急性心肌梗死患者红细胞体积分布宽度与梗死相关血管早期自发再通的关系

Relation between red blood cell volume distribution width and spontaneous recanalization of infarct-related arteries in early phase of acute myocardial infarction

目的 探讨急性ST段抬高型心肌梗死（STEMI）患者红细胞体积分布宽度（RDW）与梗死相关血管（IRA）早期自发再通的关系。方法 连续收集2016年1—8月就诊于首都医科大学附属北京安贞医院的367例STEMI患者的病历资料，患者均在症状出现12 h内接受冠状动脉造影，按照冠状动脉造影显示IRA的心肌梗死溶栓试验（TIMI）血流分级分为血管未再通组（TIMI 0～Ⅰ级，237例）和血管再通组（TIMI Ⅱ～Ⅲ级，130例）。收集患者的临床基本信息，入院后立即采集外周静脉血检测RDW以及相关血常规、血生化指标，常规行超声心动图检查并计算左心室射血分数（LVEF）。结果 2组性别、年龄、吸烟史、高血压（史）、糖尿病（史）、心肌梗死病史、症状发作至抽血时间、院前服用抗血小板药物、IRA位置、LVEF、血红蛋白水平、血小板计数、白细胞计数、尿素氮、血肌酐、总胆固醇、三酰甘油、低密度脂蛋白胆固醇及高密度脂蛋白胆固醇水平比较，差异均无统计学意义（均P＞0.05）。血管再通组患者RDW为（12.4±2.2）%，明显低于血管未再通组的（14.3±2.3）%，差异有统计学意义（P＜0.01）。结论 STEMI患者入院时RDW与IRA早期是否自发再通有关。

Objective To investigate the relation between red cell volume distribution width（RDW） and spontaneous recanalization of infarct-related artery（IRA） in early phase of ST-elevation myocardial infarction（STEMI）. Methods Clinical data of 367 patients with STEMI were consecutively selected from January to August 2016 in Beijing Anzhen Hospital, Capital Medical University. According to the thrombolysis in myocardial infarction（TIMI） of IRA by coronary angiography within 12 h after STEMI onset, the patients were divided into recanalization group（TIMI grade 0-Ⅰ, n=237） and non-revascularization group（TIMI grade Ⅱ-Ⅲ, n=130）. Basic clinical data, left ventricular ejection fraction（LVEF）, RDW on admission, results of blood routine and biochemical tests were analyzed. Results There were no significant differences of gender, age, smoking history, hypertension, diabetes, myocardial infarction history, duration between onset and blood drawing, pre-hospital use of antiplatelet drugs, IRA site, LVEF, hemoglobin level, platelet count, white blood cell count, urea nitrogen, serum creatinine, total cholesterol, triacylglycerol, low density lipoprotein cholesterol and high density lipoprotein cholesterol levels between groups（P〉0.05）. The value of RDW in recanalization group was significantly lower than that in non-revascularization group[（12.4±2.2）% vs（14.3±2.3）%]（P〈0.01）. Conclusion There is an association between RDW and spontaneous recanalization of IRA in early phase of STEMI.