接受直接经皮冠状动脉介入治疗ST段抬高性心肌梗死患者平均血小板体积、白细胞计数和中性粒细胞计数的变化及其与冠状动脉血流的关系

郭永芳; 许文亮; 王旭; 邵一兵; 惠波

doi:10.13201/j.issn.1001-1439.2013.05.013

接受直接经皮冠状动脉介入治疗ST段抬高性心肌梗死患者平均血小板体积、白细胞计数和中性粒细胞计数的变化及其与冠状动脉血流的关系

- 1. 青岛大学医学院附属医院东区心内科(山东青岛, 266061);
- 2. 青岛市市立医院心内科

详细信息

通讯作者: 许文亮,E-mail:xuwenliang@medmail.com.cn

中图分类号: R542.2

收稿日期: 2012-08-07

Changes of mean platelet volume, leukocyte and neutrophil counts in ST-segment elevation myocardial infarction patients treated with primary percutaneous coronary intervention and their relationship with coronary flow

- 1. Department of Cardiology, the Affiliated Hospital of Medical College of Qingdao University, Qingdao, Shandong, 266061, China;
- 2. Department of Cardiology, Qingdao Municipal Hospital

More Information

Corresponding author: XU Wenliang, E-mail: xuwenliang@medmail.com.cn

Received Date: 07 August 2012

摘要

摘要: 目的：观察接受直接经皮冠状动脉（冠脉）介入（PPCI）治疗的ST段抬高性心肌梗死（STEMI）患者入院时平均血小板体积（MPV）、白细胞计数（LC）和中性粒细胞计数（NC）等的变化及其与冠脉血流的关系。方法：选择179例接受PPCI治疗的STEMI患者（STEMI组），入院时测定MPV、LC、NC和血生化等指标，阅读冠脉影像资料，评估梗死相关动脉行PPCI前后的TIMI血流分级，计算梗死相关动脉行PPCI后校正TIMI血流帧数计数（CTFC）。同期冠脉造影等确诊的107例稳定型心绞痛患者作为对照（稳定型心绞痛组）。另外，根据PPCI前梗死相关动脉是否有自发性开通，将STEMI组分为PPCI前梗死相关动脉血流自发性开通亚组（50例）和无自发性开通亚组（129例）；根据梗死相关动脉行PPCI后的冠脉血流，将STEMI组分为TIMI 3级亚组（148例）和未达TIMI 3级亚组（31例）。结果：与稳定型心绞痛组比较，STEMI组MPV、LC和NC显著升高（均P<0.01），血小板压积显著降低（P<0.05）。STEMI组内各亚组间比较显示，与行PPCI前梗死相关动脉自发性开通亚组比较，无自发性开通亚组MPV、LC和NC显著升高，血小板计数显著降低（均P<0.05）；与行PPCI后梗死相关动脉血流达TIMI 3级亚组比较，未达TIMI 3级亚组LC、NC和血小板分布宽度显著升高（均P<0.05），MPV亦明显升高（P<0.01）。多元线性回归分析显示，MPV和NC是梗死相关动脉行PPCI后CTFC的独立影响因素。结论：STEMI患者MPV、LC和NC显著增加，MPV、LC和NC与梗死相关动脉行PPCI前后血流的受损程度有密切关系。
- ST段抬高性心肌梗死 /
- 平均血小板体积 /
- 白细胞计数 /
- 中性粒细胞计数 /
- TIMI血流
Abstract: Objective: To assess the changes of mean platelet volume(MPV), leukocyte count(LC) and neutrophil count(NC) in ST-segment elevation myocardial infarction(STEMI) patients treated with primary percutaneous coronary intervention(PPCI) and their relationship with coronary flow. Method: A total of 179 STEMI patients undergoing PPCI were enrolled.MPV, LC, NC and biochemical parameters were measured on admission.The TIMI flow of the infarct-related artery was evaluated before and after PPCI, and the infarct-related artery's corrected thrombolysis in myocardial infarction frame count(CTFC) was also calculated.One hundred and seven in-hospital patients with stable angina pectoris were taken as control. Result: Compared with patients with stable angina pectoris, MPV, LC and NC in STEMI patients were increased significantly(all P<0.01) and plateletcrit was decreased markedly(P<0.05).If the infarct-related artery's coronary flow was TIMI grade 1 to 3 before PPCI, it was defined as spontaneous reperfusion.STEMI patients without spontaneous reperfusion had markedly increased MPV, LC and NC and dominantly decreased platelet counts than those with spontaneous reperfusion(all P<0.05).After PPCI, STEMI patients whose infarct-related artery's TIMI flow was less than grade 3 had significantly elevated LC, NC and platelet distribution width(all P<0.05) and MPV(P<0.01) than those with TIMI flow grade 3.Multiple regression analysis showed that MPV or NC was the independent predictor for the infarct-related artery's CTFC. Conclusion: MPV, LC and NC on admission are increased in patients with STEMI, and they are independently associated with coronary flow.
- ST-elevation myocardial infarction /
- mean platelet volume /
- leukocyte count /
- neutrophil count /
- TIMI flow

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参考文献(16)

[1]	TEKBAS E, KARA A F, ARITURK Z, et al. Mean platelet volume in predicting short- and long-term morbidity and mortality in patients with or without ST-segment elevationmyocardial infarction[J]. Scand J Clin Lab Invest, 2011, 71:613-619.
[2]	CHIA S, NAGURNEY J T, BROWN D F, et al.Association of leukocyte and neutrophil counts withinfarct size, left ventricular function and outcomes af-ter percutaneous coronary intervention for ST-eleva-tion myocardial infarction[J].Am J Cardiol, 2009, 103:333-337.
[3]	ARRUDA-OLSON A M, REEDER G S, BELL M R, et al.Neutrophilia predicts death and heart failure af-ter myocardial infarction:a community-based study[J].Circ Cardiovasc Qual Outcomes, 2009, 2:656-662.
[4]	CEMIN R, DONAZZAN L, LIPPI G, et al.Blood cellscharacteristics as determinants of acute myocardialinfarc-tion[J].Clin Chem Lab Med, 2011, 49:1231-1236.
[5]	MADEN O, KACMAZ F, SELCUK M T, et al.Re-lationship of admission haematological indices with in-farct-related artery patency in patients with acute ST-segment elevation myocardial infarction treated withprimary angioplasty[J].Coronary Artery Dis, 2007, 18:639-644.
[6]	ESTVEZ-LOUREIRO R, SALGADO-FERNÁNDEZ J, MARZOA-RIVAS R, et al.Mean platelet volume predictspatency of the infarct-related artery before mechanicalreperfusion and short-term mortality in patients with ST-segment elevation myocardial infarction undergoing primarypercutaneous coronary intervention[J].Thromb Res, 2009, 124:536-540.
[7]	MADEN O, KACMAZ F, SELCUK H, et al.Rela-tionship of admission hematological indexes with myo-cardial reperfusion abnormalities in acute ST segmentelevation myocardial infarction patients treated withprimary percutaneous coronary interventions[J].CanJ Cardiol 2009, 25:e164-e168.
[8]	LI DB, HUA Q, LIU Z, et al.Association betweeninflammatory mediators and angiographic morphologicfeatures indicating thrombus formation in patientswith acute myocardial infarction[J].Chin Med J(En-gl), 2009, 122:1738-1742.
[9]	BREET N J, VAN WERKUM J W, BOUMAN H J, et al. The relationship between platelet reactivity and infarct-related artery patency in patients presenting with a ST-elevation myocardialinfarction[J]. Thromb Haemost, 2011, 106:331-336.
[10]	MARIANI M, FETIVEAU R, ROSSETTI E, et al. Significance of total and differential leucocyte count in patients with acute myocardial infarction treated with primary coronary angioplasty[J]. Eur Heart J, 2006, 27:2511-2515.
[11]	SEZER M, OKCULAR I, GOREN T, et al.Associationof haematological indices with the degree of microvascularinjury in patients with acute anterior wall myocardial in-farction treated with primary percutaneous coronary inter-vention[J].Heart, 2007, 93:313-318.
[12]	TAKAHASHI T, HIASA Y, OHARA Y, et al.Re-lation between neutrophil counts on admission, micro-vascular injury, and left ventricular functional recov-ery in patients with an anterior wall first acute myo-cardial infarction treated with primary coronary angio-plasty[J].Am J Cardiol, 2007, 100:35-40.
[13]	NICCOLI G, GIUBILATO S, RUSSO E, et al.Plasma levels of thromboxane A2 on admission are associated with no-reflow after primary percutaneous coronary inter-vention[J].Eur Heart J, 2008, 29:1843-1850.
[14]	ARAKAWA K, YASUDA S, HAO H, et al.Signif-icant association between neutrophil aggregation in as-pirated thrombus and myocardial damage in patientswith ST-segment elevation acute myocardial infarction[J].Circ J, 2009, 73:139-144.
[15]	CELIK T, IYISOY A, YUKSEL U C, et al.The im-pact of admission C-reactive protein levels on the de-velopment of no-reflow phenomenon after primary PCI in patients with acute myocardial infarction:the role of inflammation[J].Int J Cardiol, 2009, 136:86-88.
[16]	BOTTO N, SBRANA S, TRIANNI G, et al.An in-creased platelet-leukocytes interaction at the culprit site of coronary artery occlusion in acute myocardial infarction:apathogenic role for "no-reflow" phenom-enon?[J].Int J Cardiol, 2007, 117:123-130.