白细胞计数和血小板计数联合评分对急性ST段抬高型心肌梗死患者急诊经皮冠状动脉介入治疗术后在院死亡危险评估的研究

Predictive Value of Combination Scores of Leukocyte and Platelet Counts for Mortality in Patients With Acute ST Segment Elevation Myocardial Infarction After PCI Treatment

目的:探讨白细胞计数和血小板计数联合评分(COL-P评分)对急性ST段抬高型心肌梗死(STEMI)患者急诊经皮冠状动脉介入治疗(PCI)术后在院死亡危险评估的效果。方法:回顾性研究我院2009-11至2013-08的STEMI住院急诊行PCI术的患者共660例,其中生存者572例,死亡者88例。依不同COL-P评分进行分组(COL-P 0分组、COL-P 1分组、COL-P 2分组)统计学分析。结果:660例急诊行PCI术的STEMI患者住院期间死亡者88例。死亡者白细胞计数高于生存者白细胞计数,两者比较差异有统计学意义(P<0.001);死亡者血小板计数低于生存者血小板计数,两者比较差异有统计学意义(P<0.01)。Logistic回归显示,COL-P评分[COL-P(1 vs 0),OR 4.346,95%CI:2.134-8.850,P<0.001;COL-P(2 vs 0),OR 10.126,95%CI:4.061-25.250,P<0.001]为STEMI患者急诊PCI术后在院死亡的独立影响因素。COL-P 0分组、COL-P 1分组和COL-P 2分组在院期间死亡率分别为4.9%、15.4%和43.1%,三组比较差异有统计学意义(P<0.001)。结论:COL-P评分是STEMI患者急诊PCI术后住院期间死亡率危险评估的良好评价工具,但对长期死亡率的评估能力还有待进一步研究验证。

Objective： To study the predictive value of combination scores of leukocyte and platelet counts （COL-P） for in-hospital mortality in patients with acute ST segment elevation myocardial infarction （STEMI） after percutaneous coronary intervention （PCI） treatment. Methods： A total of 660 STEMI patients with emergent PCI in our hospital from 2009-11 to 2013-08 were retrospectively studied. The patients were divided into 3 groups according to COL-P scores： COL-P0 group,n=283, COL-P1 group,n=319 and COL-P3 group,n=58. The relationship between the in-hospital mortality and COL-P scores was analyzed among different groups. Results： There were 88/660 in-hospital death. The patients in death group had the higher white blood cell count and lower platelet count than those in survival group, bothP〈0.01. Logistic regression analysis indicated that compared with COL-P0 group, the COL-P scores at COL-P1 level （OR 4.346, 95% CI 2.134-8.850,P〈0.001） and COL-P2 level （OR 10.126, 95% CI 4.061-25.250,P〈0.001） were the independent risk factors for in-hospital death in STEMI patients after emergent PCI. The in-hospital mortality in COL-P0, COL-P1 and COL-P2 groups were at 4.9%, 15.4% and 43.1% respectively, allP〈0.001. Conclusion： COL-P score was useful for predicting the in-hospital mortality in STEMI patients after emergent PCI, while the long term mortality estimation should be further studied.