急性ST段抬高性心肌梗死红细胞分布宽度血小板比率的变化及其与远期心血管事件的关系

Changes of red cell distribution width and platelet ratio and its relationship with long-term cardiovascular events in patients with acute ST segment elevation myocardial infarction

目的探讨急性ST段抬高性心肌梗死(STEMI)红细胞分布宽度血小板比率(RDWPR)的变化及其与远期心血管事件的关系。方法选取2014年1月~2016年5月海南省中医院收治的经皮冠状动脉介入(PCI)治疗的STEMI患者115例,并以同期健康体检志愿者30例为对照组。检测比较两组RDWPR、血清N末端B型利钠肽原(NT-proBNP)水平及治疗前后观察组左室射血分数(LVEF)变化,随访其2年的支架血栓发生率以及再发心肌梗死、新发心力衰竭、心源性猝死等心血管事件发生情况,并分析其RDWPR与其LVEF、血清NT-proBNP水平、支架血栓及心血管事件的关系以及其RDWPR预测其远期心血管事件发生的价值。结果观察组RDWPR和血清NT-proBNP水平显著高于对照组,差异有统计学意义(P <0.05)。与治疗前比较,治疗后患者的RDWPR和血清NT-proBNP水平显著降低而LVEF显著升高(P <0.05)。患者随访2年支架血栓发生率和心血管事件发生率分别为14.78%(17/115)和18.26%(21/115),与随访2年无心血管事件发生患者比较,发生心血管事件患者治疗前后的RDWPR和血清NT-proBNP水平显著升高而LVEF显著降低,差异有统计学意义(P <0.05);与随访2年无支架血栓发生患者比较,发生支架血栓患者治疗前后的RDWPR和血清NT-proBNP水平显著升高而LVEF显著降低,差异有统计学意义(P <0.05)。Spearman相关分析结果显示,患者RDWPR与其LVEF呈负相关(r=-0.842,P <0.05),与其血清NT-proBNP水平、支架血栓发生率和心血管事件发生率则呈正相关(r=0.884,0.829,0.816,P <0.05)。受试者工作特性曲线(ROC)分析结果显示,患者治疗前后的RDWPR预测其心血管事件发生的价值良好,其中以治疗后RDWPR预测其心血管事件发生的价值最优。结论 STEMI患者的RDWPR与其心功能、支架血栓及远期心血管事件均密切相关,且对其远期心血管事件发生的预测价值良好,可能作为其心功能和远期预后评估的参考指标之一。

Objective To investigate the changes of red cell distribution width and platelet ratio(RDWPR)and its relationship with long-term cardiovascular events in patients with acute ST segment elevation myocardial infarction(STEMI).Methods 115 STEMI patients undergoing percutaneous coronary intervention(PCI)were selected as the study group,and 30 healthy volunteers had physical exam in the same time were selected as the control group.The RDWPR and serum NT-proBNP level of the 2 groups and the left ventricular ejection fraction(LVEF)changes of the patients in study group were detected,and stent thrombosis rate and recurrent myocardial infarction,new onset heart failure,sudden cardiac death and other cardiovascular events in the 2 years of follow-up were calculated.Relationship between RDWPR with serum NT-proBNP level,LVEF,stent thrombosis and cardiovascular events in study group were analyzed,and value of RDWPR predicting the long-term cardiovascular events in study group were analyzed.Results Compared with that of the control group,RDWPR and serum NT-proBNP level of the study group was increased(P<0.05).Compared with that of before treatment,after treatment RDWPR and serum NT-proBNP level was decreased and after treatment LVEF was increased(P<0.05).The stent thrombosis rate and cardiovascular events of patients in followed up for 2 years were 14.78%(17/115)and 18.26%(21/115)respectively.Compared with that of patients who had no cardiovascular events in followed up for 2 years,before and after treatment RDWPR and serum NT-proBNP level of patients who had cardiovascular events was decreased and in the same time LVEF of patients who had cardiovascular events was increased(P<0.05).Compared with that of patients who had no stent thrombosis in followed up for 2 years,before and after treatment RDWPR and serum NT-proBNP level of patients who had stent thrombosis was decreased and in the same time LVEF of patients who had cardiovascular events was increased(P<0.05).Spearman correlation analysis showed that RDWPR was negatively correlated with serum NT-proBNP level and LVEF(r=-0.842,P<0.05),and was positively related to the serum NT-proBNP level,stent thrombosis rate and cardiovascular events rate(r=0.884,0.829,0.816,P<0.05).The receiver operating characteristic curve(ROC)analysis showed that the value of before and after treatment RDWPR predicting cardiovascular events was good,in whith the value of after treatment RDWPR predicting cardiovascular events was better.Conclusion RDWPR in STEMI patients is closely related with cardiac function and cardiovascular events,and the value of RDWPR predicting long-term cardiovascular events is good,therefore,it may serve as reference index for assessment of prognosis and cardiac function.