作者：何志凌，万泽民，招煦杰

单位：

510000 广东省广州市，广州中医药大学第二临床医学院

Units：

The Second Clinical Medical College of Guangzhou University of Traditional Chinese Medicine，Guangzhou 510000，China

关键词：

心肌梗死；血小板；平均血小板体积 / 血小板计数；P 选择素；血小板 - 淋巴细胞聚集体；经皮冠状动脉介入术；TIMI 血流分级；主要不良心血管事件；预测

Keywords：

Myocardial infarction；Blood platelets；Mean platelet volume/platelet count；P-selectin；Platelet-lymphocyte aggregates；Percutaneous coronary intervention；Thrombolysis in myocardial infarction；TIMI blood flow grading；Major adverse cardiovascular events；Forecasting

CLC：

DOI：

10.12114/j.issn.1008-5971.2021.00.029

Funds：

广东省中医药局科研项目（20181126）

摘要：

背景　目前经皮冠状动脉介入术（PCI）为临床治疗急性心肌梗死（AMI）的常用、有效方法，但血流再灌注引起的心肌损伤可增加主要不良心血管事件（MACE）发生风险，影响患者预后，因而采取有效措施预测AMI患者PCI后MACE发生风险对改善患者预后具有重要意义。目的　探究平均血小板体积（MPV）/血小板计数（PC）、P 选择素、血小板 - 淋巴细胞聚集体（PLyA）与 AMI 患者 PCI 后 TIMI 血流分级的关联及其预测 MACE 的效能。方法　选取 2017—2019 年广东省中医院收治的 AMI 患者 115 例为研究对象。PCI 后 TIMI 血流分级：0 级 20 例（0 级组），Ⅰ级 25 例（Ⅰ级组），Ⅱ级 35 例（Ⅱ级组），Ⅲ级 35 例（Ⅲ级组）。比较四组一般资料、肌钙蛋白 I、MPV/PC、P 选择素及 PLyA，分析 AMI 患者 MPV/PC、P 选择素、PLyA 之间的相关性，分析 MPV/PC、P 选择素、PLyA 与 AMI患者 PCI 后 TIMI 血流分级的相关性，比较有无 MACE 患者的 MPV/PC、P 选择素、PLyA，分析 MPV/PC、P 选择素、PLyA 及其联合预测 AMI 患者 PCI 后 5 个月发生 MACE 的效能。结果　Ⅰ级组、Ⅱ级组、Ⅲ级组 MPV/PC、P 选择素、PLyA 低于 0 级组，Ⅱ级组、Ⅲ级组 MPV/PC、P 选择素、PLyA 低于Ⅰ级组，Ⅲ级组 MPV/PC、P 选择素、PLyA 低于Ⅱ级组（P ＜ 0.05）。AMI 患者 MPV/PC 与 P 选择素（r=0.664，P ＜ 0.001）、PLyA（r=0.850，P ＜ 0.001）呈正相关，P选择素与PLyA（r=0.674，P＜0.001）呈正相关。MPV/PC（r=-0.709，P＜0.001）、P选择素（r=-0.831，P＜0.001）、PLyA（r=-0.797，P ＜ 0.001）与 AMI 患者 PCI 后 TIMI 血流分级均呈负相关。115 例患者随访 5 个月后，发生 MACE 21 例。有 MACE 患者 MPV/PC、P 选择素、PLyA 高于无 MACE 患者（P ＜ 0.05）。受试者工作特征曲线（ROC 曲线）分析结果显示，MPV/PC、P选择素、PLyA预测AMI患者PCI后5个月发生MACE的曲线下面积（AUC）分别为0.777、0.819、0.766，最佳临界值分别为5.5%、182.4 ng/L、10.1%；各指标联合预测AMI患者PCI后5个月发生MACE的AUC为0.873，灵敏度、特异度分别为 80.95%、85.11%。结论MPV/PC、P 选择素、PLyA 与 AMI 患者 PCI 后 TIMI 血流分级呈负相关，且各指标联合对 AMI 患者 PCI 后 MACE 发生风险有较好的预测效能，可辅助临床制定针对性防治方案。

Abstract：

Background　Percutaneous coronary intervention（PCI）is a common and effective method for clinical treatment of acute myocardial infarction（AMI）.But myocardial injury caused by blood flow reperfusion can increase the risk of major adverse cardiovascular events（MACE）and affect the prognosis of patients.Therefore，taking effective measures to predict the risk of MACE after PCI in patients with AMI is of great significance to improve the prognosis of patients.Objective　To explore the correlation between mean platelet volume（MPV）/platelet count（PC），P-selectin，platelet-lymphocyte aggregates（PLyA）and thrombolysis in myocardial infarction（TIMI）blood flow grading in AMI patients after PCI and their predictive effect on MACE.Methods　From 2017 to 2019，115 AMI patients admitted to Guangdong Provincial Hospital of Chinese Medicine were selected as the research objects.TIMI blood flow grading after PCI：20 cases of grade 0（grade0 group），25 cases of grade Ⅰ（grade Ⅰ group），35 cases of grade Ⅱ（grade Ⅱ group），and 35 cases of grade Ⅲ（gradeⅢ group）.The general data，troponin I MPV/PC，P-selection and PLyA of the four groups were compared，the correlation between MPV/PC，P-selectin，and PLyA was analyzed，and the correlation between MPV/PC，P-selectin，PLyA and TIMI blood flow grading after PCI in AMI patients was analyzed.The MPV/PC，P-selectin，and PLyA of patients with or withoutMACE were compared，and the efficacy of MPV/PC，P-selectin，PLyA and their combination in predicting the occurrence of MACE in AMI patients at 5 months after PCI was analyzed.Results　MPV/PC，P-selectin and PLyA of grade Ⅰ group，grade Ⅱ group and grade Ⅲ group were lower than those of grade 0 group，MPV/PC，P-selectin and PLyA of grade Ⅱ group and grade Ⅲ group were lower than those of grade Ⅰ group，and MPV/PC，P-selectin and PLyA of grade Ⅲ group were lower than those of grade Ⅱ group（P ＜ 0.05）.In AMI patients，MPV/PC was positively correlated with P-selectin（r=0.664，P ＜ 0.001）and PLyA（r=0.850，P ＜ 0.001），and P-selectin was positively correlated with PLyA（r=0.674，P ＜ 0.001）.MPV/ PC（r=-0.709，P ＜ 0.001），P-selectin（r=-0.831，P ＜ 0.001），PLyA（r=-0.797，P ＜ 0.001）were negatively correlated with TIMI blood flow grading after PCI in AMI patients.After 5 months of follow-up，there were 21 cases of MACE in115 patients.The MPV/PC，P-selectin and PLyA of patients with MACE were higher than those without MACE（P ＜ 0.05）.Receiver operating characteristic（ROC）curve analysis showed that the area under the curve（AUC）of MPV/PC，P-selectin and PLyA in predicting MACE in AMI patients at 5 months after PCI were 0.777，0.819，0.766，respectively.The best cut-off values were 5.5%，182.4 ng/L，and 10.1% respectively.The AUC of the combination of all indicators in predicting MACE in AMI patients at 5 months after PCI was 0.873，and the sensitivity and specificity were 80.95% and 85.11%，respectively.Conclusion　MPV/PC，P-selectin，and PLyA are negatively correlated with TIMI blood flow classification after PCI in AMI patients，and the combination of various indicators has a good predictive effect on the risk of MACE after PCI in AMI patients，which can assist clinical development of targeted prevention and treatment programs.

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