接受直接经皮冠状动脉介入治疗ST段抬高性心肌梗死患者平均血小板体积、白细胞计数和中性粒细胞计数的变化及其与冠状动脉血流的关系

Changes of mean platelet volume,leukocyte and neutrophil counts in ST-segmentelevation myocardial infarction patients treated with primary percutaneouscoronary intervention and their relationship with coronary flow

目的:观察接受直接经皮冠状动脉(冠脉)介入(PPCI)治疗的ST段抬高性心肌梗死(STEMI)患者入院时平均血小板体积(MPV)、白细胞计数(LC)和中性粒细胞计数(NC)等的变化及其与冠脉血流的关系。方法:选择179例接受PPCI治疗的STEMI患者(STEMI组),入院时测定MPV、LC、NC和血生化等指标,阅读冠脉影像资料,评估梗死相关动脉行PPCI前后的TIMI血流分级,计算梗死相关动脉行PPCI后校正TIMI血流帧数计数(CTFC)。同期冠脉造影等确诊的107例稳定型心绞痛患者作为对照(稳定型心绞痛组)。另外,根据PPCI前梗死相关动脉是否有自发性开通,将STEMI组分为PPCI前梗死相关动脉血流自发性开通亚组(50例)和无自发性开通亚组(129例);根据梗死相关动脉行PPCI后的冠脉血流,将STEMI组分为TIMI 3级亚组(148例)和未达TIMI 3级亚组(31例)。结果:与稳定型心绞痛组比较,STEMI组MPV、LC和NC显著升高(均P<0.01),血小板压积显著降低(P<0.05)。STEMI组内各亚组间比较显示,与行PPCI前梗死相关动脉自发性开通亚组比较,无自发性开通亚组MPV、LC和NC显著升高,血小板计数显著降低(均P<0.05);与行PPCI后梗死相关动脉血流达TIMI 3级亚组比较,未达TIMI 3级亚组LC、NC和血小板分布宽度显著升高(均P<0.05),MPV亦明显升高(P<0.01)。多元线性回归分析显示,MPV和NC是梗死相关动脉行PPCI后CTFC的独立影响因素。结论:STEMI患者MPV、LC和NC显著增加,MPV、LC和NC与梗死相关动脉行PPCI前后血流的受损程度有密切关系。

Objective：To assess the changes of mean platelet volume （MPV）, leukocyte count （LC） and neu trophil count （NC） in ST segment elevation myocardial infarction （STEMI） patients treated with primary percuta neous coronary intervention （PPCI） and their relationship with coronary flow. Method： A total of 179 STEMI patients undergoing PPCI were enrolled. MPV, LC, NC and biochemical parameters were measured on admission. The TIMI flow of the infarct-related artery was evaluated before and after PPCI, and the infarct related artery＇s corrected thrombolysis in myocardial infarction frame count （CTFC） was also calculated. One hundred and seven in hospital patients with stable angina pectoris were taken as control. Result：Compared with patients with stable angina pectoris, MPV, LC and NC in STEMI patients were increased significantly （all P〈0.01） and plateletcrit was decreased markedly （P〈0.05）. If the infarct related artery＇s coronary flow was TIM1 grade 1 to 3 before PPCI, it was defined as spontaneous reperfusion. STEMI patients without spontaneous reperfusion had markedly increased MPV, I.C and NC and dominantly decreased platelet counts than those with spontaneous reperfusion （all P〈0.05）. After PPCI, STEMI patients whose infarct related artery＇s TIMI flow was less than grade 3 had signif icantly elevated LC, NC and platelet distribution width （all P〈0.05） and MPV （P〈0.01） than those with TIMI flow grade 3. Multiple regression analysis showed that MPV or NC was the independent predictor for the infarct- related artery＇s CTFC. Conclusion： MPV, LC and NC on admission are increased in patients with STEMI, and they are independently associated with coronary flow.