血小板与淋巴细胞比值在直接PCI术后发生主要不良心脑血管事件中的预测价值

The predictive value of platelet to lymphocyte ratio in patients with major adverse cardiac and cerebrovascular events after primary PCI

目的探讨血小板与淋巴细胞比值(PLR)在急性ST段抬高型心肌梗死(STEMI)患者接受直接PCI术中出现无复流和术后发生主要不良心脑血管事件(MACCE)中的预测价值。方法回顾分析我院181例接受直接PCI治疗的STEMI患者临床和冠状动脉造影资料,依据ROC曲线确定诊断术中无复流的PLR标准,将入选患者分为高PLR组和低PLR组,并比较两组临床资料、住院期间和随访期间MACCE发生率。结果对符合入选标准的181例患者术前PLR和术后TIMI血流之间的关系进行ROC曲线分析,结果显示PLR≥162.72预测发生术中无复流现象的敏感性和特异性分别为84.62%和85.5%(AUC=0.835,95%CI为0.776~0.883,Z=6.611,P<0.001)。根据术前PLR=162.72将所有患者分为高PLR组(PLR≥162.72,n=48)和低PLR组(PLR<162.72,n=133),两组患者临床一般资料比较无明显差异。与低PLR组相比,高PLR组术后CK-MB峰值浓度升高(313.55±212.76 U/L比216.64±152.41 U/L,P=0.001)、左心室射血分数(LVEF)降低(48.58%±7.30%比51.66%±6.82%,P=0.009)和住院期间MACCE发生率升高[20.83%(10/48)比9.77%(13/133),P=0.049]。术后随访6~72(25.57±18.7)个月,共发生MACCE 28例,包括不同原因死亡10例。其中,高PLR组MACCE发生率显著高于低PLR组(27.08%比11.28%,P=0.009)。生存分析显示,高PLR组全因死亡率和无MACCE生存率显著高于低PLR组(P<0.05或P<0.01)。COX比例风险回归分析显示,高PLR为预测心肌梗死发生术后MACCE的独立危险因素(HR=2.106,95%CI为1.794~5.586,P=0.035)。结论 PLR为一种预测STEMI患者直接PCI术后发生MACCE的独立而有价值的指标。

Aim To investigate the predictive value of platelet to lymphocyte ratio（ PLR） in myocardial reperfusion blood flow and major adverse cardiac and cerebrovascular events（ MACCE） in patients with acute ST-segment elevation myocardial infarction（ STEMI）. Methods Clinical and angiographic data of 181 patients with STEMI who received direct PCI in our hospital during the period of hospitalization were retrospectively analyzed. According to the ROC curve to determine the diagnosis of no reflow in the PLR standard,the selected patients were divided into high PLR group and low PLR group,and the clinical data,incidence of MACCE during hospitalization period and follow-up in the two groups were compared. Results ROC curve analyzed the relationship between preoperative PLR and postoperative TIMI blood flow,and PLR ≥ 162. 72 predicted intraoperative no-reflow with a specificity of 85. 5% and a sensitivity of84.62%（ AUC = 0.835,95%CI was 0.776 ~ 0.883,Z = 6.611,P〈0.001）. All patients were divided into two groups including high PLR group（ PLR≥162.72,n = 48） and lower PLR group（ PLR 162.72,n = 133）,there were no significant differences in clinical data between the two groups. Compared with patients in low PLR group,patients in high PLR group had higher peak levels of creatine kinase-MB（ 313.55 ± 212.76 U / L vs. 216.64 ±152.41 U / L,P = 0.001）,lower left ventricular ejection fraction（ 48.58% ±7.30% vs. 51.66% ± 6.82%,P = 0. 009）,and higher incidence of MACCE in-hospital（ 20.83%（ 10/48） vs. 9.77%（ 13/133）,P= 0.049）. During a mean follow-up of 6~72（ 25.57±18.72） months,a total of MACCE occurred in 28 cases,including 10 cases died from different reasons. The incidence of MACCE in high PLR group was significantly higher than that in low PLR group（ 27. 08%（ 13 / 48） vs. 11. 28%（ 15 / 133）,P = 0. 009）.Survival analysis showed that the all-cause mortality and the events free survival in high PLR group was significantly higher than that in low PLR group（ P = 0.003）. COX proportional hazard regression analysis showed that high PLR was an independent risk factor for MACCE after myocardial infarction（ HR = 2.106,95% CI = 1. 794,P = 0. 035）. Conclusion PLR is an independent and valuable index for predicting the occurrence of MACCE after direct PCI in patients with STEMI.