血小板/淋巴细胞计数比与急性前壁心肌梗死患者心肌灌注及院内主要不良心脏事件的相关性

Correlation between platelet/lymphocyte count ratio and myocardial perfusion,major adverse cardiac events in patients with acute anterior myocardial infarction

目的探讨血小板/淋巴细胞计数比(PLR)与行急诊冠状动脉介入治疗(PPCI)的急性前壁心肌梗死患者心肌灌注和院内主要不良心脏事件的相关性。方法回顾分析行PPCI手术的急性前壁心肌梗死患者共136例。根据患者术前PLR值,用四分位法获取患者四分位数,以三四分位数(PLR=165)为界限,将患者分为高PLR组(PLR≥165的第四分位组)和低PLR组(PLR<165的第一、二和三分位组)。比较两组患者的基线临床特征、Killip心功能分级、TIMI血流分级、心肌呈色分级(MBG)、实验室检查及院内主要不良心脏事件(MACE)。结果高PLR组患者Killip分级≥Ⅱ级的比例较低PLR组显著增高(47%比20%,P=0.005)。高PLR组术后TIMI血流0~2级(36%比14%,P=0.004)、MBG 0~1级的比例显著高于低PLR组(44%比21%,P=0.016)。高PLR组患者心肌灌注不良比例显著高于低PLR组(56%比27%,P=0.002)。Logistic多因素回归分析显示影响心肌灌注的危险因素有:PLR(OR 1.009,95%CI 1.004~1.015,P=0.001)、血栓抽吸(OR 1.473,95%CI 1.012~2.144,P=0.043)、脑钠尿肽(BNP)(OR 1.001,95%CI 1.000~1.002,P=0.034)和肌酸激酶同工酶(CK-MB)峰值(OR 1.002,95%CI1.001~1.005,P=0.067)。高PLR组的院内MACE显著高于低PLR组(25%比7%,P=0.004),全因死亡率也显著高于低PLR组(14%比2%,P=0.014)。结论急诊PCI术前PLR是急性前壁心肌梗死患者心肌灌注不良的独立预测因素。PLR增高的急性前壁心肌梗死患者院内死亡及MACE发生率增加。

Aim To investigate the relationship between platelet-to-lymphocyte ratio（PLR） and myocardial reperfusion,in-hospital major adverse cardiac events（MACE） in patients with acute anterior myocardial infarction（MI） who underwent primary percutaneous coronary intervention（PPCI）. Methods 136 consecutive patients with acute anterior MI who underwent PPCI were enrolled in this retrospective study. The quartile of PLR before the procedure was obtained by quadratic method. Patients having values in the fourth quintile group was defined as the high PLR group（PLR≥165）,and those having values in the lower 3 quintiles were defined as the low PLR group（PLR165）. Baseline clinical features,Killip classification,thrombolysis in myocardial infarction（TIMI） flow grade,myocardial blush grade（MBG） and in-hospital MACE were analyzed. Results Patients with high PLR had higher Killip grade compared with patients with low PLR（47% vs 20%,P= 0.005）. Patients in the high PLR group had significant lower TIMI flow（36% vs 14%,P= 0.004） and MBG grade（44% vs 21%,P = 0.016） than those in the low PLR group. More patients with high PLR had impaired myocardial perfusion than those with low PLR（56% vs 27%,P = 0.002）. Multivariate analyses indicated that the independent risk factors of impaired myocardial perfusion were PLR（OR 1.009,95% CI 1.004 - 1.015,P = 0.001）,thrombus aspiration（OR1.473,95% CI 1.012 - 2.144,P = 0. 043）,BNP（OR 1. 001,95% CI 1. 000 - 1.002,P = 0. 034） and CK-MB peak（OR1.002,95% CI 1.001 - 1.005,P = 0.067）. Furthermore,the high PLR group had significantly higher MACE（25% vs 7%,P = 0.004） and all-cause mortality（14% vs 2%,P = 0.014） than the low PLR group. Conclusion The study suggested that PLR was an independent risk factor of impaired myocardial perfusion. Moreover,higher PLR is related to all-cause death and in-hospital MACE in patients with anterior MI who underwent PPCI.急性心肌梗死（acute myocardial infarction,AMI）