ST段抬高型心肌梗死病人远期死亡率与入院首次化验时平均血小板体积的关系

杨楠; 陈宇; 易诗琼; 张露

doi:10.13898/j.cnki.issn.1000-2200.2021.12.022

ST段抬高型心肌梗死病人远期死亡率与入院首次化验时平均血小板体积的关系

Study on the relationship between long-term mortality and mean platelet volume at the first test in patients with ST-segment elevation myocardial infarction

摘要

摘要:
目的探讨ST段抬高型心肌梗死（STEMI）病人远期死亡率与入院首次化验时平均血小板体积（MPV）的关系。
方法选择STEMI病人193例进行研究，病人均在STEMI后随诊至2019年10月8日，根据随访结果将病人分为存活组及死亡组，对比2组血常规指标水平，采用多元线性回归对血常规指标与STEMI远期预后关系进行分析，以ROC分析MPV对STEMI远期死亡的预测截断值，以Kaplan-Meier曲线进行生存分析，采用Log-Rank检验。
结果血常规指标比较显示，存活组病人中性粒细胞、嗜碱性粒细胞与MPV水平均低于死亡组病人（P < 0.05~P < 0.01），嗜酸性粒细胞高于死亡组病人（P < 0.01）。MPV对STEMI病人远期死亡预测截断值为13.14 fL，AUC为0.741，95%CI：0.658~0.824，灵敏度为78.94%（30/38），特异度为83.33%（105/126），准确度为82.32%（135/164），阳性预测值为58.82%（30/51），阴性预测值为92.92%（105/113）。ROC分析结果显示，MPV低水平组（MPV < 13.14 fL）病人113例，死亡8例；MPV高水平组（MPV ≥ 13.14 fL）51例，死亡30例。Kaplan-Meier分析显示，MPV低水平组中位生存时间为33个月（95%CI：31.09~34.26），高于MPV高水平组的25个月（95%CI：22.13~27.29）（P < 0.01）。MPV低水平组脑血管事件发生率24.78%低于高水平组的76.47%（P < 0.01）。193例STEMI病人中，共有98例（50.78%）出现不同程度的心肌缺血再灌注损伤，心肌缺血再灌注损伤病人MPV水平高于无心肌缺血再灌注损伤病人（P < 0.01）。
结论STEMI病人入院首次化验时MPV水平明显高于健康人群，MPV可作为STEMI病人远期预后的评价指标，当STEMI病人MPV ≥ 13.14 fL时病人的远期死亡风险明显增加，同时MPV水平升高心肌缺血再灌注风险上升。

Abstract:
ObjectiveTo investigate the relationship between long-term mortality and mean platelet volume(MPV) at the first test in patients with ST-segment elevation myocardial infarction(STEMI).
MethodsA total of 193 STEMI patients were followed up until October 8, 2019 after STEMI.According to the results of following up, the patients were divided into the survival group and death group.The blood routine indexes between the two groups were compared.The relationship between the blood routine indexes and long-term prognosis of STEMI was analyzed using multiple linear regression analysis, the cut-off value of MPV to long-term mortality of STEMI was analyzed using ROC analysis, the survival analysis was conducted by Kaplan-Meier curve, and the Log-Rank test was used.
ResultsThe results of blood routine indicators analysis showed that the levels of neutrophils, eosinophils, basophils and MPV in survival group were significantly lower than those in death group(P < 0.05 to P < 0.01).The cut-off value of MPV predicting long-term death in STEMI patients was 13.14 fL, the AUC was 0.741, the 95%CI was 0.658-0.824, the sensitivity was 78.94%(30/38), the specificity was 83.33%(105/126), the accuracy was 82.32% (135/164), the positive predictive value was 58.82% (30/51), and the negative predictive value was 92.92%(105/113).The results of ROC analysis showed that 8 patients died in the low-level MPV group(113 cases, MPV < 13.14 fL), and 30 patients died in the high level MPV group(51 cases, MPV ≥ 13.14 fL).The results of Kaplan-Meier analysis showed that the median survival time in low-level MPV group was 33 months(95%CI: 31.09-34.26), which was higher than that in high-level MPV group25 months, (95%CI: 22.13-27.29) (P < 0.01).The incidence rates of cerebrovascular events in low-level MPV group(24.78%) was lower than that in high-level MPV group(76.47%)(P < 0.01).Among 193 STEMI patients, 98 patients (50.78%) with different degrees of myocardial ischemia reperfusion injury were identified, and the level of MPV in patients with myocardial ischemia reperfusion injury was higher than that in patients without myocardial ischemia reperfusion injury(P < 0.01).
ConclusionsThe level of MPV in STEMI patients is significantly higher than that in healthy people at the first test, and the MPV can be used as an indicator for the long-term prognosis of STEMI patients.When the MPV is more than or equal to 13.14 fL, the risk of long-term death in patients with STEMI significantly increases, and the risk of myocardial ischemia reperfusion increases with the increasing of MPV level.

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