本文選題：ST段抬高型心肌梗死 + 紅細(xì)胞分布寬度　； 參考：《新疆醫(yī)科大學(xué)》2016年碩士論文

【摘要】：目的:研究紅細(xì)胞分布寬度(RDW)對(duì)急性ST段抬高性心肌梗死患者行急診PCI術(shù)后的長(zhǎng)期預(yù)后的預(yù)測(cè)價(jià)值。方法:連續(xù)前瞻性選取我院2011年09月至2014年11月的急性ST段抬高性心肌梗死(STEMI)急診行PCI術(shù)的住院患者共309例患者作為研究對(duì)象。依據(jù)RDW正常范圍上限(14%),將患者分為高RDW組和低RDW組患者。選取死亡作為主要研究終點(diǎn)事件,心血管不良事件(MACE)作為次要研究指標(biāo)。采用Kaplan-Meier生存分析判斷高低RDW組患者累計(jì)生存率的差異,采用多元Cox回歸分析研究STEMI患者PCI術(shù)后死亡的獨(dú)立影響因素。結(jié)果:309例STEMI患者納入本研究,最長(zhǎng)隨訪時(shí)間40月,中位隨訪時(shí)間10(3-24)月。高RDW組患者住院期間死亡率高于低RDW組患者(P=0.018),高RDW組患者出院后隨訪期間的MACE(P=0.003)和死亡事件(P=0.029)均高于低RDW組患者,且具有統(tǒng)計(jì)學(xué)差異,但兩組患者再發(fā)心梗、靶血管重建和腦卒中事件無統(tǒng)計(jì)學(xué)差異。多因素Cox回歸分析顯示,年齡(HR:1.06,95%CI:1.02-1.08,P=0.004),白細(xì)胞(HR:1.16,95%CI:1.07-1.25,P0.001),高RDW(HR:2.21,95%CI:1.23-4.67,P=0.023),肌酐(HR:1.007,95%CI:1.003-1.011,P=0.001)和左室射血分?jǐn)?shù)(HR:0.93,95%CI:0.89-0.98,P=0.002)為STEMI患者死亡的獨(dú)立影響因素。Kaplan-Meier生存分析顯示,高RDW組患者累計(jì)生存率明顯低于低RDW組患者,且具有統(tǒng)計(jì)學(xué)差異(Log Rank=8.00,P=0.005)。高RDW組患者累計(jì)死亡率為19.5%,低RDW組患者累計(jì)死亡率為8.1%,且差異具有統(tǒng)計(jì)學(xué)意義(χ2=8.80,P=0.003)。結(jié)論:高RDW是STEMI患者行急診PCI術(shù)后長(zhǎng)期死亡的獨(dú)立危險(xiǎn)因素,可用于患者入院后危險(xiǎn)分層。
[Abstract]:Objective: to study the prognostic value of RDW in patients with acute ST-segment elevation myocardial infarction after emergency PCI. Methods: a total of 309 patients with acute ST-segment elevation myocardial infarction (STEMI) undergoing emergent PCI operation in our hospital from September 2011 to November 2014 were selected as subjects. According to the upper limit of RDW, the patients were divided into high RDW group and low RDW group. Death and adverse cardiovascular events were selected as the main endpoint events and MACEE as the secondary criteria. Kaplan-Meier survival analysis was used to judge the difference of cumulative survival rate in patients with high and low RDW. Multiple Cox regression analysis was used to study the independent factors influencing the death after PCI in STEMI patients. Results in this study, 309 STEMI patients were included in the study. The longest follow-up period was 40 months, and the median follow-up time was 103 to 24 months. The in-hospital mortality rate of high RDW group was higher than that of low RDW group, and that of high RDW group was higher than that of low RDW group (P 0.029), and the mortality of high RDW group was higher than that of low RDW group. However, there was a significant difference between the two groups in recurrent myocardial infarction. There was no significant difference in target vascular remodeling and stroke events. 澶氬洜绱燙ox鍥炲綊鍒嗘瀽鏄劇ず,騫撮緞(HR:1.06,95%CI:1.02-1.08,P=0.004),鐧界粏鑳，

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