PDW和PLR对急性SETMI患者PPCI后心肌微循环障碍的预测价值
|
摘要
目的研究血小板分布宽度(PDW)和血小板淋巴细胞比值(PLR)对急性ST段抬高型心肌梗死(STEMI)患者直接经皮冠状动脉介入治疗(PPCI)后心肌微循环障碍的预测价值。方法回顾分析2016-2017年80例发病12h内在该院行PPCI的STEMI患者,PPCI术后使用压力导丝测定心肌微循环阻力指数(IMR),并以IMR值大于24为发生心肌微循环障碍的界值,分为微循环正常组(52例)和微循环障碍组(28例)。比较两组间的临床资料、实验室结果、PPCI结果,应用受试者工作曲线(ROC)分析术前PDW、PLR对心肌微循环障碍的预测价值。结果心肌微循环障碍组PDW水平、PLR值均明显高于无微循环障碍组[(18.13±1.34)%vs.(1.76±1.08)%,P<0.01;(180.06±93.04)%vs.(157.63±84.71)%,P<0.05]。ROC分析PDW及PLR对心肌微循环障碍的预测价值,曲线下面积(AUC)分别为0.783(95%CI:0.625～0.903,P<0.01)、0.801(95%CI:0.598～0.887,P<0.01)。当PDW的截点值为16.83%时预测的敏感度和特异度分别为86.7%和75.3%;而PLR截点值为173.24%时预测的敏感度和特异度分别为82.3%和70.2%。结论 PDW和PLR是STEMI患者PPCI术后发生心肌微循环障碍的预测因素,并具有良好的敏感度和特异度。
Objective To analyze the predictive value of platelet distribution width(PDW)and platelet lymphocyte ratio(PLR)for myocardial microcirculation disturbance in patients with acute ST segment elevation myocardial infarction(STEMI)undergoing primary percutaneous coronary intervention(PPCI).Methods Eighty patients with STEMI underwent PPCI were retrospectively enrolled.Myocardial microcirculation resistance index(IMR)was measured with pressure guidewire after PPCI,and according the cut-off value 24 of IMR,all the cases were divided into the normal microcirculation group(52 cases)and the disorder microcirculation group(28 cases).The factors associated with microcirculation disorder were analyzed.ROC curve was used to identify predictive value of PDW and PLR on microcirculation disorder.Results The value of PDW and PLR were significantly higher in the disorder microcirculation group than that in the normal microcirculation group[(18.13±1.34)%vs.(1.76±1.08)%,P<0.01;(180.06±93.04)%vs.(157.63 ±84.71)%,P<0.05].ROC curve was use to analyze the predictive value of preoperative PDW and PLR for myocardial microcirculation disturbance and area under the ROC curve was 0.783(95%CI:0.625-0.903,P<0.01).0.801(95%CI:0.598-0.887,P<0.01)respectively.The predicted sensitivity and specificity were 86.7%and75.3% when the cutoff value of PDW was 16.83%,and the predicted sensitivity and specificity were 82.3%and 70.2% when the PLR cutoff value was 173.24%.Conclusion PDW and PLR are predictors of myocardial microcirculation disturbance after PPCI in patients have STEMI,which with high sensitivity and specificity.
Objective To analyze the predictive value of platelet distribution width(PDW)and platelet lymphocyte ratio(PLR)for myocardial microcirculation disturbance in patients with acute ST segment elevation myocardial infarction(STEMI)undergoing primary percutaneous coronary intervention(PPCI).Methods Eighty patients with STEMI underwent PPCI were retrospectively enrolled.Myocardial microcirculation resistance index(IMR)was measured with pressure guidewire after PPCI,and according the cut-off value 24 of IMR,all the cases were divided into the normal microcirculation group(52 cases)and the disorder microcirculation group(28 cases).The factors associated with microcirculation disorder were analyzed.ROC curve was used to identify predictive value of PDW and PLR on microcirculation disorder.Results The value of PDW and PLR were significantly higher in the disorder microcirculation group than that in the normal microcirculation group[(18.13±1.34)%vs.(1.76±1.08)%,P<0.01;(180.06±93.04)%vs.(157.63 ±84.71)%,P<0.05].ROC curve was use to analyze the predictive value of preoperative PDW and PLR for myocardial microcirculation disturbance and area under the ROC curve was 0.783(95%CI:0.625-0.903,P<0.01).0.801(95%CI:0.598-0.887,P<0.01)respectively.The predicted sensitivity and specificity were 86.7%and75.3% when the cutoff value of PDW was 16.83%,and the predicted sensitivity and specificity were 82.3%and 70.2% when the PLR cutoff value was 173.24%.Conclusion PDW and PLR are predictors of myocardial microcirculation disturbance after PPCI in patients have STEMI,which with high sensitivity and specificity.
引文
[1]CHEN C,WEI J,ALBADRI A,et al.Coronary microvascular dysfunction-epidemiology,pathogenesis,prognosis,diagnosis,risk factors and therapy[J].Circ J,2017,81(1):3-11.
[2]NICCOLI G,SCALONE G,LERMAN A,et al.Coronary microvascular obstruction in acute myocardial infarction[J].Eur Heart J,2016,37(13):1024-1033.
[3]NG M K,YEUNG A C,FEARON W F.Invasive assessment of the coronary microcirculation:superior reproducibility and less Hemodynamic dependence of index of microcirculatory resistance compared with coronary flow reserve[J].Circulation,2006,113:2054-2061.
[4]VAGDATLI E,GOUNARI E,LAZARIDOU E,et al.Platelet distribution width:a simple,practical and specific marker of activation of coagulation[J].Hippokratia,2010,14(1):28-32.
[5]SMITH R A,GHANEH P,SUTTON R,et al.Prognosis of resected ampullary adenocarcinoma by preoperative serum CA19-9levels and Platelet-lymphocyte ratio[J].JGastrointest Surg,2008,12(8):1422-1428.
[6]WANG D,YANG J X,CAO D Y,et al.Preoperative neutrophil-lymphocyte and platelet-lymphocyte ratios as independent predictors of cervical stromal involvement in surgically treated endometrioid adenocarcinoma[J].Onco Targets Ther,2013,6:211-216.
[7]ELSENBERG E H,VAN WERKUM J W,VAN DE WALR M,et al.The influence of clinical characteristics,laboratory and inflammatory markers on“high on-treatment platelet reactivity”as measured with different platelet function tests[J].Thromb Haemost,2009,102(4):719-727.
[8]REZKALLA S H,KLONER R A.No-reflow phenomenon[J].Circulation,2002,105(5):656-662.
[9]OMMEN S R,GIBBONS R J,HODGE D O,et al.Usefulness of the lymphocyte concentration as a prognostic marker in coronary artery disease[J].Am J Cardiol 1997,79(4):812-814.
[10]AZAB B,SHAH N,AKERMAN M,et al.Value of platelet/lymphocyte ratio as a predictor of all cause mortality after non ST elevation myocardial infarction[J].JThromb Thrombolysis,2012,34:326-34.
[11]BHATTI I,PEACOC O,LLOYD G,et al.Preoperative hematologic markers as independent predictors of prognosis in resected pancreatic ductal adenocarcinoma:neutrophil lymphocyte versus platelet lymphocyte ratio[J].Am J Surg,2010,200:197203.
[12]YILDIZ A,YUKSEL M,OYLUMLU M,et al.The utility of the platelet-lymphocyte ratio for predicting no reflow in patients with ST-segment elevation myocardial infarction[J].Clin Appl Thromb Hemost,2015,21(3):223-228.
[13]欧阳敏.血小板分布宽度在血栓前状态中的临床意义[J].江西医药,2007,42(5):424-425.
[14]KHANDEKAR M M,KHURANA A S,DESHMUKH SD,et al.Platelet volume indices in patients with coronary artery disease and acute myocardial infarction:an Indian scenario[J].J Clin Pathol,2006,59(2):146-149.
[15]JINDAL S,GUPTA S,GUPTA R,et al.Platelet indices in diabetes mellitus:indicators of diabetic microvascular complications[J].Hematology,2011,16(2):86-89.
[2]NICCOLI G,SCALONE G,LERMAN A,et al.Coronary microvascular obstruction in acute myocardial infarction[J].Eur Heart J,2016,37(13):1024-1033.
[3]NG M K,YEUNG A C,FEARON W F.Invasive assessment of the coronary microcirculation:superior reproducibility and less Hemodynamic dependence of index of microcirculatory resistance compared with coronary flow reserve[J].Circulation,2006,113:2054-2061.
[4]VAGDATLI E,GOUNARI E,LAZARIDOU E,et al.Platelet distribution width:a simple,practical and specific marker of activation of coagulation[J].Hippokratia,2010,14(1):28-32.
[5]SMITH R A,GHANEH P,SUTTON R,et al.Prognosis of resected ampullary adenocarcinoma by preoperative serum CA19-9levels and Platelet-lymphocyte ratio[J].JGastrointest Surg,2008,12(8):1422-1428.
[6]WANG D,YANG J X,CAO D Y,et al.Preoperative neutrophil-lymphocyte and platelet-lymphocyte ratios as independent predictors of cervical stromal involvement in surgically treated endometrioid adenocarcinoma[J].Onco Targets Ther,2013,6:211-216.
[7]ELSENBERG E H,VAN WERKUM J W,VAN DE WALR M,et al.The influence of clinical characteristics,laboratory and inflammatory markers on“high on-treatment platelet reactivity”as measured with different platelet function tests[J].Thromb Haemost,2009,102(4):719-727.
[8]REZKALLA S H,KLONER R A.No-reflow phenomenon[J].Circulation,2002,105(5):656-662.
[9]OMMEN S R,GIBBONS R J,HODGE D O,et al.Usefulness of the lymphocyte concentration as a prognostic marker in coronary artery disease[J].Am J Cardiol 1997,79(4):812-814.
[10]AZAB B,SHAH N,AKERMAN M,et al.Value of platelet/lymphocyte ratio as a predictor of all cause mortality after non ST elevation myocardial infarction[J].JThromb Thrombolysis,2012,34:326-34.
[11]BHATTI I,PEACOC O,LLOYD G,et al.Preoperative hematologic markers as independent predictors of prognosis in resected pancreatic ductal adenocarcinoma:neutrophil lymphocyte versus platelet lymphocyte ratio[J].Am J Surg,2010,200:197203.
[12]YILDIZ A,YUKSEL M,OYLUMLU M,et al.The utility of the platelet-lymphocyte ratio for predicting no reflow in patients with ST-segment elevation myocardial infarction[J].Clin Appl Thromb Hemost,2015,21(3):223-228.
[13]欧阳敏.血小板分布宽度在血栓前状态中的临床意义[J].江西医药,2007,42(5):424-425.
[14]KHANDEKAR M M,KHURANA A S,DESHMUKH SD,et al.Platelet volume indices in patients with coronary artery disease and acute myocardial infarction:an Indian scenario[J].J Clin Pathol,2006,59(2):146-149.
[15]JINDAL S,GUPTA S,GUPTA R,et al.Platelet indices in diabetes mellitus:indicators of diabetic microvascular complications[J].Hematology,2011,16(2):86-89.