急性ST段抬高心肌梗死患者平均血小板体积与心功能的关系

The relationship between mean platelet volume and heart function in patients with ST-segment elevation myocardial infarction

目的观察急性ST段抬高心肌梗死（ST-segment elevation myocardial infarction,STEMI）患者急性期平均血小板体积（mean platelet volume,MPV）的动态变化,并探讨其与Killip分级的关系。方法连续入选发病12 h内行直接经皮冠状动脉介入治疗（percutaneous coronary intervention,PCI）的STEMI患者357例,于直接PCI术前及术后24 h、72 h和7 d分别检测MPV,分析MPV与反映心功能的临床参数Killip分级的相关性。结果 MPV于急诊就诊时达到最高值（10.13±1.03）fL,直接PCI术后24 h后开始迅速下降,直至术后7 d。Killip分级≥2级的患者在心肌梗死1周内各时间点MPV均高于Killip分级1级的患者。校正了年龄、糖尿病、高血压、是否前壁心肌梗死、空腹血糖、发病至就诊时间、直接PCI后ST段回落及发病前是否有心绞痛这些混杂因素后,Logistic回归分析显示,急诊就诊时较高的MPV是较差心功能（Killip分级≥2级）的独立预测因子（OR 1.671,95%CI 1.177-2.222,P〈0.05）。结论行直接PCI的STEMI患者心功能较差者MPV水平较高,提示MPV与心肌梗死后左心室功能相关。

Objective To investigate the relationship between the mean platelet volume（ MPV）and heart function in patients with ST-segment elevation myocardial infarction（ STEMI）. Methods 357 consecutive patients with STEMI receiving primary percutaneous coronary intervention（ PCI） within 12 h of symptom onset were included. MPV data were obtained on admission,24 h,72 h and the 7 d after PCI,respectively. The correlations of the above haematological indices with Killip class which reflects the left ventricle function were examined. Results MPV had their peak values at admission（ 10. 13 ± 1. 03） fL,and then reduced from the first day to the seventh day. The higher levels of MPV were found in patients of high Killip classes（ Killip class ≥2） at all the time points. A logistic regression model was used to assess the association between MPV and Killip levels, adjusting for confounders（ age, diabetes mellitus,hypertension,anterior myocardial infarction,fasting blood glucose levels,time from onset to admission,ST segment resolution after PCI,and angina prior to onset）. After adjusting for the above factors,high MPV remained an independent predictor of high Killip classes（ OR 1. 671,95% CI 1. 177- 2. 222,P〈0. 05）.Conclusions MPV was higher in patients with high Killip classes,suggesting an important role of MPV in the prediction of left ventricular function.