监测PDW、MPV、PLT水平变化对AMI患者1年内MACE的预测价值

The predictive value of PDW, MPV and PLT levels in AMI patients with MACE in 1 year

目的监测血小板分布宽度(PDW)、平均血小板体积(MPV)、血小板计数(PLT)水平变化对急性心肌梗死(AMI)患者1年内主要不良心脏事件(MACE)的预测价值,为AMI患者预后质量的评估提供参考依据。方法选取解放军第309医院2013年6月-2015年6月收治的117例AMI患者为观察组,并选取同期80名健康体检者作为对照组,比较两组受试者PDW、MPV、PLT等血小板参数差异。对AMI患者实施1年随访,记录其随访期间MACE发生情况,并按照MACE发生情况,分别纳入发生MACE组、未发生MACE组,比较两组患者血小板参数差异,分析血小板参数预测MACE发生的价值。结果观察组治疗前、治疗后3 d PDW、MPV高于对照组,其PLT低于对照组,差异有统计学意义(P<0.05)。两组受试者治疗后7 d血小板参数比较,差异无统计学意义(P>0.05)。随访期间39例患者发生MACE,发生率为33.33%。发生MACE组术前PDW、MPV高于未发生MACE组,其PLT低于后者,差异有统计学意义(P<0.05);两组患者治疗后7 d PDW、MPV均较治疗前下降,PLT均较治疗前升高,未发生MACE组改善更为明显,差异有统计学意义(P<0.05)。ROC曲线示,治疗前、治疗后7 d PDW、MPV、PLT对预测患者1年内MACE发生风险均具有较高价值(P<0.05)。结论血小板分布宽度、体积增加及计数减少可能与AMI发生发展及预后变化具有密切关联,密切监测治疗前后血小板参数可有效预测患者1年内MACE发生风险,指导临床诊治。

Objective To analyze the predictive value of monitoring platelet distribution width （PDW） , mean platelet volume （MPV） , platelet count （PLT） levels in patients with acute myocardial infarction （AMI） with 1 year of major adverse cardiac events （MACE） , and provide a reference for the quality evaluation of prognosis of patients with AMI. Methods 117 patients with AMI in our hospital from June 2013-June 2015 were enrolled as the observation group, and 80 healthy subjects were selected as the control group. The platelet parameters PDW, MPV, PLT and other parameters of the two groups were compared. The AMI patients were follow-up for 1 year and recorded for the occurrence of MACE. According to the occurrence of MACE, the patients were divided into MACE group and non MACE group. The MACE prediction values of the platelet parameters were analyzed. Results The PDW and MPV levels before and 3 d after treatment were higher than those of control group, but the PLT was lower than the control group; the differences were statistically significant （P〈 0.05 ）. There was no significant difference in the platelet parameter between the two groups 7 d after treatment （P〉0.05）. MACE occurred in 39 patients during follow-up ; the incidence was 33.33%. The preoperative PDW and MPV levels of the MACE group were significantly higher than those of the non MACE group, but the PLT level was significantly lower （P〈 0.05 ）. The PDW and MPV levels 7 d after treatment of both groups were significantly lower than those before treatment, but the PLT level was significantly increased after 7 d of treatment; the changes of these parameters of the non MACE group were more significant than those of the MACE group （P〈0.05）. ROC curve indicated that the PDW, MPV and PLT levels had a high value for predicting MACE in 1 year after operation （P〈0.05）. Conclusion The platelet distribution width, volume increase and count decrease might be closely related to the development and prognosis of AMI. The monitoring of platelet parameters before and after treatment could effectively predict the risk of MACE in 1 year and guide the clinical diagnosis and treatment.