平均血小板体积联合尿酸预测急性心肌梗死患者支架术后心功能的意义

Significance of mean platelet volume combined with uric acid in predicting cardiac function in patients with acute myocardial infarction after stenting

目的探讨平均血小板体积(mean platelet volume,MPV)联合尿酸浓度能否预测急性心肌梗死患者支架术后的心功能。方法随机选择2017年6月至2019年1月于中山大学附属江门医院拟诊ST段抬高型心肌梗死(ST-segment elevation myocardial infarction,STEMI)、急性非ST段抬高型心肌梗死(non ST-segment elevation myocardial infarction,NSTEMI)和健康体检者各55名为STEMI组、NSTEMI组和对照组。检测3组患者的MPV及尿酸浓度。起病后1周和40 d,对急性心肌梗死患者进行心功能评定,并记录这两个时间段超声心动图的左心室舒张末期内径(left ventricular end-diastolic dimension,LVEDD)和左心室射血分数(left ventricular ejection fraction,LVEF)。结果与对照组比较,NSTEMI组和STEMI组的MPV、尿酸浓度较高,差异有统计学意义(P<0.05)。起病1周时心功能(Killip分级)≥2级急性心肌梗死患者的MPV、尿酸浓度、LVEDD较心功能(Killip分级)1级患者升高,差异有统计学意义(P<0.05)。起病40 d时纽约心脏协会(New York Heart Association,NYHA)心功能分级≥2级急性心肌梗死患者MPV、尿酸浓度、LVEDD较心功能NYHA分级1级患者升高,差异有统计学意义(P<0.01)。回归分析结果显示,起病1周时心功能Killip≥2级急性心肌梗死患者MPV、尿酸浓度的β值分别为0.573(P<0.05)和2.073(P<0.01);起病40 d时心功能NYHA分级≥2级急性心肌梗死患者的MPV、尿酸浓度的β值分别为0.516(P<0.01)和0.397(P<0.05)。高水平的MPV和高尿酸浓度都是急性心肌梗死患者起病1周、40 d时发生心功能不全的危险因素;MPV、尿酸浓度共同预测急性心肌梗死患者1周、40 d发生心功能不全的R^2分别为0.543(P<0.05)和0.756(P<0.01)。结论联合检测MPV、尿酸浓度能准确预测支架术后急性心肌梗死患者起病1周、40 d的心功能。

Objectives To investigate whether mean platelet volume(MPV)combined with concentration of uric acid can predict cardiac function in patients with acute myocardial infarction(AMI)after stenting.Methods Totally 55 patients with acute ST-segment elevation myocardial infarction(STEMI),55 patients with acute non-ST-segment elevation myocardial infarction(NSTEMI)and 55 healthy people were randomly selected as STEMI group,NSTEMI group and control group respectively from June 2017 to January 2019 in Affiliated Jiangmen Hospital of Sun Yat-sen University.MPV and concentration of uric acid of the three groups were measured.Cardiac function was assessed 1 week and 40 days after the onset of AMI.Left ventricular end-diastolic diameter(LVEDD)and left ventricular ejection fraction(LVEF)were recorded by color Doppler echocardiography.Results Compared with those in control group,MPVs and concentrations of uric acid in NSTEMI group and STEMI group were significantly higher(P<0.05).At 1 week after the onset of AMI,MPVs,concentrations of uric acid and LVEDD in AMI patients with cardiac function(Killip)≥grade 2 were significantly higher than those in patients with cardiac function(Killip)grade=1(P<0.05).At 40 days after the onset of AMI,MPVs,concentrations of uric acid and LVEDD in AMI patients with cardiac faction[New York Heart Association(NYHA)]≥grade 2 were significantly higher than those in patients with cardiac faction(NYHA)grade=1(P<0.01).Regression analysis showed that the β values of MPV and concentration of uric acids were 0.573(P<0.05)and 2.073(P<0.01)respectively in patients with cardiac function(Killip)≥grade 2 at 1 week after AMI.The β values of MPV and concentration of uric acid were 0.516(P<0.01)and 0.397(P<0.05)respectively in patients with cardiac function(NYHA)≥grade 2 at 40 days after AMI.High levels of MPV and concentrations of uric acid were risk factors for cardiac insufficiency at 1 week and 40 days after AMI.Combined detection of MPV and concentration of uric acid predicted cardiac insufficiency in AMI 1 week and 40 days with R^2=0.543(P<0.05),0.756(P<0.01),respectively.Conclusions Combined detection of MPV and concentration of uric acid can accurately predict the cardiac function of patients with AMI after stenting treated by transcatheter coronary intervention for 1 week and 40 days after onset.