血小板参数与未接受血运重建治疗的高龄急性非ST段抬高型心肌梗死患者不良临床预后的关系

Association of platelets param eters with the 1 year major adverse cardiac events in elder NSTEMI patients who did not receive revascularazation therapy

目的评估入院血小板参数与未接受血运重建治疗的高龄急性非ST段抬高型心肌梗死(NSTEMI)患者临床预后之间的关系.方法对2014年1月1日至2016年12月31日因NSTEMI入住我院急诊科病房未接受血运重建治疗的高龄患者(年龄≥75岁)进行随访,并对入院血小板参数与患者临床预后的关系进行分析.结果研究共纳入患者89例,完成随访患者73例,1年随访期间发生主要心血管事件(MACE)患者45例.单因素分析结果发现,发生MACE组与未发生MACE组年龄[(79.40±3.13)岁比(78.00±2.93岁,P=0.06]、性别(男性55.6%比64.3%,P=0.63)、既往是否合并高血压(68.9%比78.1%,P=1.00)、糖尿病(64.4%比46.4%,P=0.15)、高脂血症(48.9%比57.1%,P=0.63)、慢性肾脏病(51.1%比28.6%,P=0.09)、陈旧性心肌梗死(51.1%比35.7%,P=0.23)差异均无统计学意义.生化检查结果发现,同未发生MACE组比较,发生MACE组患者入院血小板计数高[(192.91±49.82)×10^9/L比(161.93±65.74)×10^9/L,P=0.025]、血小板/淋巴细胞比值(PLR)高(19.10±15.34比12.05±9.80,P=0.019)、平均血小板体积/血小板计数比值(MPR)低(0.06±0.02比0.08±0.05,P=0.032)、脑钠肽(BNP)水平高[(4603.87±1516.56)pg/ml比(2887.88±1572.63)pg/ml,P<0.05]、入院期间肌钙蛋白峰值[(15.29±6.40)ng/ml比(11.43±8.53)ng/ml,P=0.031]、D-Dimer水平(2758.33±1376.78比2108.64±1183.61,P=0.043)和丙氨酸转氨酶(ALT)较高[(29.56±23.96)U/L比(17.54±10.93)U/L,P=0.005],且血糖[(7.85±2.7)mmol/L比(9.74±3.45)mmol/L,P=0.016]、血白蛋白[(35.55±4.40)g/L比(37.60±3.75)g/L,P=0.045]和低密度脂蛋白胆固醇(LDL-C)水平[(2.94±0.67)mmol/L比(3.37±0.69)mmol/L,P=0.011]较低,同时全球急性冠状动脉综合征登记研究评分(GRACE)评分分值高(155.89±14.29比143.21±17.78,P=0.001).进一步的Logistic回归分析提示,入院proBNP水平高、GRACE评分高、D-Dimer水平高、血白蛋白水平低是这些患者1年发生MACE的独立危险因素.入院血小板计数、PLR高和MPR低不是这些患者1年发生MACE的独立危险因素.结论入院血小板计数高、血小板/淋巴细胞比值高以及平均血小板体积/血小板计数比值高与未接受血运重建治疗的高龄NSTEMI患者发生MACE有关,但不是这些患者1年内发生MACE的独立危险因素.

ObjectiveTo cvaluate the association of the platelets parameters at admission with l year MACE rate in older NSTEMI patients who did not receive revascularazation therapy.Methods Acute non-ST-elevation myocardial infarction(NSTEMI)patients older than 75 years old who did not receive revascularazation therapy were enrolled from January 1st 2014 to December 31st 2016 in our department and clinical information and relative clinical data were collected and analyzed.Results Eighty-nine patients were enrolled and seventy-three patients completed the follow up.Forty-five patients were divided into major adverse cardiovascular events(MACE)group and twenty-cight patients were divided into non-MACE group.Univariable analyse reveals that the average[(79.40±3.13)years old vs.(78.00±2.93)years old,P=0.06 and male 55.6%vs.64.3%e,P=0.63,respectively]were similar;there was no significant difference in prior medical history including hypertension(68.9%vs.78.1%,P=1.00),diabetes mellitus(64.4%vs.46.4%e,P=0.15),hyperlipidemia(48.9%e vs.57.1%,P=0.63),chronic kidney disease(51.1%vs.28.6%,P=0.09),old myocardial infarction(51.1%vs.35.7%,P=0.23).Compared with the patients in non-MACE,patients in MACE group had the higher level of platelet counts[(192.91±±49.82)×10^9L vs.(161.93165.74)×10^9YL,P=0.025],platelet to lymphocyte ratio(PLR)(19.10115.34 vs.12.05±9.80,P=0.019),brain natriuretic peptide(BNP)[(4603.87±1516.56)pg/ml vs.(2887.88±1572.63)pg/ml,P<0.05],peak of cardiac troponin I[(15.29±6.40)ng/ml vs.(11.43±8.53)ng/ml,P=0.031],D-Dimer(2758.331376.78 vs.2108.64±1183.61,P=0.043)and alanine aminotransferase(ALT)[(29.56±23.96)U/L vs.(17.54±10.93)U/L,P=0.005],with the lower level of the blood glucose[(7.85±2.7)mmol/L vs.(9.74±3.45)mmol/L,P=0.016]but lower level of mcan platclet volume to platelet count ratio(MPR)(0.06=0.02 vs.0.0840.05,P=0.032),serum albumin[(35.55±4.40)g/L vs.(37.60±3.75)g/L,P=0.045]and low density lipoprotcin chesterol(LDL-C)[(2.94±0.67)mmol/L vs.(3.37±0.69)mmol/L,P=0.011];also the global registry of acute coronary events(GRACE)score was higher(155.89±14.29 vs.143.21±17.78,P=0.001).Logistic analyses revealed that higher level of proBNP,D-Dimer and GRACE score and low level of serum albumin were all the independent risk factor;platelets counts,PLR and MPR were not the independent risk factors.Conclusion Some of the platelets parameters like the higher platelets counts,PLR and MPR were the risk factor but not the independent risk factors for 1 year MACE rate for older NSTEMI patients who did not receive revascularazation therapy.