平均血小板体积/血小板计数、P选择素、血小板-淋巴细胞聚集体与急性心肌梗死患者经皮冠状动脉介入术后TIMI血流分级的关联及其预测主要不良心血管事件的效能研究

Correlation between MPV/PC,P-selectin,PLyA and TIMI Blood Flow Grading in Patients with AMI after PCI and Their Predictive Effect on MACE

背景目前经皮冠状动脉介入术(PCI)为临床治疗急性心肌梗死(AMI)的常用、有效方法,但血流再灌注引起的心肌损伤可增加主要不良心血管事件(MACE)发生风险,影响患者预后,因而采取有效措施预测AMI患者PCI后MACE发生风险对改善患者预后具有重要意义。目的探究平均血小板体积(MPV)/血小板计数(PC)、P选择素、血小板-淋巴细胞聚集体(PLyA)与AMI患者PCI后TIMI血流分级的关联及其预测MACE的效能。方法选取2017—2019年广东省中医院收治的AMI患者115例为研究对象。PCI后TIMI血流分级:0级20例(0级组),Ⅰ级25例(Ⅰ级组),Ⅱ级35例(Ⅱ级组),Ⅲ级35例(Ⅲ级组)。比较四组一般资料、肌钙蛋白I、MPV/PC、P选择素及PLyA,分析AMI患者MPV/PC、P选择素、PLyA之间的相关性,分析MPV/PC、P选择素、PLyA与AMI患者PCI后TIMI血流分级的相关性,比较有无MACE患者的MPV/PC、P选择素、PLyA,分析MPV/PC、P选择素、PLyA及其联合预测AMI患者PCI后5个月发生MACE的效能。结果Ⅰ级组、Ⅱ级组、Ⅲ级组MPV/PC、P选择素、PLyA低于0级组,Ⅱ级组、Ⅲ级组MPV/PC、P选择素、PLyA低于Ⅰ级组,Ⅲ级组MPV/PC、P选择素、PLyA低于Ⅱ级组(P<0.05)。AMI患者MPV/PC与P选择素(r=0.664,P<0.001)、PLyA(r=0.850,P<0.001)呈正相关,P选择素与PLyA(r=0.674,P<0.001)呈正相关。MPV/PC(r=-0.709,P<0.001)、P选择素(r=-0.831,P<0.001)、PLyA(r=-0.797,P<0.001)与AMI患者PCI后TIMI血流分级均呈负相关。115例患者随访5个月后,发生MACE 21例。有MACE患者MPV/PC、P选择素、PLyA高于无MACE患者(P<0.05)。受试者工作特征曲线(ROC曲线)分析结果显示,MPV/PC、P选择素、PLyA预测AMI患者PCI后5个月发生MACE的曲线下面积(AUC)分别为0.777、0.819、0.766,最佳临界值分别为5.5%、182.4 ng/L、10.1%;各指标联合预测AMI患者PCI后5个月发生MACE的AUC为0.873,灵敏度、特异度分别为80.95%、85.11%。结论MPV/PC、P选择素、PLyA与AMI患者PCI后TIMI血流分级呈负相关,且各指标联合对AMI患者PCI后MACE发生风险有较好的预测效能,可辅助临床制定针对性防治方案。

Background Percutaneous coronary intervention(PCI)is a common and effective method for clinical treatment of acute myocardial infarction(AMI).But myocardial injury caused by blood flow reperfusion can increase the risk of major adverse cardiovascular events(MACE)and affect the prognosis of patients.Therefore,taking effective measures to predict the risk of MACE after PCI in patients with AMI is of great significance to improve the prognosis of patients.Objective To explore the correlation between mean platelet volume(MPV)/platelet count(PC),P-selectin,plateletlymphocyte aggregates(PLyA)and thrombolysis in myocardial infarction(TIMI)blood flow grading in AMI patients after PCI and their predictive effect on MACE.Methods From 2017 to 2019,115 AMI patients admitted to Guangdong Provincial Hospital of Chinese Medicine were selected as the research objects.TIMI blood flow grading after PCI:20 cases of grade 0(grade 0 group),25 cases of gradeⅠ(gradeⅠgroup),35 cases of gradeⅡ(gradeⅡgroup),and 35 cases of gradeⅢ(gradeⅢgroup).The general data,troponin I,MPV/PC,P-selection and PLyA of the four groups were compared,the correlation between MPV/PC,P-selectin,and PLyA was analyzed,and the correlation between MPV/PC,P-selectin,PLyA and TIMI blood flow grading after PCI in AMI patients was analyzed.The MPV/PC,P-selectin,and PLyA of patients with or without MACE were compared,and the efficacy of MPV/PC,P-selectin,PLyA and their combination in predicting the occurrence of MACE in AMI patients at 5 months after PCI was analyzed.Results MPV/PC,P-selectin and PLyA of gradeⅠgroup,gradeⅡgroup and gradeⅢgroup were lower than those of grade 0 group,MPV/PC,P-selectin and PLyA of gradeⅡgroup and gradeⅢgroup were lower than those of gradeⅠgroup,and MPV/PC,P-selectin and PLyA of gradeⅢgroup were lower than those of gradeⅡgroup(P<0.05).In AMI patients,MPV/PC was positively correlated with P-selectin(r=0.664,P<0.001)and PLyA(r=0.850,P<0.001),and P-selectin was positively correlated with PLyA(r=0.674,P<0.001).MPV/PC(r=-0.709,P<0.001),P-selectin(r=-0.831,P<0.001),PLyA(r=-0.797,P<0.001)were negatively correlated with TIMI blood flow grading after PCI in AMI patients.After 5 months of follow-up,there were 21 cases of MACE in 115 patients.The MPV/PC,P-selectin and PLyA of patients with MACE were higher than those without MACE(P<0.05).Receiver operating characteristic(ROC)curve analysis showed that the area under the curve(AUC)of MPV/PC,P-selectin and PLyA in predicting MACE in AMI patients at 5 months after PCI were 0.777,0.819,0.766,respectively.The best cutoff values were 5.5%,182.4 ng/L,and 10.1%,respectively.The AUC of the combination of all indicators in predicting MACE in AMI patients at 5 months after PCI was 0.873,and the sensitivity and specificity were 80.95%and 85.11%,respectively.Conclusion MPV/PC,P-selectin,and PLyA are negatively correlated with TIMI blood flow classification after PCI in AMI patients,and the combination of various indicators has a good predictive effect on the risk of MACE after PCI in AMI patients,which can assist clinical development of targeted prevention and treatment programs.