基于倾向性评分匹配法探讨白细胞/平均血小板体积对STEMI患者急诊PCI术后短期预后的影响

李末寒; 张弛; 许天宝; 刘燕荣; 陆士奇; 吴云

doi:10.13201/j.issn.1001-1439.2021.06.005

基于倾向性评分匹配法探讨白细胞/平均血小板体积对STEMI患者急诊PCI术后短期预后的影响

- 1. 苏州大学附属第一医院重症医学科(江苏苏州,215006);
- 2. 苏州大学附属第一医院心内科;
- 3. 南京医科大学附属克州人民医院心内科;
- 4. 江苏省人民医院心内科

详细信息

通讯作者: 吴云,E-mail:yunwu1988@126.com

中图分类号: R542.2

收稿日期: 2020-11-04

The effect of white blood cell/mean platelet volume on the short-term prognosis after emergency PCI in patients with STEMI based on propensity score matching

- 1. Department of ICU,The First Affiliated Hospital of Soochow University;
- 2. Department of Cardiology,The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu, 215006, China;
- 3. Department of Cardiology,Kezhou People's Hospital Affiliated to Nanjing Medical University;
- 4. Department of Cardiology,Jiangsu Province Hospital

More Information

Corresponding author: WU Yun, E-mail: yunwu1988@126.com

Received Date: 04 November 2020

摘要

摘要: 目的:探讨白细胞/平均血小板体积(WMR)与接受急诊经皮冠状动脉介入术(PCI)的急性ST段抬高型心肌梗死(STEMI)患者术后30 d内主要心血管不良事件(MACE)发生情况的关系。方法:收集2018年1月—2019年1月就诊于苏州大学附属第一医院的586例STEMI患者以及2019年7月—2020年4月南京医科大学附属克州人民医院的86例STEMI患者入院时的临床资料。以同时期健康体检者的WMR的中位数(0.57)为界限,将患者分为WMR高值组和WMR低值组,使用倾向性评分匹配法(PSM)均衡两组患者其他临床指标的组间差异,对进行PSM后的临床资料进行Cox回归分析,并绘制生存曲线。结果:PSM后WMR高值组的MACE发生率高于WMR低值组(23.08%∶39.74%,P=0.038),PSM后的Cox回归分析显示,WMR是患者PCI术后30 d内发生MACE的独立危险因素(OR=2.677,95%CI:1.417~5.057,P=0.002)。结论:PSM可以提高回归性研究数据之间的可比性及结果的可信度,经PSM减轻其他临床资料在组间分布不均衡的混杂影响后,WMR仍是STEMI患者短期不良预后的独立危险因素。
- 急性ST段抬高型心肌梗死 /
- 白细胞/平均血小板体积 /
- 预后 /
- 倾向性评分匹配
Abstract: Objective: To explore the effect of white blood cell/mean platelet volume(WMR) on the occurrence of major cardiovascular adverse events(MACE) within 30 days after emergency PCI in patients with acute ST segment elevation myocardial infarction(STEMI).Methods: Totally 586 patients with STEMI who were admitted to the First Affiliated Hospital of Soochow University from January 2018 to January 2019 and 86 STEMI patients from Kezhou People's Hospital Affiliated to Nanjing Medical University from July 2019 to April 2020 were collected. All patients were divided into high-WMR group and low-WMR group according to the median WMR(0.57) in health people in the same period. The propensity score matching method was used to balance differences of other clinical data between the two groups, Cox regression analysis was performed on the clinical data after PSM and survival curves were drawn.Results: The incidence of MACE in the high-WMR group after PSM was higher than that in the low-WMR group(23.08%∶39.74%,P=0.038). Cox regression analysis after PSM showed that WMR was an independent risk factor for MACE within 30 days after PCI(OR=2.677,95%CI:1.417-5.057,P=0.002).Conclusion: After PSM reducing the confounding influence of the uneven distribution of other clinical data between groups, PSM can improve the comparability of regression study data and the credibility of the results. WMR is still an independent risk factor for short-term poor prognosis in patients with STEMI.
- acute ST-segment elevation myocardial infarction /
- white blood cell/mean platelet volume /
- prognosis /
- propensity score matching

HTML全文

参考文献(20)

[1]	胡盛寿,高润霖,刘力生,等.《中国心血管病报告2018》概要[J].中国循环杂志,2019,34(3):209-220.
[2]	中华医学会心血管病学分会,中华心血管病杂志编辑委员会.急性ST段抬高型心肌梗死诊断和治疗指南(2019)[J].中华心血管病杂志,2019,47(10):766-783.
[3]	Fox KA,Dabbous OH,Goldberg RJ,et al.Prediction of risk of death and myocardial infarction in the six months after presentation with acute coronary syndrome:prospective multinational observational study(GRACE)[J].BMJ,2006,333(7578):1091.
[4]	Libby P,Ridker PM,Hansson GK.Progress and challenges in translating the biology of atherosclerosis[J].Nature,2011,473(7347):317-325.
[5]	吴晴晴,华琦,张迎花,等.白细胞计数对急性ST段抬高型心肌梗死患者长期预后的影响[J].中华老年心脑血管病杂志,2017,19(6):592-595.
[6]	龙虹宇,邓波,伍玲娜,等.白细胞联合D-二聚体评分预测行急诊PCI的ST段抬高型心肌梗死患者在院死亡风险的效力分析[J].临床急诊杂志,2018,19(5):288-293.
[7]	Shah B,Baber U,Pocock SJ,et al.White blood cell count and major adverse cardiovascular events after percutaneous coronary intervention in the contemporary era:insights from the PARIS study(patterns of non-adherence to anti-platelet regimens in stented patients registry)[J].Circ Cardiovasc Interv,2017,10(9):e004981.
[8]	蒋主辉,许黎莉,谢艳,等.白细胞计数与平均血小板体积比值对于急性心肌梗死患者PCI术后主要不良事件的预测价值[J].检验医学与临床,2017,14(12):1765-1767.
[9]	Haim M,Boyko V,Goldbourt U,et al.Predictive value of elevated white blood cell count in patients with preexisting coronary heart disease:the Bezafibrate Infarction Prevention Study[J].Arch Intern Med,2004,164(4):433-439.
[10]	Soehnlein O,Zernecke A,Eriksson EE,et al.Neutrophil secretion products pave the way for inflammatory monocytes[J].Blood,2008,112(4):1461-1471.
[11]	Dharma S,Hapsari R,Siswanto BB,et al.Blood leukocyte count on admission predicts cardiovascular events in patients with acute non-ST elevation myocardial infarction[J].Int J Angiol,2015,24(2):127-132.
[12]	Balta S,Celik T,Mikhailidis DP,et al.The relation between atherosclerosis and the neutrophil-lymphocyte ratio[J].Clin Appl Thromb Hemost,2016,22(5):405-411.
[13]	方士杰,张强,杨丽红,等.MPV、PDW、RDW与冠心病的相关性研究[J].临床心血管病杂志,2019,35(1):15-19.
[14]	Amraotkar AR,Song DD,Otero D,et al.Platelet count and mean platelet volume at the time of and after acute myocardial infarction[J].Clin Appl Thromb Hemost,2017,23(8):1052-1059.
[15]	韩松梅,廖文丽,于帅.血小板聚集率与富血小板血浆血小板浓度关系的研究[J].中国实验血液学杂志,2017,25(2):582-586.
[16]	胡志德,孙懿,韩志君,等.血小板平均体积对急性心肌梗死患者住院期间死亡事件的预测价值[J].血栓与止血学,2013,19(2):70-75.
[17]	李华柱,徐默玲,王莉华.PCI术后白细胞计数与平均血小板体积比值对ST段抬高型急性心肌梗死患者临床预后的预测价值[J].浙江医学,2018,40(16):95-98.
[18]	许云梦,徐晓东,方中,等.白细胞计数/平均血小板体积比值及中性粒细胞/淋巴细胞比值评估急性冠脉综合征患者介入治疗预后的价值[J].安徽医学,2017,38(1):33-37.
[19]	Demirer Z,Uslu AU.More work needed in examining the relationship between mean platelet volume and inflammation in varicocele pathophysiology[J].Can Urol Assoc J,2015,9(9-10):E639.
[20]	林珑,刘冠男,高丽霓,等.经皮冠状动脉介入术后主要不良心脏事件危险因素研究进展[J].临床急诊杂志,2020,21(11):918-922.