红细胞体积分布宽度对STEMI患者术后心肌灌注水平及近期预后的预测价值

Predictive value of RBC volume distribution width on myocardial perfusion level and short-term prognosis in patients with STEMI

目的研究红细胞体积分布宽度(RDW)对ST段抬高型心肌梗死(STEMI)患者术后心肌灌注水平及近期预后的预测价值。方法选择2017年1月~2018年1月于成都市第三人民医院住院治疗的首发急性STEMI患者138例进行研究。按照是否符合完全ST段回落将患者分成观察组(无复流,术后未符合完全ST段回落,47例)和对照组(正常复流,术后符合完全ST段回落,91例)。检测并比较两组临床指标,分析RDW及超敏C反应蛋白(hs-CRP)对经皮冠状动脉介入治疗(PCI)术后无复流的预测效果;以RDW=14.48%作为最佳截断点,将首发急性STEMI患者分为RDW≥14.48%组(52例)、RDW<14.48%组(86例),比较两组患者的无复流、不良心血管事件(MACEs)发生率及生存预后。结果观察组的RDW及hs-CRP水平明显高于对照组,PCI术后梗死有关动脉至TIMI血流3级比例明显低于对照组(均P<0.05)。ROC曲线分析发现,RDW对PCI术后无复流的预测效果较hs-CRP更好,其曲线下面积为0.794、RDW为14.48%时,预测价值最高。RDW≥14.48%组的无复流及MACEs发生率明显高于RDW<14.48%组(均P<0.05)。RDW≥14.48%组的无复流及MACEs发生率明显高于RDW<14.48%组(均P<0.05);两组的生存预后比较,差异无统计学意义(P>0.05)。结论RDW对STEMI患者术后的心肌灌注水平以及MACEs的预测价值较高,临床上可通过早期监测RDW水平,从而更好地评估并判断患者的预后情况,有助于选择更加科学的治疗方案。

Objective To study the predictive value of RBC volume distribution width(RDW)on post-operative myocardial perfusion level and short-term prognosis in patients with ST-segment elevation myocardial infarction(STEMI).Methods One hundred and thirty-eight patients with first-episode acute STEMI who were enrolled in Chengdu Third People′s Hospital from January 2017 to January 2018 were selected for the study.The patients were divided into observation group(no reflow,no complete ST segment resolution after operation,47 cases)and control group(normal reflow,complete ST segment resolution after operation,91 cases).The clinical indexes of two groups were detected and compared,the predictive effect of RDW and high sensitivity C-reactive protein(hs-CRP)on no reflow after percutaneous coronary intervention(PCI)was analyzed;RDW=14.48%was taken as the best cut-off point,the patients with first-episode acute STEMI was divided into the RDW≥14.48%group(52 cases)and the RDW<14.48%group(86 cases),and the incidence of no reflow,adverse cardiovascular events(MACEs)and survival prognosis between two groups were compared.Results The levels of RDW and hs-CRP in observation group were significantly higher than those in control group,and the ratio of infarct related artery to TIMI blood flow grade 3 after PCI in observation group was significantly lower than that in control group(all P<0.05).ROC curve analysis showed that RDW was better than hs-CRP in the prediction of no reflow after PCI.When the area under the curve was 0.794 and RDW was 14.48%,the prediction value was the highest.The incidence of no reflow and MACEs in RDW≥14.48%group was significantly higher than that in RDW<14.48%group(all P<0.05).The incidence of no reflow and MACEs in RDW≥14.48%group was significantly higher than that in RDW<14.48%group(all P<0.05).There was no significant difference between two groups in survival and prognosis(P>0.05).Conclusion RDW has a high predictive value for myocardial perfusion level and MACEs in patients with STEMI.Early monitoring of RDW level can be used to evaluate and judge the prognosis of STEMI patients.Ultimately,it helps to choose more scientific treatment options.