血小板反应性与平均血小板体积对急性ST段抬高型心肌梗死相关梗死动脉自发再通的预测价值

Predictive Value of Platelet Reactivity and Mean Platelet Volume on Predicting Spontaneous Recanalization of Infarct-related Artery in Patients with Acute ST-segment Elevation Myocardial Infarction

目的:探讨血小板反应性与平均血小板体积(MPV)对急性ST段抬高型心肌梗死(STEMI)相关梗死动脉(IRA)自发再通(SR)的预测价值。方法:回顾性分析2017年5月-2020年5月因急性STEMI在本院就诊的202例患者的临床资料。均行PCI治疗后根据TIMI血流分级结果将患者分为非SR组(n=152)和SR组(n=50)。比较两组患者的一般资料以及实验室结果,采用多因素二元logistic回归分析STEMI患者IRA自发再通的影响因素,采用受试者工作特征(ROC)曲线分析MPV、MAR_(AA)、MAR_(ADP)预测急性STEMI患者IRA自发再通的价值,采用散点图绘制MPV与MAR_(AA)、MAR_(ADP)关系并采用Pearson相关分析。结果:SR组的MPV、MAR_(AA)、MAR_(ADP)均低于非SR组,差异均有统计学意义(P<0.05)。多因素二元logistic回归分析结果显示,MPV、MAR_(AA)、MAR_(ADP)均是急性STEMI患者IRA自发再通的影响因素(P<0.05)。ROC曲线分析结果显示,MPV、MAR_(AA)、MAR_(ADP)预测IRA自发再通的ROC曲线下面积分别为0.632[95%CI(0.543,0.721)]、0.628[95%CI(0.536,0.720)]、0.612[95%CI(0.518,0.707)],预测临界值分别为11.7 fL、56.5%、53.5%,预测临界值对应的灵敏度分别为0.72、0.84、0.79,特异度分别为0.48、0.38、0.36。Pearson相关性分析结果显示,MPV与MAR_(AA)、MAR_(ADP)均呈正相关(r=0.553、0.454,P=0.004、0.017)。结论:MPV、MAR_(AA)、MAR_(ADP)是急性STEMI患者IRA自发再通的预测因素,并且MPV与MAR_(AA)、MAR_(ADP)呈正相关。

Objective:To investigate the value of platelet reactivity and mean platelet volume(MPV)at admission on predicting spontaneous recanalization(SR)of infarct-related artery(IRA)in patients with acute ST-segment elevation myocardial infarction(STEMI).Method:Clinical data of 202 patients with acute STEMI admitted to our hospital from May 2017 to May 2020 were retrospectively analyzed.After PCI treatment,all patients were divided into non-SR group(n=152)and SR group(n=50)according to the results of TIMI blood flow grading.The general data and laboratory results of two groups were compared,and multivariate binary logistic regression was used to analyze the influencing factors of spontaneous IRA recanalization in STEMI patients.Receiver operating characteristic(ROC)curve was used to analyze the value of MPV,MAR_(AA)and MAR_(ADP)in predicting spontaneous IRA recanalization in patients with acute STEMI.Scatter plot was used to plot the relationship between MPV,MAR_(AA)and MAR_(ADP),and Pearson correlation analysis was performed.Result:The MPV,MAR_(AA)and MAR_(ADP)of SR group were lower than those of non-SR group,the differences were statistically significant(P<0.05).Multivariate binary logistic regression analysis showed that MPV,MAR_(AA)and MAR_(ADP)were the influencing factors of spontaneous IRA recanalization in patients with acute STEMI(P<0.05).The ROC curve analysis results showed that the areas under the ROC curve for MPV,MAR_(AA)and MAR_(ADP)to predict spontaneous recirculation of IRA were 0.632[95%CI(0.543,0.721)],0.628[95%CI(0.536,0.720)]and 0.612[95%CI(0.518,0.707)],respectively.The predictive critical values were 11.7 fL,56.5%,53.5%,respectively.The sensitivity corresponding to the predictive critical values were 0.72,0.84,0.79,and the specificity were 0.48,0.38,0.36.Pearson correlation analysis showed that MPV was positively correlated with MAR_(AA)and MAR_(ADP)(r=0.553,0.454,P=0.004,0.017)..Conclusion:MPV,MAR_(AA)and MAR_(ADP)are predictors of spontaneous recanalization of IRA in patients with acute STEMI,and MPV is positively correlated with MAR_(AA)and MAR_(ADP).