發(fā)布時(shí)間：2018-06-23 21:43

  本文選題：血小板與淋巴細(xì)胞比率 + 急性心肌梗死　； 參考：《第四軍醫(yī)大學(xué)》2016年碩士論文

【摘要】：研究背景:急性ST段抬高型心肌梗死(STEMI)患者進(jìn)行早期再灌注治療可以改善預(yù)后。經(jīng)皮冠狀動(dòng)脈介入治療(PCI)是急性ST段抬高型心肌梗死可行的最佳再灌注策略[1],有近95%的冠脈閉塞血管可以被重新開通[2-5]。但是,雖然心外膜冠脈血管被重建,心肌組織卻不一定能恢復(fù)理想的再灌注。微血管水平的再灌注失敗的現(xiàn)象被稱為冠脈無復(fù)流現(xiàn)象[6-10]。以往研究顯示,多達(dá)60%的血管重建的STEMI患者發(fā)生無復(fù)流現(xiàn)象[3,11-19]。無復(fù)流顯著減少了再灌注治療的益處,導(dǎo)致患者心功能及預(yù)后惡化。無復(fù)流現(xiàn)象與急性STEMI患者較差的心功能恢復(fù)、心肌梗死面積增加、更高的并發(fā)癥發(fā)生率、短期及長期死亡率有關(guān)。無復(fù)流現(xiàn)象一旦出現(xiàn)很難逆轉(zhuǎn),所以對(duì)潛在的高�；颊哌M(jìn)行篩選十分重要,尋找簡單、實(shí)用的預(yù)測(cè)因子十分必要。國內(nèi)外已經(jīng)開展了許多有關(guān)無復(fù)流預(yù)測(cè)因素的研究。有研究發(fā)現(xiàn),心電圖出現(xiàn)2個(gè)以上Q波、心功能Killip II級(jí)、冠脈內(nèi)出現(xiàn)血栓、以及血管成形術(shù)作為唯一的再灌注治療方式,均可能為冠脈無復(fù)流的預(yù)測(cè)因素[20]。最近國外研究發(fā)現(xiàn),血小板與淋巴細(xì)胞比率(Platelet-to-Lymphocyte Ratio,PLR)是主要不良心血管事件的一個(gè)新的預(yù)測(cè)因子[21,22,23]。國內(nèi)目前尚缺乏PLR和無復(fù)流的關(guān)系的研究,那么PLR是否為STEMI患者PCI后無復(fù)流的預(yù)測(cè)因子,是否是一個(gè)敏感度及特異度較好的臨床指標(biāo),這個(gè)問題需要進(jìn)一步研究。目的:研究入院時(shí)PLR值對(duì)國內(nèi)急性ST段抬高型心肌梗死患者冠脈介入治療后無復(fù)流的預(yù)測(cè)價(jià)值,為尋找簡單、實(shí)用的無復(fù)流預(yù)測(cè)因子提供理論依據(jù)。方法:共收集190例急性STEMI患者,發(fā)病12小時(shí)內(nèi)并且行PCI術(shù)。按術(shù)后即刻心肌梗死溶栓試驗(yàn)(Thrombolysis In Myocardial Infarction,TIMI)血流分級(jí)將病人分為2組:正常復(fù)流組(138例)和無復(fù)流組(52例),比較兩組患者的基本臨床資料、實(shí)驗(yàn)室檢查結(jié)果及PCI術(shù)中靶病變及用藥,用Logistic回歸分析無復(fù)流的預(yù)測(cè)因素,用受試者工作特征曲線(ROC)論證得到PLR預(yù)測(cè)無復(fù)流的最佳臨界值及其敏感度和特異度。結(jié)果:無復(fù)流組與正常復(fù)流組相比PLR顯著升高(P=0.004)、心電圖出現(xiàn)2個(gè)以上Q波(P=0.005)及冠狀動(dòng)脈內(nèi)血栓征象較高(P=0.023)。當(dāng)PLR值為188時(shí),預(yù)測(cè)無復(fù)流的敏感度為70%,特異度為72%。結(jié)論:PLR、心電圖出現(xiàn)2個(gè)以上Q波、冠狀動(dòng)脈內(nèi)血栓征象均是無復(fù)流的預(yù)測(cè)因素。當(dāng)PLR值為188時(shí),對(duì)無復(fù)流預(yù)測(cè)的敏感度及特異度均較好。
[Abstract]:Background: early reperfusion therapy can improve prognosis in patients with acute St segment elevation myocardial infarction (STEMI). Percutaneous coronary intervention (PCI) is the best reperfusion strategy for acute ST-segment elevation myocardial infarction [1], and nearly 95% of coronary artery occlusion can be re-opened [2-5]. However, although epicardial coronary vessels are reconstructed, myocardial tissue may not be able to recover ideal reperfusion. The failure of reperfusion at the microvascular level is known as coronary anoreflex [6-10]. Previous studies have shown that up to 60% of STEMI patients with revascularization have no reflow. No reflow significantly reduced the benefits of reperfusion therapy, leading to deterioration of cardiac function and prognosis. The absence of reflow was associated with poor cardiac function recovery, increased myocardial infarction size, higher incidence of complications, and short and long term mortality in patients with acute STEMI. Once no reflow occurs, it is difficult to reverse, so it is very important to screen potential high-risk patients, and it is necessary to find simple and practical predictors. At home and abroad, many researches have been carried out on the prediction factors of no complex flow. Two or more Q waves in electrocardiogram, Killip II cardiac function, thrombosis in coronary artery and angioplasty as the only method of reperfusion therapy may be the predictors of no reflow in coronary artery [20]. Recent foreign studies have found that Platelet-to-Lymphocyte Ratio- PLR (PLR) is a new predictor of major adverse cardiovascular events [21: 2223]. There is a lack of research on the relationship between PLR and no reflow in China, so whether PLR is a predictor of no reflow after PCI in STEMI patients is a sensitive and specific clinical index, which needs further study. Objective: to study the predictive value of PLR on admission in patients with acute ST-segment elevation myocardial infarction without reflow after coronary intervention, and to provide a theoretical basis for finding a simple and practical predictor of no-reflow. Methods: 190 patients with acute STEMI were treated with PCI within 12 hours. According to the blood flow grade of Thrombolysis in myocardial infarction thrombolysis test (TIMI), patients were divided into two groups: normal reflow group (138 cases) and non-reflow group (52 cases). The optimal critical value, sensitivity and specificity of PLR for predicting no complex flow were demonstrated by using the operating characteristic curve (ROC) of subjects by logistic regression analysis. Results: compared with normal reflow group, PLR was significantly higher in non-reflow group (P0. 004), more than 2 Q waves appeared in ECG (P0. 005), and the signs of coronary thrombus were higher (P0. 023). When the PLR value was 1888, the sensitivity and specificity of predicting no reflow were 70 and 72, respectively. Conclusion there were more than 2 Q waves in the electrocardiogram (ECG) and coronary thromboembolism were the predictors of no reflow. When the PLR value is 1888, the sensitivity and specificity of prediction without complex flow are better.
【學(xué)位授予單位】：第四軍醫(yī)大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2016
【分類號(hào)】：R542.22

【相似文獻(xiàn)】

相關(guān)期刊論文 前10條

1 夏菁;冠脈無復(fù)流現(xiàn)象治療的研究進(jìn)展[J];現(xiàn)代診斷與治療;2005年05期

2 程璐;;急診經(jīng)皮冠狀動(dòng)脈介入術(shù)無復(fù)流與左心功能恢復(fù)的關(guān)系[J];遼寧醫(yī)學(xué)雜志;2006年06期

3 陳桂英;周立君;黃永麟;李為民;;冠脈無復(fù)流現(xiàn)象的臨床意義及處理[J];中國實(shí)用內(nèi)科雜志;2007年02期

4 荀平;高航;;冠脈無復(fù)流現(xiàn)象的診治進(jìn)展[J];心臟雜志;2007年06期

5 楊秀秀;陳韻岱;;無復(fù)流現(xiàn)象的預(yù)防與治療[J];心肺血管病雜志;2008年01期

6 張春震;趙郁;;冠狀動(dòng)脈無復(fù)流現(xiàn)象的防治進(jìn)展[J];中國現(xiàn)代醫(yī)生;2008年10期

7 郭任維;任艷琴;邢愛華;王全義;呂曉春;郝愛萍;;經(jīng)皮冠狀動(dòng)脈介入術(shù)中無復(fù)流現(xiàn)象臨床分析[J];中國介入心臟病學(xué)雜志;2009年05期

8 劉玉鵬;王曉麗;;經(jīng)皮冠狀動(dòng)脈介入治療術(shù)中無復(fù)流現(xiàn)象的研究進(jìn)展[J];新醫(yī)學(xué);2010年02期

9 施佳;歐少君;金惠根;;藥物防治無復(fù)流研究進(jìn)展[J];心血管病學(xué)進(jìn)展;2010年02期

10 張艷芳;;無復(fù)流現(xiàn)象的基礎(chǔ)與臨床[J];中國實(shí)用醫(yī)藥;2010年30期

相關(guān)會(huì)議論文 前10條

1 黃東;馬劍英;王翔飛;張峰;錢菊英;葛雷;葛均波;;經(jīng)微導(dǎo)管使用不同血管擴(kuò)張劑對(duì)急診經(jīng)皮冠狀動(dòng)脈介入治療術(shù)中無復(fù)流現(xiàn)象的療效比較[A];中華醫(yī)學(xué)會(huì)第11次心血管病學(xué)術(shù)會(huì)議論文摘要集[C];2009年

2 朱升四;劉俊;周旭晨;朱皓;鄭曉群;曲新凱;黃榕，

本文編號(hào)：2058529