血小板/淋巴细胞计数比与急性前壁心肌梗死患者心肌灌注及院内主要不良心脏事件的相关性
作者:
作者单位:

(南京大学附属鼓楼医院心内科,江苏省南京市 210008)

作者简介:

李洋,博士研究生,主要研究方向为冠心病的预防与治疗。

基金项目:

南京市科技发展计划重点项目(201704003)


Correlation between platelet/lymphocyte count ratio and myocardial perfusion, major adverse cardiac events in patients with acute anterior myocardial infarction
Author:
Affiliation:

Department of Cardiology, Drum Tower Hospital Affiliated to Nanjing University, Nanjing, Jiangsu 210008, China)

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    摘要:

    目的 探讨血小板/淋巴细胞计数比(PLR)与行急诊冠状动脉介入治疗(PPCI)的急性前壁心肌梗死患者心肌灌注和院内主要不良心脏事件的相关性。 方法 回顾分析行PPCI手术的急性前壁心肌梗死患者共136例。根据患者术前PLR值,用四分位法获取患者四分位数,以三四分位数(PLR=165)为界限,将患者分为高PLR组(PLR≥165的第四分位组)和低PLR组(PLR<165的第一、二和三分位组)。比较两组患者的基线临床特征、Killip心功能分级、TIMI血流分级、心肌呈色分级(MBG)、实验室检查及院内主要不良心脏事件(MACE)。 结果 高PLR组患者Killip分级≥Ⅱ级的比例较低PLR组显著增高(47%比20%,P=0.005)。高PLR组术后TIMI血流0~2级(36%比14%, P=0.004)、MBG 0~1级的比例显著高于低PLR组(44%比21%, P=0.016)。高PLR组患者心肌灌注不良比例显著高于低PLR组(56% 比27%,P=0.002)。Logistic多因素回归分析显示影响心肌灌注的危险因素有:PLR(OR 1.009,95%CI 1.004~1.015, P=0.001)、血栓抽吸(OR 1.473,95%CI 1.012~2.144,P=0.043)、脑钠尿肽(BNP)(OR 1.1,5%CI 1.000~1.002,P=0.034)和肌酸激酶同工酶(CK-MB)峰值(OR 1.2,5%CI 1.001~1.005,P=0.067)。高PLR组的院内MACE显著高于低PLR组(25% 比7%,P=0.004),全因死亡率也显著高于低PLR组(14%比2%,P=0.014)。 结论 急诊PCI术前PLR是急性前壁心肌梗死患者心肌灌注不良的独立预测因素。PLR增高的急性前壁心肌梗死患者院内死亡及MACE发生率增加。

    Abstract:

    Aim To investigate the relationship between platelet-to-lymphocyte ratio (PLR) and myocardial reperfusion, in-hospital major adverse cardiac events (MACE) in patients with acute anterior myocardial infarction (MI) who underwent primary percutaneous coronary intervention (PPCI). Methods 136 consecutive patients with acute anterior MI who underwent PPCI were enrolled in this retrospective study. The quartile of PLR before the procedure was obtained by quadratic method. Patients having values in the fourth quintile group was defined as the high PLR group ( PLR≥165), and those having values in the lower 3 quintiles were defined as the low PLR group (PLR<165). Baseline clinical features, Killip classification, thrombolysis in myocardial infarction (TIMI) flow grade, myocardial blush grade (MBG) and in-hospital MACE were analyzed. Results Patients with high PLR had higher Killip grade compared with patients with low PLR (47% vs 20%, P=0.005). Patients in the high PLR group had significant lower TIMI flow (36% vs 14%, P=0.004) and MBG grade (44% vs 21%, P=0.016) than those in the low PLR group. More patients with high PLR had impaired myocardial perfusion than those with low PLR (56% vs 27%, P=0.002). Multivariate analyses indicated that the independent risk factors of impaired myocardial perfusion were PLR (OR 1.9,5% CI 1.004~1.015, P=0.001), thrombus aspiration (OR 1.3,5% CI 1.012~2.144, P=0.043), BNP (OR 1.1,5% CI 1.000~1.002, P=0.034) and CK-MB peak (OR 1.2,5% CI 1.001~1.005, P=0.067). Furthermore, the high PLR group had significantly higher MACE (25% vs 7%, P=0.004) and all-cause mortality (14% vs 2%, P=0.014) than the low PLR group. Conclusion The study suggested that PLR was an independent risk factor of impaired myocardial perfusion. Moreover, higher PLR is related to all-cause death and in-hospital MACE in patients with anterior MI who underwent PPCI.

    参考文献
    [1] Reed GW, Rossi JE, Cannon CP.Acute myocardial infarction.Lancet, 7,9(10065):197-210.
    [2] Steg PG, James SK, Atar D, et al.ESC guidelines for the management of acute myocardial infarction in patients presenting with ST-segment elevation.Eur Heart J, 2,3(20):2 569-619.
    [3] Gupta S, Gupta MM.No reflow phenomenon in percutaneous coronary interventions in ST-segment elevation myocardial infarction.Indian Heart J, 6,8(4):539-551.
    [4] Haeck JD.Relationship between myocardial reperfusion, infarct size, and mortality.JACC Cardiovasc Interv, 3,6(12):1 328.
    [5] Stone GW, Peterson MA, Lansky AJ, et al.Impact of normalized myocardial perfusion after successful angioplasty in acute myocardial infarction.J Am Coll Cardiol, 2,9(4):591-597.
    [6] Gibson CM, Cannon CP, Murphy SA, et al.Relationship of TIMI myocardial perfusion grade to mortality after administration of thrombolytic drugs.Circulation, 0,1(2):125-130.
    [7] Hoffmann R, Haager P, Arning J, et al.Usefulness of myocardial blush grade early and late after primary coronary angioplasty for acute myocardial infarction in predicting left ventricular function.Am J Cardiol, 3,2(9):1 015-019.
    [8] Kapoor JR.Platelet activation and atherothrombosis.N Engl J Med, 8,8(15):1 638-639.
    [9] Ly HQ, Kirtane AJ, Murphy SA, et al.Association of platelet counts on presentation and clinical outcomes in ST-elevation myocardial infarction (from the TIMI Trials) .Am J Cardiol, 6,8(1):1-5.
    [10] Horne BD, Anderson JL, John JM, et al.Which white blood cell subtypes predict increased cardiovascular risk.J Am Coll Cardiol, 5,5(10):1 638-643.
    [11] Bian C, Wu Y, Shi Y, et al.Predictive value of the relative lymphocyte count in coronary heart disease.Heart Vessels, 0,5(6):469-473.
    [12] Azab B, Shah N, Akerman M, et al.Value of platelet/lymphocyte ratio as a predictor of all-cause mortality after non-ST-elevation myocardial infarction.J Thromb Thrombolysis, 2,4(3):326-334.
    [13] Kurtul A, Murat SN, Yarlioglues M, et al.Association of platelet-to-lymphocyte ratio with severity and complexity of coronary artery disease in patients with acute coronary syndromes.Am J Cardiol, 4,4(7):972-978.
    [14] Ugur M, Gul M, Bozbay M, et al.The relationship between platelet to lymphocyte ratio and the clinical outcomes in ST elevation myocardial infarction underwent primary coronary intervention.Blood Coagul Fibrinolysis, 4,5(8):806-811.
    [15] Falk E:Pathogenesis of atherosclerosis.J Am Coll Cardiol, 6,7(8 Suppl):7-12.
    [16] Klovaite J, Benn M, Yazdanyar S, et al:High platelet volume and increased risk of myocardial infarction:9,1 participants from the general population.J Thromb Haemost, 1,9:49-56.
    [17] Lindemann S, Krmer B, Seizer P, et al.Platelets, inflammation and atherosclerosis.J Thromb Haemost, 7,5(Suppl.1):203-211.
    [18] Libby P:Current concepts of the pathogenesis of the acute coronary syndromes.Circulation, 1,4:365-372.
    [19] Gary T, Pichler M, Belaj K, et al.Platelet-to-lymphocyte ratio:a novel marker for critical limb ischemia in peripheral arterial occlusive disease patients.PLoS One, 3,8:676-688.
    [20] David G, Patrono C.Platelet activation and atherothrombosis.N Engl J Med, 7,7:2 482-494.
    [21] Frangogiannis NG, Smith CW, Entman ML.The inflammatory response in myocardial infarction.Cardiovasc Res, 2,3:31-412.
    [22] Ommen SR, Gibbons RJ, Hodge DO, et al.Usefulness of the lymphocyte concentration as a prognostic marker in coronary artery disease.Am J Cardiol 7,9:812-814.
    [23] Yildiz A, Yuksel M, Oylumlu M, et al.The utility of the platelet-lymphocyte ratio for predicting no reflow in patients with ST-segment elevation myocardial infarction.Clin Appl Thromb Hemost, 5,1(3):223-228.
    [24] Ayca B, Akin F, Okuyan E.Platelet to lymphocyte ratio as a prognostic marker in primary percutaneous coronary intervention.Platelets, 5,6(8):816.
    [25] Fuentes QE, Fuentes QF, Andres V, et al.Role of platelets as mediators that link inflammation and thrombosis in atherosclerosis.Platelets, 3,4(4):255-262.
    [26] Vandermolen S, Marciniak M, Byrne J, et al.Thrombus aspiration in acute myocardial infarction:concepts, clinical trials, and current guidelines.Coron Artery Dis, 6,7(3):233-243.
    [27] Hoole SP, Jaworski C.Assessment of the index of microcirculatory resistance during primary percutaneous coronary intervention comparing manual aspiration catheter thrombectomy with balloon angioplasty (IMPACT study):a randomized controlled pilot study.Open Heart, 5,2:e000238.
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李洋,魏钟海,康丽娜,王涟.血小板/淋巴细胞计数比与急性前壁心肌梗死患者心肌灌注及院内主要不良心脏事件的相关性[J].中国动脉硬化杂志,2017,25(11):1132~1137.

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  • 收稿日期:2017-07-12
  • 最后修改日期:2017-08-31
  • 在线发布日期: 2017-11-28