發(fā)布時(shí)間：2018-08-02 16:29

【摘要】：目的探討血小板與淋巴細(xì)胞比值(PLR)在急性ST段抬高型心肌梗死(STEMI)患者接受直接PCI術(shù)中出現(xiàn)無復(fù)流和術(shù)后發(fā)生主要不良心腦血管事件(MACCE)中的預(yù)測價(jià)值。方法回顧分析我院181例接受直接PCI治療的STEMI患者臨床和冠狀動(dòng)脈造影資料,依據(jù)ROC曲線確定診斷術(shù)中無復(fù)流的PLR標(biāo)準(zhǔn),將入選患者分為高PLR組和低PLR組,并比較兩組臨床資料、住院期間和隨訪期間MACCE發(fā)生率。結(jié)果對符合入選標(biāo)準(zhǔn)的181例患者術(shù)前PLR和術(shù)后TIMI血流之間的關(guān)系進(jìn)行ROC曲線分析,結(jié)果顯示PLR≥162.72預(yù)測發(fā)生術(shù)中無復(fù)流現(xiàn)象的敏感性和特異性分別為84.62%和85.5%(AUC=0.835,95%CI為0.776~0.883,Z=6.611,P0.001)。根據(jù)術(shù)前PLR=162.72將所有患者分為高PLR組(PLR≥162.72,n=48)和低PLR組(PLR162.72,n=133),兩組患者臨床一般資料比較無明顯差異。與低PLR組相比,高PLR組術(shù)后CK-MB峰值濃度升高(313.55±212.76 U/L比216.64±152.41 U/L,P=0.001)、左心室射血分?jǐn)?shù)(LVEF)降低(48.58%±7.30%比51.66%±6.82%,P=0.009)和住院期間MACCE發(fā)生率升高[20.83%(10/48)比9.77%(13/133),P=0.049]。術(shù)后隨訪6~72(25.57±18.7)個(gè)月,共發(fā)生MACCE 28例,包括不同原因死亡10例。其中,高PLR組MACCE發(fā)生率顯著高于低PLR組(27.08%比11.28%,P=0.009)。生存分析顯示,高PLR組全因死亡率和無MACCE生存率顯著高于低PLR組(P0.05或P0.01)。COX比例風(fēng)險(xiǎn)回歸分析顯示,高PLR為預(yù)測心肌梗死發(fā)生術(shù)后MACCE的獨(dú)立危險(xiǎn)因素(HR=2.106,95%CI為1.794~5.586,P=0.035)。結(jié)論 PLR為一種預(yù)測STEMI患者直接PCI術(shù)后發(fā)生MACCE的獨(dú)立而有價(jià)值的指標(biāo)。
[Abstract]:Objective to investigate the predictive value of platelet-lymphocyte ratio (PLR) in patients with acute ST-segment elevation myocardial infarction (STEMI) without reflow during direct PCI and (MACCE) with major adverse cardiovascular and cerebrovascular events. Methods the clinical and coronary angiography data of 181 patients with STEMI who received direct PCI therapy were retrospectively analyzed. According to the ROC curve, the PLR criteria for the diagnosis of no reflow during operation were determined. The patients were divided into high PLR group and low PLR group, and the clinical data of the two groups were compared. Incidence of MACCE during hospitalization and follow-up. Results the relationship between preoperative PLR and postoperative TIMI blood flow was analyzed by ROC curve in 181 patients who met the inclusion criteria. The results showed that the sensitivity and specificity of PLR 鈮，

本文編號(hào)：2160015