intervention[J].Am J Cardiol,2012,110(5):621-627.
[5]Eeckhout E,Kern MJ.The coronary no-reflow phenomenon:a review of mechanisms and therapies[J].Eur Heart J,2001,22(9):729-739.
[6]Kurtul A,Yarlioglues M,Murat SN,et al.Usefulness of the platelet-to-lymphocyte ratio in predicting angiographic reflow after primary percutaneous coronary intervention in patients with acute ST-segment elevation myocardial infarction[J].Am J Cardiol,2014,114(3):342-347.
[7]Vakili H,Shirazi M,Charkhkar M,et al.Correlation of platelet-to-lymphocyte ratio and neutrophil-to-lymphocyte ratio with thrombolysis in myocardial infarction frame count in ST-segment elevation myocardial infarction[J].Eur JClin Invest,2017,47(4):322-327.
[8]Martin JF,Trowbridge EA,Salmon G,et al.The biological significance of platelet volume:its relationship to bleeding time,platelet thromboxane B2 production and megakaryocyte nuclear DNA concentration[J].Thromb Res,1983,32(5):443-460.
[9]Giles H,Smith RE,Martin JF.Platelet glycoproteinⅡb-Ⅲa and size are increased in acute myocardial infarction[J].Eur J Clin Invest,1994,24(1):69-72.
[10]Kurtul A,Acikgoz SK.Usefulness of mean platelet volumeto-lymphocyte ratio for predicting angiographic no-reflow and short-term prognosis after primary percutaneous coronary intervention in patients with ST-segment elevation myocardial infarction[J].Am J Cardiol,2017,120(4):534-541.
[11]Niccoli G,Burzotta F,Galiuto L,et al.Myocardial no-reflow in humans[J].J Am Coll Cardiol,2009,54(4):281-292.
[12]杨溶海,梁建光,汪学军.血小板-淋巴细胞比率预测非ST段抬高型急性心肌梗死患者左心室收缩功能障碍的准确性[J].中国动脉硬化杂志,2015,23(8):802-806.
[13]李少辉,王海昌,张英梅,等.血小板与淋巴细胞比率对急性ST段抬高型心肌梗死患者PCI术后无复流的预测价值[J].现代生物医学进展,2016,16(17):3268-3271.
[14]Thompson CB,Eaton KA,Princiotta SM,et al.Size dependent platelet subpopulations:relationship of platelet volume to ultrastructure,enzymatic activity,and function[J].Br J Haematol,1982,50(3):509-519.
[15]May AE,Langer H,Seizer P,et al.Platelet-leukocyte interactions in inflammation and atherothrombosis[J].Semin Thromb Hemost,2007,33(2):123-127.
[16]巩洁,任晖,高天林,等.冠心病患者血清尿酸与平均血小板体积的关系及二者对心血管事件的预测价值[J].中国动脉硬化杂志,2016,24(8):821-824.
[17]Forteza MJ,Trapero I,Hervas A,et al.Apoptosis and mobilization of lymphocytes to cardiac tissue is associated with myocardial infarction in a reperfused porcine model and infarct size in post-PCI patients[J].Oxid Med Cell Longev,2018,2018:1975167.
[18]Hudzik B,Szkodziński J,Lekston A,et al.Mean platelet volume-to-lymphocyte ratio:a novel marker of poor shortand long-term prognosis in patients with diabetes mellitus and acute myocardial infarction[J].J Diabetes Complications,2016,30(6):1097-1102.