CAJ | 학술논문

目的：探讨平均血小板体积（MPV）与血小板计数（PLT）比值（MPV/ PLT）和白细胞计数（WBC）对 ST 段抬高型心肌梗死（STEMI）晚期血运重建经皮冠状动脉腔内支架植入（PCI）术后患者住院死亡的预测价值。方法回顾性分析2009年11月—2013年8月在新疆医科大学第一附属医院住院的 STEMI 患者660例，其中死亡88例（死亡组），生存572例（生存组）。收集一般资料、血压、左心室射血分数（LVEF）及冠状动脉狭窄情况；采用 ROC曲线判断入院时 MPV/ PLT 及 WBC 预测住院死亡的临床最佳截点；采用 Logistic 回归分析 STEMI 晚期血运重建 PCI 术后住院死亡的影响因素。结果死亡组患者 MPV/ PLT〔0.052（0.037）〕高于生存组〔0.045（0.022），u ＝-4.629，P﹤0.001〕；死亡组患者 WBC〔12.25（9.30）×109/ L〕高于生存组〔8.22（4.49）×109/ L，u ＝-8.561，P ﹤0.001〕。采用 ROC 判断 STEMI 晚期血运重建 PCI 术后患者住院死亡的 MPV/ PLT、WBC 临床最佳截点分别为0.047、9.28×109/ L。MPV/ PLT ﹥和≤0.047的晚期血运重建 PCI 术后患者病死率分别为19.2％（60/313）和8.1％（28/347），差异有统计学意义（χ2＝17.547，P ﹤0.001）；WBC ﹥和≤9.28×109/ L 的晚期血运重建 PCI 术后患者病死率分别为22.6％（64/283）和6.4％（24/377），差异有统计学意义（χ2＝36.935，P ﹤0.001）。Logistic 回归分析结果显示，MPV/ PLT〔OR ＝2.665，95％ CI（1.632，4.351），P ＝0.027〕和 WBC〔OR ＝4.258，95％ CI（2.572，7.049）， P ＝0.015〕为 STEMI 晚期血运重建 PCI 术后患者住院死亡的独立影响因素。结论 MPV/ PLT ﹥0.047和 WBC ﹥9.28×109/ L均为 STEMI 患者晚期血运重建 PCI 术后住院死亡独立危险因素，并且对 STEMI 患者晚期血运重建 PCI 术后住院死亡有较高的预测价值。
목적：탐토평균혈소판체적（MPV）여혈소판계수（PLT）비치（MPV/ PLT）화백세포계수（WBC）대 ST 단태고형심기경사（STEMI）만기혈운중건경피관상동맥강내지가식입（PCI）술후환자주원사망적예측개치。방법회고성분석2009년11월—2013년8월재신강의과대학제일부속의원주원적 STEMI 환자660례，기중사망88례（사망조），생존572례（생존조）。수집일반자료、혈압、좌심실사혈분수（LVEF）급관상동맥협착정황；채용 ROC곡선판단입원시 MPV/ PLT 급 WBC 예측주원사망적림상최가절점；채용 Logistic 회귀분석 STEMI 만기혈운중건 PCI 술후주원사망적영향인소。결과사망조환자 MPV/ PLT〔0.052（0.037）〕고우생존조〔0.045（0.022），u ＝-4.629，P﹤0.001〕；사망조환자 WBC〔12.25（9.30）×109/ L〕고우생존조〔8.22（4.49）×109/ L，u ＝-8.561，P ﹤0.001〕。채용 ROC 판단 STEMI 만기혈운중건 PCI 술후환자주원사망적 MPV/ PLT、WBC 림상최가절점분별위0.047、9.28×109/ L。MPV/ PLT ﹥화≤0.047적만기혈운중건 PCI 술후환자병사솔분별위19.2％（60/313）화8.1％（28/347），차이유통계학의의（χ2＝17.547，P ﹤0.001）；WBC ﹥화≤9.28×109/ L 적만기혈운중건 PCI 술후환자병사솔분별위22.6％（64/283）화6.4％（24/377），차이유통계학의의（χ2＝36.935，P ﹤0.001）。Logistic 회귀분석결과현시，MPV/ PLT〔OR ＝2.665，95％ CI（1.632，4.351），P ＝0.027〕화 WBC〔OR ＝4.258，95％ CI（2.572，7.049）， P ＝0.015〕위 STEMI 만기혈운중건 PCI 술후환자주원사망적독립영향인소。결론 MPV/ PLT ﹥0.047화 WBC ﹥9.28×109/ L균위 STEMI 환자만기혈운중건 PCI 술후주원사망독립위험인소，병차대 STEMI 환자만기혈운중건 PCI 술후주원사망유교고적예측개치。
Objective To study the association between ratio( MPV/ PLT)of mean platelet volume( MPV)to platelet count(PLT)and white blood cell count( WBC)and in - hospital mortality of ST - segment elevation myocardial infarction(STEMI)with selective percutaneous coronary intervention( PCI). Methods 660 STEMI patients admitted to the First Affiliated Hospital of Xinjiang Medical University from November 2009 to August 2013 were retrospectively analyzed. Among the patients,88 of them died,572 of them survived. The clinical data of the patients were collected,including general information,blood pressure,left ventricular ejection fraction(LVEF) and coronary artery stenosis. The best clinical cut - off values of MPV/ PLT and WBC for in - hospital mortality were found by ROC curve. The influencing factors for the in - hospital mortality of advanced STEMI after PCI were analyzed by Logistic regression analysis. Results The MPV/ PLT ratio〔0. 052 (0. 037)vs. 0. 045(0. 022),u = - 4. 629,P ﹤ 0. 001〕and WBC〔12. 25(9. 30) × 109 / L vs. 8. 22(4. 49) × 109 / L,u= - 8. 561,P ﹤ 0. 001〕of the dead patients were higher than the survivors with statistically significant differences. The cut - off values of MPV/ PLT ratio and WBC were 0. 047 and 9. 28 × 109 / L,respectively. The mortality of patients with more than and less than the cut - off values of MPV/ PC ratio were 19. 2% (60 / 313)and 8. 1% (28 / 347)respectively with statistically significant differences(χ2 = 17. 547,P ﹤ 0. 001). The mortality of patients with more than and less than the cut - off values of WBC were 22. 6% (64 / 283 ) and 6. 4% ( 24 / 377 ) with statistically significant differences( χ2 = 36. 935,P ﹤ 0. 001 ) . Logistic regression analysis showed that MPV/ PLT ratio〔OR = 2. 665,95% CI(1. 632,4. 351),P = 0. 027〕and WBC〔OR = 4. 258, 95% CI(2. 572,7. 049),P = 0. 015〕were independent risk factors for the in - hospital mortality of advanced STEMI patients with PCI. Conclusion MPV/ PLT ﹥ 0. 047 and WBC ﹥ 9. 28 × 109 / L are independent risk factors and have predictive value for the in - hospital mortality of advanced STEMI patients with PCI.