本文選題：血小板與淋巴細胞比率 + 急性心肌梗死��； 參考：《第四軍醫(yī)大學》2016年碩士論文

【摘要】：研究背景:急性ST段抬高型心肌梗死(STEMI)患者進行早期再灌注治療可以改善預后。經(jīng)皮冠狀動脈介入治療(PCI)是急性ST段抬高型心肌梗死可行的最佳再灌注策略[1],有近95%的冠脈閉塞血管可以被重新開通[2-5]。但是,雖然心外膜冠脈血管被重建,心肌組織卻不一定能恢復理想的再灌注。微血管水平的再灌注失敗的現(xiàn)象被稱為冠脈無復流現(xiàn)象[6-10]。以往研究顯示,多達60%的血管重建的STEMI患者發(fā)生無復流現(xiàn)象[3,11-19]。無復流顯著減少了再灌注治療的益處,導致患者心功能及預后惡化。無復流現(xiàn)象與急性STEMI患者較差的心功能恢復、心肌梗死面積增加、更高的并發(fā)癥發(fā)生率、短期及長期死亡率有關(guān)。無復流現(xiàn)象一旦出現(xiàn)很難逆轉(zhuǎn),所以對潛在的高�；颊哌M行篩選十分重要,尋找簡單、實用的預測因子十分必要。國內(nèi)外已經(jīng)開展了許多有關(guān)無復流預測因素的研究。有研究發(fā)現(xiàn),心電圖出現(xiàn)2個以上Q波、心功能Killip II級、冠脈內(nèi)出現(xiàn)血栓、以及血管成形術(shù)作為唯一的再灌注治療方式,均可能為冠脈無復流的預測因素[20]。最近國外研究發(fā)現(xiàn),血小板與淋巴細胞比率(Platelet-to-Lymphocyte Ratio,PLR)是主要不良心血管事件的一個新的預測因子[21,22,23]。國內(nèi)目前尚缺乏PLR和無復流的關(guān)系的研究,那么PLR是否為STEMI患者PCI后無復流的預測因子,是否是一個敏感度及特異度較好的臨床指標,這個問題需要進一步研究。目的:研究入院時PLR值對國內(nèi)急性ST段抬高型心肌梗死患者冠脈介入治療后無復流的預測價值,為尋找簡單、實用的無復流預測因子提供理論依據(jù)。方法:共收集190例急性STEMI患者,發(fā)病12小時內(nèi)并且行PCI術(shù)。按術(shù)后即刻心肌梗死溶栓試驗(Thrombolysis In Myocardial Infarction,TIMI)血流分級將病人分為2組:正常復流組(138例)和無復流組(52例),比較兩組患者的基本臨床資料、實驗室檢查結(jié)果及PCI術(shù)中靶病變及用藥,用Logistic回歸分析無復流的預測因素,用受試者工作特征曲線(ROC)論證得到PLR預測無復流的最佳臨界值及其敏感度和特異度。結(jié)果:無復流組與正常復流組相比PLR顯著升高(P=0.004)、心電圖出現(xiàn)2個以上Q波(P=0.005)及冠狀動脈內(nèi)血栓征象較高(P=0.023)。當PLR值為188時,預測無復流的敏感度為70%,特異度為72%。結(jié)論:PLR、心電圖出現(xiàn)2個以上Q波、冠狀動脈內(nèi)血栓征象均是無復流的預測因素。當PLR值為188時,對無復流預測的敏感度及特異度均較好。
[Abstract]:Background: early reperfusion therapy can improve prognosis in patients with acute St segment elevation myocardial infarction (STEMI). Percutaneous coronary intervention (PCI) is the best reperfusion strategy for acute ST-segment elevation myocardial infarction [1], and nearly 95% of coronary artery occlusion can be re-opened [2-5]. However, although epicardial coronary vessels are reconstructed, myocardial tissue may not be able to recover ideal reperfusion. The failure of reperfusion at the microvascular level is known as coronary anoreflex [6-10]. Previous studies have shown that up to 60% of STEMI patients with revascularization have no reflow. No reflow significantly reduced the benefits of reperfusion therapy, leading to deterioration of cardiac function and prognosis. The absence of reflow was associated with poor cardiac function recovery, increased myocardial infarction size, higher incidence of complications, and short and long term mortality in patients with acute STEMI. Once no reflow occurs, it is difficult to reverse, so it is very important to screen potential high-risk patients, and it is necessary to find simple and practical predictors. At home and abroad, many researches have been carried out on the prediction factors of no complex flow. Two or more Q waves in electrocardiogram, Killip II cardiac function, thrombosis in coronary artery and angioplasty as the only method of reperfusion therapy may be the predictors of no reflow in coronary artery [20]. Recent foreign studies have found that Platelet-to-Lymphocyte Ratio- PLR (PLR) is a new predictor of major adverse cardiovascular events [21: 2223]. There is a lack of research on the relationship between PLR and no reflow in China, so whether PLR is a predictor of no reflow after PCI in STEMI patients is a sensitive and specific clinical index, which needs further study. Objective: to study the predictive value of PLR on admission in patients with acute ST-segment elevation myocardial infarction without reflow after coronary intervention, and to provide a theoretical basis for finding a simple and practical predictor of no-reflow. Methods: 190 patients with acute STEMI were treated with PCI within 12 hours. According to the blood flow grade of Thrombolysis in myocardial infarction thrombolysis test (TIMI), patients were divided into two groups: normal reflow group (138 cases) and non-reflow group (52 cases). The optimal critical value, sensitivity and specificity of PLR for predicting no complex flow were demonstrated by using the operating characteristic curve (ROC) of subjects by logistic regression analysis. Results: compared with normal reflow group, PLR was significantly higher in non-reflow group (P0. 004), more than 2 Q waves appeared in ECG (P0. 005), and the signs of coronary thrombus were higher (P0. 023). When the PLR value was 1888, the sensitivity and specificity of predicting no reflow were 70 and 72, respectively. Conclusion there were more than 2 Q waves in the electrocardiogram (ECG) and coronary thromboembolism were the predictors of no reflow. When the PLR value is 1888, the sensitivity and specificity of prediction without complex flow are better.
【學位授予單位】：第四軍醫(yī)大學
【學位級別】：碩士
【學位授予年份】：2016
【分類號】：R542.22

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