血小板与淋巴细胞比率对急性ST段抬高型心肌梗死患者冠脉介入治疗后无复流的预测研究

发布时间：2018-06-23 21:43

本文选题：血小板与淋巴细胞比率 + 急性心肌梗死　；参考：《第四军医大学》2016年硕士论文

【摘要】：研究背景:急性ST段抬高型心肌梗死(STEMI)患者进行早期再灌注治疗可以改善预后。经皮冠状动脉介入治疗(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%的冠脉闭塞血管可以被重新开通[2-5]。但是,虽然心外膜冠脉血管被重建,心肌组织却不一定能恢复理想的再灌注。微血管水平的再灌注失败的现象被称为冠脉无复流现象[6-10]。以往研究显示,多达60%的血管重建的STEMI患者发生无复流现象[3,11-19]。无复流显著减少了再灌注治疗的益处,导致患者心功能及预后恶化。无复流现象与急性STEMI患者较差的心功能恢复、心肌梗死面积增加、更高的并发症发生率、短期及长期死亡率有关。无复流现象一旦出现很难逆转,所以对潜在的高危患者进行筛选十分重要,寻找简单、实用的预测因子十分必要。国内外已经开展了许多有关无复流预测因素的研究。有研究发现,心电图出现2个以上Q波、心功能Killip II级、冠脉内出现血栓、以及血管成形术作为唯一的再灌注治疗方式,均可能为冠脉无复流的预测因素[20]。最近国外研究发现,血小板与淋巴细胞比率(Platelet-to-Lymphocyte Ratio,PLR)是主要不良心血管事件的一个新的预测因子[21,22,23]。国内目前尚缺乏PLR和无复流的关系的研究,那么PLR是否为STEMI患者PCI后无复流的预测因子,是否是一个敏感度及特异度较好的临床指标,这个问题需要进一步研究。目的:研究入院时PLR值对国内急性ST段抬高型心肌梗死患者冠脉介入治疗后无复流的预测价值,为寻找简单、实用的无复流预测因子提供理论依据。方法:共收集190例急性STEMI患者,发病12小时内并且行PCI术。按术后即刻心肌梗死溶栓试验(Thrombolysis In Myocardial Infarction,TIMI)血流分级将病人分为2组:正常复流组(138例)和无复流组(52例),比较两组患者的基本临床资料、实验室检查结果及PCI术中靶病变及用药,用Logistic回归分析无复流的预测因素,用受试者工作特征曲线(ROC)论证得到PLR预测无复流的最佳临界值及其敏感度和特异度。结果:无复流组与正常复流组相比PLR显著升高(P=0.004)、心电图出现2个以上Q波(P=0.005)及冠状动脉内血栓征象较高(P=0.023)。当PLR值为188时,预测无复流的敏感度为70%,特异度为72%。结论:PLR、心电图出现2个以上Q波、冠状动脉内血栓征象均是无复流的预测因素。当PLR值为188时,对无复流预测的敏感度及特异度均较好。
[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.
【学位授予单位】：第四军医大学
【学位级别】：硕士
【学位授予年份】：2016
【分类号】：R542.22

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