血小板/淋巴细胞比值对急性ST段抬高型心肌梗死患者PCI术后心肌无复流的预测价值

Diagnostic value of platelet / lymphocyte ratio in patients with acute ST-segment elevation myocardial infarction without myocardial reflux after PCI

摘要:

目的 探讨血小板/淋巴细胞比值（PLR）对急性ST段抬高型心肌梗死（STEMI）患者经皮冠脉介入术（PCI）后心肌无复流的预测价值。方法 选取2014年10月—2018年10月蚌埠市第二人民医院收治的STEMI患者118例，详细记录病史和体格检查结果，检测血小板计数（PLT）、淋巴细胞计数（LY），计算PLR；评估PCI术中情况，记录术中梗死相关动脉的病变情况，采用Gensini积分评价冠状动脉病变程度，采用TIMI血流分级将患者分为正常复流组（TIMI 3级）和无复流组（TIMI 0～2级）。结果 两组患者年龄、性别构成比、高血压、糖尿病、吸烟、卒中、发病时间、Killip分级构成比比较，差异均无统计学意义（P?>0.05）；无复流组患者PLT、PLR和Gensini积分高于正常复流组（P?<0.05），其余指标两组间比较，差异均无统计学意义（P?>0.05），相关性分析显示PLR与Gensini积分呈正相关（r?=0.581，P?=0.006）；多因素Logistic回归结果显示：PLR高[OlR=2.737（95% CI：1.433，5.227）]和Gensini积分高[OlR=1.490（95% CI：1.087，2.042）]为影响PCI术后心肌无复流的危险因素。ROC曲线分析结果显示以PLR为诊断模型变量，曲线下面积为0.751，以最大约登指数计算的诊断阈值为188.21，预测无复流的敏感性为70%，特异性为73%。结论 PLR与STEMI患者冠状动脉病变程度呈正相关，PLR对PCI术后心肌无复流具有一定的的预测价值。

Abstract:

Objective To investigate the diagnostic value of platelet / lymphocyte (PLR) ratio in predicting no-reflow after percutaneous coronary intervention (PCI) in patients with acute ST-segment elevation myocardial infarction (STEMI). Methods Totally 118 STEMI patients admitted in hospital from October 2014 to October 2018 were recruited. Detailed medical history and physical examination result was recorded. Venous blood was collected to detect platelet count (PLT), lymphocyte count (LY) and calculate PLR. The condition of PCI was evaluated, and the pathological change of infarct-related arteries was recorded. Gensini score was used to evaluate the degree of coronary atherosclerosis. The patients were divided into normal reflow group (TIMI grade 3) and no-reflow group (TIMI grade 0-2) by TIMI blood flow grading. Results There was no significant differences in age, sex ratio, hypertension, diabetes, smoking history, stroke history, onset time and Killip classification between the two groups (P?>?0.05). The PLT, PLR and Gensini score in no reflow group were significantly higher than those in normal reflow group (all P??0.05). PLR was positively correlated with Gensini score (r?=?0.581, P?=?0.006). Logistic regression showed that PLR [OlR?=?2.737, (95% CI: 1.433, 5.227)], right coronary artery infarction [OlR?=?1.572, (95% CI: 1.051, 2.350)] and Gensini score [OlR?=?1.490, (95% CI: 1.087, 2.042)] were risk factors for no-reflow after PCI (P??1). ROC curve analysis showed that the area under the curve was 0.751 (P?=?0.017) based on PLR model. The shear value calculated by Yoden index was 188.21, the sensitivity and specificity of predicting no reflow was 70% and 73%. Conclusion PLR is positively correlated with the severity of coronary atherosclerosis in patients with acute STEMI. PLR has a good predictive ability for infarction-related vascular reflow after PCI.