急性ST段抬高型心肌梗死PCI术后血小板CD40L与血小板指标临床相关性分析

Clinical analysis of the relationship between CD40L and platdet index in patients with acute ST segment elevation myocardial infarction after PCI

目的 研究急性ST段抬高型心肌梗死PCI术后血小板CD40L与血小板指标的相关性.方法 选择2014年5月至2015年5月我院接收的急性ST段抬高型心肌梗死患者中实施PCI术的患者58例作为观察组,选择同期健康体检人员53名作为对照组.观察组男性39例,女性19例,年龄52～76（64.39±8.62）岁;对照组男性32例,女性21例,年龄51～78（65.27±7.63）岁.对所有研究对象的血小板CD40L、血小板体积分布宽度（PDW）、血小板计数（PLT）、血小板压积（PCT）、血小板平均体积（MPV）、肌钙蛋白Ⅰ（Tn-Ⅰ）等指标进行测定.观察组测定时间为患者手术前、后,对照组人员测定时间为参加研究时,比较两组研究对象各项指标水平,研究血小板CD40L与血小板指标的相关性.结果 观察组患者术前测得血小板CD40L（MFI）、Tn-Ⅰ与对照组比较差异有统计学意义[（4.69±0.38）a.u比（0.79±0.16）a.u,（11.670±1.762）μg/L比（0.011±0.008）μg/L,P＜0.05];观察组患者术前测得PCT、PLT、PDW、MPV与对照组比较未见统计学差异（P＞0.05）;观察组患者术后测得血小板CD40L （MFI）、Tn-Ⅰ、MPV、PDW与对照组比较差异均有统计学意义[（9.01±0.62）a.u比（0.79±0.16）a.u,（17.691±2.558）μg/L比（0.011±0.008）μg/L,（12.15±2.26）fl比（8.86±1.27）fl,（21.38±1.75）％比（15.76±1.28）％,P＜0.05];观察组患者术后测得PCT、PLT与对照组比较未见统计学差异（P＞0.05）;观察组患者术后测得血小板CD40L （MFI）、Tn-Ⅰ、MPV、PDW与术前比较差异均有统计学意义[（4.69±0.38）a.u比（9.01 ±0.62）a.u,（11.670±1.762）μg/L比（17.691±2.558）μg/L,（8.31±1.08）fl比（12.15±2.26）fl,（16.39±1.88）％比（21.38±1.75）％,P＜0.05];观察组患者术后测得PCT、PLT与对照组比较未见统计学差异（P＞0.05）.观察组患者行PCI术后,MPV（r=0.812）、PDW（r=0.722）与血小板CD40L呈正相关（P＜0.05）;Tn-Ⅰ、PCT、PLT与血小板CD40L之间没有相关性（P＞0.05）.结论 血小板形态发生变化是急性ST段抬高型心肌梗死患者进行PCI术后血小板活化的特征,而血小板CD40L的表达受到血小板指标的影响,会产生炎症、凝血等情况,应予以重视.

Objective To study the relationship between CD40L and platelet parameters in patients with acute ST segment elevation myocardial infarction after PCI. Methods 58 patients with acute ST segment elevation myocardial infarction in our hospital were selected from May 2015 to May 2014. The patients were selected as the research object, the patients were observed group, and 53 healthy persons were selected as control group. In the observation group, 39 males, 19 females, age 52-76 （64.39±8.62）years old. In the control group, 32 males, 21 females, aged 51-78（65.27±7.63）years old. The patients with CD40L, platelet volume distribution width（PDW）, platelet count （PLT）, platelet count （PCT）, platelet count （Tn-1）, cardiac troponin I （MPV） were determined.Results The preoperative observation group measured platelet CD40L （MFI）, Tn-I were statistically significantly different with the control group[ （4.69±0.38）a.u vs （0.79±0.16）a.u, （11.670±1.762）μg/L vs （0.011±0.008）μg/L, P〈0.05 ], preoperative PCT measured observation group, PLT, PDW, MPV and the control group was small, no statistically significant （P〉0.05）. Postoperative observation group measured platelet CD40L （MFI）, Tn-I, MPV, PDW were significantly different from the control group was statistically significant [ （9.01±0.62）a.u vs （0.79±0.16）a.u, （17.691±2.558）μg/L vs （0.011±0.008）μg/L, （12.15±2.26）fl vs （8.86±1.27）fl, （21.38±1.75）% vs （15.76± 1.28）% ,P〈0.05], postoperative measured PCT, PLT and the control group was observed a smaller group of pa- tients, no statistically significant（P〉0.05）. Postoperative observation group were measured to obtain platelet CD40L （MFI）, Tn-l, MPV, PDW were there with preoperative big difference was statistically significant in STEMI pa- tients [（4.69±0.38）a.u vs （9.01±0.62）a.u, （11.670±1.762）μg/L vs （17.691±2.558）μg/L, （8.31±1.08）fl vs （12.15±2.26）fl, （16.39±1.88）% vs （21.38±1.75）%,P〈0.05], postoperative observation group measured PCT, PLT and the control group was small and not statistically significant （P〉0.05） row after PCI, MPV （r=0.812）, PDW （r=0.722） and platelet CD40L positive correlation （P〈0.05）, Tn-I, PCT, between the PLT and platelet CD40L no correlation （/9〉0.05）. Conclusion The changes of platelet morphology are the characteristics of the acti- vation of platelet in patients with acute ST segment elevation myocardial infarction after PCI, and the expression of platelet CD40L is influenced by the platelet index, which can produce inflammation and coagulation.