王洪敏,王毅,孙鑫新,吕静,周松,张朝霞.RDW与PLT比值与STEMI行直接PCI患者心肌灌注水平的相关性[J].内科急危重症杂志,2017,23(4):
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| DOI： |
| 中文关键词: 红细胞体积分布宽度 急性ST段抬高型心肌梗死 血小板计数 经皮冠状动脉介入治疗 无复流现象 |
| 英文关键词:Red cell distribution width, ST segment elevation myocardial infarction, platelet count, percutaneous coronary intervention, no-reflow phenomenon. |
| 基金项目:邢台市科技计划项目（2016ZC110） |
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| 中文摘要: |
| 目的 本研究主要探讨红细胞体积分布宽度与血小板计数比值与急性ST段抬高型心肌梗死行直接经皮冠状动脉介入治疗患者心肌灌注水平的相关性。方法 研究对象来自2014年5月至2016年10月在我院明确诊断为急性ST段抬高型心肌梗死并接受急诊经皮冠状动脉介入治疗的患者,共108例,其中男性81例,女性27例。根据TIMI心肌灌注分级结果,将患者分为两组：无复流组(术后TMPG分级为0-2级)和正常血流组(术后TMPG分级达到3级)。两组患者术后均行抗血小板聚集、抗凝治疗,并使用硝酸酯类、β受体阻滞剂、血管紧张素II受体阻滞剂/血管紧张素转换酶抑制剂、调脂以及钙通道阻滞剂等药物治疗。比较正常血流组和无复流组患者的一般临床资料、术前血常规、心肌损伤标志物、D-Dimer、血浆BNP、低密度脂蛋白-C、随机血糖等指标,患者于术后病情稳定及术后30天均行心脏彩超检查以明确左室射血分数,比较两组患者在随访30天内主要心脏不良事件的差异,并记录患者心源性再入院的情况。结果 无复流组的平均年龄、糖尿病患者比例和TIMI评分均明显高于正常血流组(P＜0.05),梗死性心绞痛发作史患者比例明显低于正常血流组(P=0.017),两组患者在性别、BMI、家族史、吸烟史、高血压、高血脂等方面无统计学差异(P＞0.05)。无复流组患者的胸痛发作至球囊扩张时间明显长于正常血流组(P=0.013),术后TIMI3级血流比例明显低于血流正常组(P=0.000),无复流组的红细胞体积分布宽度、中性粒细胞百分比、红细胞体积分布宽度与血小板计数比值、B型钠尿肽、高敏C反应蛋白以及D-dimer明显高于正常血流组(P＜0.05),估测的肾小球滤过率明显低于正常血流组(P=0.000)。无复流组PCI术后基线和PCI术后30天的LVEF均明显低于正常血流组(P＜0.05),无复流组术后基线LVEF明显低于术后30天(P=0.001),正常血流组的术后基线LVEF也明显低于术后30天(P=0.000)。在术后30天内,无复流组出现心原性死亡、恶性心律失常、心力衰竭、再发性心梗、靶血管重建患者比例均明显高于正常血流组(P＜0.05),两组心原性再入院患者比例无统计学差异(P＞0.05)。Logistic回归分析结果显示,RPR 是急性ST段抬高型心肌梗死患者行直接PCI术后无复流现象发生的独立危险因素(OR=8.306, 95%CI=1.492~46.245,P=0.016)。结论红细胞体积分布宽度与血小板计数比值是发生无复流的独立危险因素,与急性ST段抬高型心肌梗死行直接经皮冠状动脉介入治疗患者的心肌灌注水平有一定相关性,应引起临床工作人员的重视。 |
| 英文摘要: |
| Objective To explore and assess the correlation of red cell distribution width to platelet ratio and myocardial perfusion in patients with ST-segment elevation myocardial infarction undergoing primary percutaneous coronary intervention. MethodsA total of 108 subjects (81males and 27 females) from May 2014 to October 2016 were analyzed in this study. All subjects were diagnosed with ST-segment elevation myocardial infarction undergone primary percutaneous coronary intervention in our hospital. According to TMPG grade, all patients involved were assigned to normal group and No-Reflow group. Two groups were undergone the same medical treatment, including antiplatelet or anticoagulant medicine, ARB/ACEI, beta-blocker, CCB, nitrates, statins and other medication. All baseline clinical characteristics, blood routine test, hs-CRP, cTnI，CK-MB, BNP, LDL-C, D-dimer and glucose. All patients were undergone echocardiography to check left ventricular ejection fraction in admission and 30 days after operation. The incidence of major adverse cardiac events in 30days of two groups was compared. ResultsThe average age and TIMI score of no-reflow group were significantly higher than normal group and patients with DM of no-reflow group were more than normal group (P＜0.05), while patients who had CHD history were less than normal group (P=0.017). There were no significant differences in gender distribution, BMI, family history, smoking history, hypertension and hyperlipidemia between two groups (All P>0.05). The delaying time from onset of chest pain to balloon dilatation of no-reflow group was obviously longer than normal group (P=0.013), and the percentage of TIMI grade 3 after PCI was significantly lower than normal group (P=0.000). There were significant differences in RDW,NE%, RPR, BNP, hs-CRP, D-dimer and eGFR between no-reflow group and normal group (P＜0.05). The LVEF when patients admitted and 30days after PCI of no-reflow group was significantly lower than normal group (P＜0.05), and the LVEF of no-reflow group when patients admitted was lower than the LVEF of 30 days after PCI (P=0.001), and the LVEF of normal group when patients admitted was lower than the LVEF of 30 days after PCI (P=0.000). During 30 days after PCI, there were obvious differences in the incidence of cardiac death, malignant arrhythmia, heart failure, re-myocardial infraction and received vessel reconstruction between two groups (P＜0.05), while there was no obvious differences in re-hospitalization because of cardiac reasons (P>0.05). In the logistic multivariate analysis, RPR was an independent risk factor for no-reflow in patients with STEMI undergoing primary PCI (OR=8.306, 95%CI=1.492~46.245, P=0.016). Conclusions Red cell distribution width to platelet ratio is an independent predictor of no-reflow, which has correlation with myocardial perfusion in patients with ST-segment elevation myocardial infarction undergoing PCI, and clinical physicians should pay attention to this. |
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