血小板相关指标及Gensini评分在PCI术后预后评估中的作用

Role of platelet-related indexes and Gensini scores in prognostic reviewing after PCI

目的探讨在行经皮冠状动脉介入治疗(PCI)的急性ST段抬高型心肌梗死(STEMI)患者中应用血小板相关指标及Gensini评分进行预后评估的价值。方法选取2016年6月至2020年6月于安徽医科大学附属巢湖医院全科医学科及心内科住院的103例STEMI患者,收集患者PCI术前临床资料、血小板相关指标及Gensini评分等指标。结合患者术后半年是否发生心血管事件(MACE),分为MACE组(n=19)和非MACE组(n=84),比较并分析相关指标与患者6月内MACE发生的相关性。结果19例患者(18.45%)发生MACE,与非MACE组患者相比,MACE组血小板(PLT)、血小板计数/淋巴细胞计数(PLR)、血小板分布宽度(PDW)、平均血小板体积(MPV)、Gensini评分差异均有统计学差异(P<0.001)。受试者工作特征(ROC)曲线显示,当PLR临床分界点为131.8,敏感度为0.842,特异度为0.702,曲线下面积为0.825(95%CI:0.739~0.911,P<0.001)。当PDW临床分界点为12.52,敏感度为0.842,特异度为0.798,曲线下面积为0.918(95%CI:0.858~0.977,P<0.001)。当MPV临床分界点为12.51,敏感度为0.895,特异度为0.798,曲线下面积为0.823(95%CI:0.729~0.917,P<0.001)。当Gensini评分临床分界点为83.50,敏感度为0.947,特异度为0.869,曲线下面积为0.963(95%CI:0.903~1.000,P<0.001)。结论血小板相关指标及Gensini评分在预测STEMI患者PCI术后6月内发生MACE具有一定价值。

Objective To investigate the value of platelet(PLT)-related indexes and Gensini scores to prognostic reviewing in patients with acute STEMI after PCI.Methods STEMI patients(n=103)were chosen from Department of General Practice and Department of Cardiology in Chaohu Hospital affiliated to Anhui Medical University from June 2016 to June 2020.The clinical materials,PLT-related indexes and Gensini scores were collected from the patients before PCI.According to occurrence of MACE in each patient within 6 months after PCI,all patients were divided into MACE group(n=19)and non-MACE group(n=84).The correlation between relevant indexed and occurrence of MACE within 6 months were compared and analyzed.Results MECE occurred in 19 patients(18.45%).The difference in PLT,platelet to lymphocyte ratio(PLR),platelet distribution width(PDW),mean platelet volume(MPV)and Gensini scores had statistical significance between non-MACE group and MACE group(P<0.001).The results of ROC curve analysis showed that when clinical cut-off point of PLR was 131.8,sensitivity was 0.842,specificity was 0.702 and AUC of ROC curve was 0.825(95%CI:0.739~0.911,P<0.001).When clinical cut-off point of PDW was 12.52,sensitivity was 0.842,specificity was 0.798 and AUC of ROC curve was 0.918(95%CI:0.858~0.977,P<0.001).When clinical cut-off point of MPV was 12.51,sensitivity was 0.895,specificity was 0.798 and AUC of ROC curve was 0.823(95%CI:0.729~0.917,P<0.001).When clinical cut-off point of Gensini scores was 83.50,sensitivity was 0.947,specificity was 0.869 and AUC of ROC curve was 0.963(95%CI:0.903~1.000,P<0.001).Conclusion PLT-related indexes and Gensini scores have certain value in predicting MACE in STEMI patients within 6 months after PCI.