PDW-LYR-R在急性STEMI患者急诊PCI中对无复流的预测价值

Predictive value of PDW-LYR-R on no-reflow phenomenon in acute st segment elevation myocardial infarction patients during emergency treatment of pci

目的探讨研究血小板分布宽度与淋巴细胞比率之比(PDW-LYR-R)与急诊经皮冠状动脉介入治疗术(PCI)中发生无复流是否存在相关性,并探讨其预测价值。方法回顾性分析2015年1月至2016年6月宝鸡市中心医院心内科的107例急性ST段抬高型心肌梗死,且均在发病12小时内行急诊PCI的病例。根据患者PCI术中是否发生无复流分为血流正常组(84例)和无复流组(23例)。比较两组病例的临床基本资料,实验室检查结果及PCI结果 ,应用logistic回归分析无复流的独立危险因素。用受试者工作曲线(ROC曲线)分析评价其对无复流发生的预测价值。结果无复流组较血流正常组,发病至球囊扩张时间是否≥26小时的比例更高,60.9%vs23.8%;血糖更高[(11.44±5.83)mmol/L(8.68±3.94)mmol/L];淋巴细胞计数更低[(1.02±0.34)×10~9/L vs(1.46±0.75)×109/L];淋巴细胞比率更低[(9.3±2.92)%vs(14.05±8.09)%];PWD-LYR-R更高(202.60±87.22 vs 125.36±63.08)。Logistic回归分析提示发病至球囊扩张时间是否≥6小时,入院时血糖水平,PDW-LYR-R均为发生无复流的独立危险因素。ROC曲线分析提示PWDLYR-R对急性ST段抬高型心肌梗死患者急诊PCI治疗中发生无复流存在中等水平的预测价值,ROC曲线下面积为0.738(95%CI;0.627～0.848,P<0.01),其截点值为135.55时,PDW-LYR-R预测无复流的敏感度为95.7%,特异度为70.2%。结论血细胞分析的衍生指标PDW-LYR-R在对急性STEMI患者急诊经皮介入治疗术中发生无复流的总体预测价值上具有中等水平,其最佳界值为135.55时,敏感度为95.7%,特异度为70.2%。

Objective To identify the relevance between the ratio of platelet distribution to lymphocyte ratio（PDW-LYR-R） and the occurrence of no reflow phenomenon during percutaneous coronary intervention（PCI）,as well as its predictive value.Methods The present study retrospected and analyzed 107 cases of acute ST elevated myocardial infarction（STEMI） in the Department of Cardiology,Baoji Central Hospital from January 2015 to June 2016.All the cases were treated by PCI within 12 hours after the disease onset.The patients were divided into normal blood flow group（84 cases） and no-reflow group（23 cases） The following information was selected and analyzed in both groups：the general information of the patients,laboratory test results and PCI reports.The logistic regression was introduced to identify the independent predictors of no-reflow phenomenon during the PCI.The predictive value of the predictive index for the occurrence of no reflow was evaluated by the receiver operating curve（ROC curve）.Results Compared to the control group,the percentage of those onset-to-balloon dilatation time more than 6 hours（60.9% vs 23.8%）,PWD-LYR-R（202.60± 87.22 vs 125.36± 63.08） and the blood glucose level were elevated（[11.44±5.83] mmol/L vs [8.68±3.94] mmol/L）;while the lymphocyte count（[1.02±0.34]×109/L vs（1.46±0.75）×109/L） and ration（[9.3±2.92]% vs [14.05±8.09]%） are declined in the no reflow group.Logistic regression analysis indicatesd that onset-to-balloon time more than 6 hours,admission blood glucose level,platelet distribution width and PDW-LYR-R are independent risk factors for the incidence of no reflow.ROC curve analysis shows that there was moderate overall value for PDWLYR-R predicting the incidence of no reflow during the PCI operation for STEMI patients.The area under the ROC curve was 0.738（95% Cl：0.627-0.848,P 0.01）,the optimal threshold is 135.55.The sensitivity of PDW-LYR-R to no reflow is 95.7% and specificity is 70.2%.Conclusions PDW-LYR-R has moderate predictive value in predicting the incidence of no reflow during the PCI operation for STEMI patients.The optimal threshold is 135.55,the sensitivity is 95.7%,and the specificity is 70.2%.