血小板平均容积对老年急性心肌梗死患者急诊介入治疗后心肌灌注不良的预测

Mean platelet volume is a predictor of poor myocardial perfusion in elderly acute myocardial infarction patients after PCI

目的探讨急性心肌梗死（AMI）患者急诊PCI术前血小板平均容积（MPV）水平与术后心肌灌注情况之间的关系。方法选择AMI并接受急诊PCI的老年患者273例,根据术后心肌呈色分级（MBG）分为灌注良好组（MBG 3级）159例和灌注不良组（MBG 0-2级）114例。比较2组入院时血常规等情况,分析急诊PCI术后心肌灌注不良的相关因素。结果灌注不良组MPV[（11.2±1.4）fl vs（9.4±1.2）fl]及白细胞计数[（11.2±1.0）×10^9/L vs（10.1±1.3）×10^9/L]较灌注良好组明显增高（P〈0.01）。多因素logistic回归分析显示,MPV（OR=2.409,95%CI：1.640-3.539,P〈0.01）和白细胞计数（OR=1.683,95%CI：1.107-2.558,P〈0.05）是急诊PCI术后心肌灌注不良的预测因素;相关分析显示,MPV和白细胞计数分别与急诊PCI术后MBG（r=-0.616,P〈0.01;r=-0.449,P〈0.05）和左心室射血分数（r=-0.671,P〈0.01;r=-0.265,P〈0.05）呈负相关。结论在接受急诊PCI术成功开通梗死相关血管的老年AMI患者中,其MPV和白细胞计数越高,术后心肌灌注情况越差。

Objective To study the relationship between mean platelet volume（MPV）before PCI and myocardial perfusion after PCI in elderly acute myocardial infarction（AMI）patients.Methods Two hundred and seventy-three elderly AMI patients after PCI were divided into good perfusion group（n=159）and poor perfusion group（n=114）.The patients underwent blood routine examination on admission.The factors associated with good myocardial perfusion were analyzed by myocardial blush grade（MBG）in elderly AMI patients after PCI.Results The MPV and WBC count were significantly higher in poor perfusion group than in good perfusion group（P〈0.01）.Multivariate logistic regression analysis showed that MPV and WBC count were the predictors of poor myocardial perfusion in elderly AMI patients after PCI（OR=2.409,95%CI：1.640-3.539,P〈0.01;OR=1.683,95%CI：1.107-2.558,P〈0.05）.Correlation analysis showed that MPV and WBC count were negatively correlated with MBG and LVEF in elderly AMI patients after PCI（r=0.616,P〈0.001;r=0.449,P〈0.05;r=-0.671,P〈0.01;r=-0.265,P〈0.05）.Conclusion The higher the MPV and WBC count are,the poorer the myocardial perfusion is in elderly AMI patients after PCI.