李保银 万大国 刘淑珍 徐慧慧

【摘要】 目的：探討血小板反应性与平均血小板体积（MPV）对急性ST段抬高型心肌梗死（STEMI）相关梗死动脉（IRA）自发再通（SR）的预测价值。方法：回顾性分析2017年5月-2020年5月因急性STEMI在本院就诊的202例患者的临床资料。均行PCI治疗后根据TIMI血流分级结果将患者分为非SR组（n=152）和SR组（n=50）。比较两组患者的一般资料以及实验室结果，采用多因素二元logistic回归分析STEMI患者IRA自发再通的影响因素，采用受试者工作特征（ROC）曲线分析MPV、MARAA、MARADP预测急性STEMI患者IRA自发再通的价值，采用散点图绘制MPV与MARAA、MARADP关系并采用Pearson相关分析。结果：SR组的MPV、MARAA、MARADP均低于非SR组，差异均有统计学意义（P<0.05）。多因素二元logistic回归分析结果显示，MPV、MARAA、MARADP均是急性STEMI患者IRA自发再通的影响因素（P<0.05）。ROC曲线分析结果显示，MPV、MARAA、MARADP预测IRA自发再通的ROC曲线下面积分别为0.632[95%CI（0.543，0.721）]、0.628[95%CI（0.536，0.720）]、0.612[95%CI（0.518，0.707）]，预测临界值分别为11.7 fL、56.5%、53.5%，预测临界值对应的灵敏度分别为0.72、0.84、0.79，特异度分别为0.48、0.38、0.36。Pearson相关性分析结果显示，MPV与MARAA、MARADP均呈正相关（r=0.553、0.454，P=0.004、0.017）。结论：MPV、MARAA、MARADP是急性STEMI患者IRA自发再通的预测因素，并且MPV与MARAA、MARADP呈正相关。

【关键词】 血小板反应性 平均血小板体积 心肌梗死 相关梗死动脉 自发再通 预测

Predictive Value of Platelet Reactivity and Mean Platelet Volume on Predicting Spontaneous Recanalization of Infarct-related Artery in Patients with Acute ST-segment Elevation Myocardial Infarction/LI Baoyin， WAN Daguo， LIU Shuzhen， XU Huihui. //Medical Innovation of China， 2021， 18（12）： 00-006

[Abstract] Objective： To investigate the value of platelet reactivity and mean platelet volume （MPV） at admission on predicting spontaneous recanalization （SR） of infarct-related artery （IRA） in patients with acute ST-segment elevation myocardial infarction （STEMI）. Method： Clinical data of 202 patients with acute STEMI admitted to our hospital from May 2017 to May 2020 were retrospectively analyzed. After PCI treatment， all patients were divided into non-SR group （n=152） and SR group （n=50） according to the results of TIMI blood flow grading. The general data and laboratory results of two groups were compared， and multivariate binary logistic regression was used to analyze the influencing factors of spontaneous IRA recanalization in STEMI patients. Receiver operating characteristic （ROC） curve was used to analyze the value of MPV， MARAA and MARADP in predicting spontaneous IRA recanalization in patients with acute STEMI. Scatter plot was used to plot the relationship between MPV， MARAA and MARADP， and Pearson correlation analysis was performed. Result： The MPV， MARAA and MARADP of SR group were lower than those of non-SR group， the differences were statistically significant （P<0.05）. Multivariate binary logistic regression analysis showed that MPV， MARAA and MARADP were the influencing factors of spontaneous IRA recanalization in patients with acute STEMI （P<0.05）. The ROC curve analysis results showed that the areas under the ROC curve for MPV， MARAA and MARADP to predict spontaneous recirculation of IRA were 0.632 [95%CI（0.543， 0.721）]， 0.628 [95%CI（0.536， 0.720）] and 0.612 [95%CI（0.518， 0.707）]， respectively. The predictive critical values were 11.7 fL， 56.5%， 53.5%， respectively. The sensitivity corresponding to the predictive critical values were 0.72， 0.84， 0.79， and the specificity were 0.48， 0.38， 0.36. Pearson correlation analysis showed that MPV was positively correlated with MARAA and MARADP （r=0.553， 0.454， P=0.004， 0.017）.. Conclusion： MPV， MARAA and MARADP are predictors of spontaneous recanalization of IRA in patients with acute STEMI， and MPV is positively correlated with MARAA and MARADP.

[Key words] Platelet reactivity Mean platelet volume Myocardial infarction Infarct-related artery Spontaneous reperfusion Prediction

First-authors address： The Second Affiliated Hospital of Zhengzhou University， Zhengzhou 450000， China

doi：10.3969/j.issn.1674-4985.2021.12.001

急性ST段抬高型心肌梗死（ST-segment elevation myocardial infarction， STEMI）梗死相關动脉（infarct-related artery， IRA）自发再通是指急性STEMI患者在未接受溶栓等治疗的情况下行冠状动脉造影时发现，IRA前向血流达心肌梗死溶栓临床试验（thrombolysis in myocardial infarction， TIMI）血流分级2～3级，即定义为IRA的自发再通（spontaneous reperfusion， SR）[1]。研究发现，STEMI患者IRA自发再通的发生率占10%～30%，这部分患者的左心室功能及预后较好[2]。IRA自发再通的机制主要是血栓自溶，即冠状动脉不稳定斑块糜烂或破裂，释放血小板活化因子，血小板开始激活、聚集，同时凝血系统激活、纤溶系统随之激活，急性血小板血栓形成，当纤溶系统亢进时，血栓就会发生溶解，因此血小板在急性心肌梗死过程中起重要作用[3]。研究发现，血小板反应性不仅与急性冠脉综合征（ACS）患者的血栓形成、冠状动脉硬化严重程度有关，还能预测主要心血管不良事件发生[4-5]。……