平均血小板体积对急性ST段抬高型心肌梗死患者预后的影响

Impact of Mean Platelet Volume on Prognosis in Patients With ST-segment Elevation Myocardial Infarction

目的:评价平均血小板体积(MPV)对急性ST段抬高型心肌梗死(STEMI)患者预后的影响。方法:连续入选2010-01-01至2014-10-31于我院住院确诊为STEMI并接受经皮冠状动脉介入治疗(PCI)的1 012例患者,于2015-10进行随访,记录主要不良心血管事件(MACE)。基于受试者工作特征(ROC)曲线确定的全因死亡的MPV最佳界值,将患者分为低MPV组和高MPV组。比较两组患者MACE发生率,并用单因素及多因素COX回归分析MPV对接受PCI治疗的STEMI患者预后的影响。结果:ROC曲线确定的全因死亡的MPV最佳界值为9.466 fl,低MPV组549例(MPV≤9.466 fl)和高MPV组463例(MPV>9.466 fl)。随访时间为34(12~69)个月。与低MPV组比,高MPV组患者PCI后具有更高的全因死亡(P<0.001)及心原性死亡发生率(P=0.001)。多因素校正后,COX回归分析仍显示入院高MPV为接受PCI的STEMI患者全因死亡(HR=1.463,P<0.001)及心原性死亡(HR=1.458,P<0.001)事件的独立危险因素。结论:入院MPV增高对PCI后STEMI患者的长期预后有预测价值。

Objective： To evaluate the impact of mean platelet volume （MPV） on prognosis in patients with ST-segment elevation myocardial infarction （STEMI）. Methods： A total of 1012 consecutive STEMI patients received percutaneous coronary intervention （PCI） in our hospital from 2010-01-01 to 2014-10-31 were enrolled. Major adverse cardiovascular events （MACE） were recorded in 2015-10. Based on ROC curve measured optimal critical point of MPV in all-cause death, the patients were divided into Low MPV group and High MPV group. The incidence of MACE was compared between 2 groups, the impact of MPV on prognosis of PCI treated STEMI patients was studied by uni- and multivariate COX regression analysis. Results： By ROC curve, the optimal critical point of MPV in all-cause death was MPV≤9. 466 fl. MPV≤9. 466 fl in Low MPV group, n=549 and MPV〉9. 466 fl in High MPV group, n=463. The patients were followed-up for 34 （12-69） months. Compared with Low MPV group, the patients in High MPV group had the higher incidences of all-cause death and cardiac death, P〈0. 001 and P=0. 001. With adjusted multivariates, COX regression analysis showed that MPV was an independent risk factor of all-cause death （HR=1. 463, P〈0. 001） and cardiac death （HR=1. 458, P〈0. 001） in relevant patients. Conclusions： Increased MPV at admission had the predictive value for long-term prognosis in PCI treated STEMI patients.