【作者】 李洋；

【导师】 徐标； 王涟；

【作者基本信息】 南京大学 ， 临床医学， 2017， 硕士

【摘要】 目的:探讨血小板/淋巴细胞计数比(platelet/lymphocyte ratio,PLR)与行急诊冠状动脉介入治疗(primary percutaneous coronary intervention,PPCI)的急性前壁心肌梗死患者心肌灌注和院内主要不良事件的相关性。方法:连续入选2015年1月至2016年12月在南京鼓楼医院行PPCI手术的急性前壁心肌梗死患者共136例。根据患者术前的PLR值,用四分位法获患者四分位数,以三四分位数(PLR=165)为界限,将患者分为两组。将PLR≥165的第四分位组作为高PLR组,PLR<165的第一、二和三分位组分为低PLR组。比较两组患者的基线临床特征、Killip心功能分级、TIMI血流分级、心肌呈色分级(MBG)、实验室检查及院内主要不良事件(MACE,包括全因死亡、再发的非致死性心肌梗死和卒中)。心肌灌注不良定义为TIMI血流0-2级或TIMI血流3级但MBG 0-1级。Logistic多因素回归分析心肌灌注不良的危险因素。结果:高PLR组患者Killip分级≥Ⅱ级的比例较低PLR组显著增高(47%比 20%,P=0.005)。高 PLR 组术后 TIMI 血流 0-2 级(36%比 14%,P=0.004),MBG 0-1级的比例显著高于低PLR组(44%比21%,P=0,016)。高PLR组患者心肌灌注不良比例显著高于低PLR组(56%比27%,P=0.002)。Logistic多因素回归分析影响心肌灌注的危险因素有:PLR(OR 1.009,95%CI 1.004-1.015,P=0.001)、血栓抽吸(OR 1.473,95%CI 1.012-2.144,P=0.043)、BNP(OR 1.001,95%CI 1.000-1.002,P=0.034)和 CK-MB 峰值(OR 1.002,95%CI 1.001-1.005,P=0.067)。高PLR组的院内MACE显著高于低PLR组(25%比7%,P=0.004),全因死亡率也显著高于低PLR组(14%比2%,P=0.014)。结论:急诊PCI术前PLR是急性前壁心肌梗死患者心肌灌注不良的独立预测因素。PLR增高的急性前壁心肌梗死患者院内死亡及MACE发生率增加。更多还原

【Abstract】 Objective:To investigate the relationship between platelet-to-lymphocyte ratio(PLR)and myocardial reperfusion and in-hospital major adverse events(MACE)in patients with acute anterior myocardial infarction(MI)who underwent primary percutaneous coronary intervention(PPCI).Methods:From January 2015 to December 2016,136 consecutive patients with acute anterior MI who underwent PPCI in Nanjing Drum Tower Hospital were enrolled in this retrospectively study.The quartile of PLR before the procedure was obtained by quadratic method.Patients having values in the fourth quintile group was defined as the high PLR group(PLR ≥165),and those having values in the lower 3 quintiles were defined as the low PLR group(PLR<165).Baseline clinical features,Killip classification,Thrombolysis In Myocardial Infarction(TIMI)flow grade,Myocardial Blush Grade(MBG)and in-hospital MACE(including all-cause death,recurrent non-fatal myocardial infarction and stroke)were analyzed.Impaired myocardial perfusion was defined as TIMI flow grade 0-2 or TIMI flow grade 3 but with MBG grade 0-1.Multivariate logistic regression analysis was performed to identify independent predictors of impaired myocardial perfusion.Results:Patients with high PLR had higher Killip grade compared with patients with low PLR(20%vs.47%,P=0.005).Patients in the high PLR group had significant lower TIMI flow(36%vs.14%,P=0.004)and MBG grade(44%vs.21%,P=0.016)than those in the low PLR group.More patients with high PLR had impaired myocardial perfusion than those with low PLR(56%vs.27%,P=0.002).Multivariate analyses indicated that the independent risk factors of impaired myocardial perfusion were PLR(OR 1.009,95%CI 1.004-1.015,P=0.001),thrombus aspiration(OR 1.473,95%CI 1.012-2.144,P=0.043);BNP(OR 1.001,95%CI 1.000-1.002,P=0.034)and CK-MB peak(OR 1.002,95%CI 1.001-1.005,P=0.067).Furthermore,the high PLR group had significantly higher MACEs(25%vs.7%,P=0.004)and all-cause mortality(14%vs.2%,P=0.014)than the low PLR group.Conclusions:The study suggested that PLR was an independent risk factor of impaired myocardial perfusion.Moreover,higher PLR is related to all-cause death and in-hospital MACE in patients with anterior MI who undergo PPCI.更多还原