急性心肌梗死患者经皮冠状动脉介入治疗后红细胞分布宽度和梗死相关血管预后的关系

Correlation between red blood cell distribution width and clinical prognosis of infarct related artery in patients with acute myocardial infarction after percutaneous coronary intervention

目的研究急性心肌梗死患者经皮冠状动脉介入(percutaneous coronary intervention,PCI)治疗后红细胞分布宽度和梗死相关血管预后的关系。方法选取2015年1月至2016年12月在西安医学院第二附属医院心内科行PCI治疗的急性心肌梗死患者204例,收集患者一般临床资料并术后随访1年,绘制生存曲线评估患者的手术预后效果。根据1年的随访结果,将手术患者分为预后不良组以及预后良好组,利用单因素分析比较两组患者在红细胞分布宽度等相关因素上存在的差异;随后根据红细胞分布宽度中位数将患者分为两组,分别绘制生存曲线,比较两组患者在梗死相关血管手术预后上存在的差异;最后绘制受试者工作特征(receiver operator characteristic,ROC)曲线评估红细胞分布宽度在诊断梗死相关血管手术预后上的诊断效能。结果204例患者被纳入本研究,其中25例在1年的随访中出现梗死相关血管再闭塞(12.32%)。单因素分析结果表明预后不良组的血清心肌肌钙蛋白(cardiac troponin,cTn)I浓度、红细胞分布宽度均高于预后良好组,差异有统计学意义(t=-2.356,P=0.019;t=-3.443,P=0.001)。根据患者红细胞分布宽度中位数(15.02)分为两组,Kaplan-Meier生存曲线结果显示红细胞分布宽度升高的患者在梗死相关血管再狭窄的发生上明显高于正常组,差异具有统计学意义(χ~2=4.715,P=0.030)。ROC结果表明,红细胞分布宽度预测梗死相关血管再狭窄的ROC曲线下面积为0.791,截断值为15.429(敏感性87.50%,特异性57.80%)。结论红细胞分布宽度升高人群有更高的梗死相关血管再闭塞发生率,临床医师应对红细胞分布宽度偏离正常值的患者给予足够的重视,在术后合理地进行抗血小板、抗凝治疗以减少再狭窄的发生。

Objectives To study the correlation between peripheral red blood cell distribution width and clinical prognosis of infarct related artery （IRA） in patients with acute myocardial infarction （AMI） after percutaneous coronary intervention （PCI）. Methods Totally 204 patients with AMI who undertook PCI between January 2015 to 2016 December in The Second Affiliated Hospital of Xi＇an Medical University were enrolled in the study, and all patients were followed up for one year to record the clinical prognosis of IRA. Clinical data was carefully collected and survival curve was used to evaluate clinical prognosis of IRA. According to the follow-up result, the patients were divided into two groups, which were the good prognosis group and the bad prognosis group respectively. Single factor analysis was used to compare the differences of the clinical data between the two groups, including red blood cell distribution width. Furthermore, survival curve was again used to compare the difl＇erences in prognosis of IRA between the two groups. Finally, receiver operator characteristic （ ROC ） curve was draw to evaluate the diagnostic value of red blood cell distribution width in forecasting the prognosis of IRA in patients with AMI after PCI. Results Totally 204 patients were enrolled in the study, 25 of which had restenosis. Univariate analysis showed that red blood cell distribution width and serum concentrations of cardiac troponin （cTn） I were higher in bad prognosis group than those in good prognosis group （t=-2.356, P=0.019 ; t=-3.443, P=0.001 ）. According to the median value of red blood cell distribution width, the patients were divided into two groups. Kaplan-Meier survival curve showed that incidence of restenosis in patients with higher red blood cell distribution width was higher than that in patients with lower red blood cell distribution width （χ^2=4.715, P=0.030）. Area under ROC curve of red blood cell distribution width in forecasting the prognosis of IRA was 0.791, and the best cut off point was 15.429 with a sensitivity and specificity of 87.50% and 57.80% respectively. Conclusions AMI patients with higher red blood cell distribution width were more likely to have restenosis after PCI. More strategies should be taken to induce the incidence of restenosis in those patients with high red blood cell distribution width, including the usage of antiplatelet and anticoagulant therapy.