杨静杰,张艳敏,陈玉国
YANG Jingjie,ZHANG Yanmin,CHEN Yuguo

• 1:山东大学齐鲁医院急诊科
• 2:聊城市人民医院急诊科

摘要(Abstract)：

目的:探讨急性ST段抬高型心肌梗死(STEMI)经皮冠状动脉介入(PCI)治疗患者红细胞分布宽度(RDW)升高的危险因素。方法:STEMI经PCI治疗患者424例,分为高RDW组(n=85,RDW≥14%)及正常RDW组(n=339,RDW<14%);记录2组患者的一般资料及并发疾病,入院时检测2组患者外周血白细胞(WBC)、粒细胞(GR)、RDW、血红蛋白(Hb)、血小板(PLT)、平均血小板体积(MPV)及血小板分布宽度(PDW),记录2组患者行PCI时的冠脉内血栓负荷及冠状动脉血管病变发生率,比较PCI术后2组患者的血清N末端前脑利钠肽(NTpro-BNP)、促甲状腺激素(TSH)、高敏C反应蛋白(hs CRP)、高密度脂蛋白胆固醇(HDLC)、低密度脂蛋白胆固醇(LDL-C)、总胆固醇(TC),左心房内径(LA)及左心室舒张末期内径(EDD);采用Logistic回归分析2组患者差异有统计学意义指标与RDW水平的相关性,探讨STEMI患者RDW升高的危险因素。结果:高RDW组的血脂异常、NTpro-BNP显著高于正常RDW组,MPV、TC、LDL及hs CRP显著低于正常RDW组(P<0.05),高RDW组冠脉内血栓负荷、三分支或左主干病变发生率高于正常RDW组(P<0.05),Logistic回归分析显示,RDW与MPV、冠状动脉血栓负荷、三分支或左主干病变发生率及NTpro-BNP是RDW升高的独立危险因素(P<0.05)。结论:冠状动脉血栓负荷、三分支及左主干病变发生率及NTpro-BNP是STEMI行PCI治疗患者外周血RDW升高的独立危险因素。
Objective: To investigate the independent risk factors of increased erythrocyte distribution width( RDW) in patients with acute ST segment elevation myocardial infarction( STEMI) treated with percutaneous coronary intervention( PCI). Methods: 424 patients with STEMI treated with PCI were divided into high RDW group( n = 85,RDW ≥14%) and normal RDW group( n = 339,RDW <14%). The general information and complications of the two groups were recorded. Peripheral blood leukocytes( WBC),granulocytes( GR),RDW,hemoglobin( Hb),platelet( PLT),mean platelet volume( MPV),and platelet distribution width( PDW) at admission were recorded. The incidence of intracoronary thrombus load andcoronary angiopathy during PCI in both groups were recorded,and serum N-terminal pro-brain natriuretic peptide( NTpro-BNP),thyroid-stimulating hormone( TSH),high-sensitivity C-reactive protein( hs CRP),lipoprotein cholesterol( HDL-C),low-density lipoprotein cholesterol( LDL-C),total cholesterol( TC),left atrial diameter( LA) and left ventricular end-diastolic diameter( EED) of patients in both groups were compared after PCI. Logistic regression analysis was used to study the correlation between the significant differences and the level of RDW in patients of the two groups,and to explore the independent risk factors for elevated RDW in STEMI patients.Results: The dyslipidemia and NTpro-BNP in the high RDW group were significantly higher than those in the normal RDW group,and the MPV,TC,LDL and hs CRP were significantly lower than those in the normal RDW group( P < 0. 05). The incidence of intracoronary thrombus load,three-branch or left main coronary artery disease and vascular lesion in the high RDW group was higher than that in the normal RDW group( P < 0. 05). Logistic regression analysis showed that RDW and MPV,intracoronary thrombus load,incidence of three-or left main artery lesions,and NTpro-BNP were independent risk factor for elevated RDW( P < 0. 05). Conclusions: Intracoronary thrombus load,incidence of three-branch and left main artery lesions and NTpro-BNP were independent risk factors for elevated peripheral blood RDW in STEMI patients treated with PCI.

关键词(KeyWords)： 心肌梗塞,急性;经皮冠状动脉介入治疗;危险因素;红细胞分布宽度;N末端前脑利钠肽
myocardial infarction,acute;percutaneous coronary intervention;risk factors;erythrocyte distribution width;N-terminal pro-brain natriuretic peptide

Abstract:

Keywords:

基金项目(Foundation): 山东省科学技术厅科技惠民计划项目(2014kjhm0102)

作者(Author): 杨静杰,张艳敏,陈玉国
YANG Jingjie,ZHANG Yanmin,CHEN Yuguo

DOI: 10.19367/j.cnki.1000-2707.2018.08.023

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