血小板与淋巴细胞比值在前壁 ST 段抬高型心肌梗死合并左心室功能障碍患者左心室血栓形成预测中的价值。
Value of the platelet-to-lymphocyte ratio in the prediction of left ventricular thrombus in anterior ST-elevation myocardial infarction with left ventricular dysfunction.
机构信息
Department of Cardiology, China-Japan Union Hospital of Jilin University, Xiantai Street NO.126, Changchun, Jilin, China.
Department of Neurology, China-Japan Union Hospital of Jilin University, Changchun, Jilin, China.
出版信息
BMC Cardiovasc Disord. 2020 Sep 29;20(1):428. doi: 10.1186/s12872-020-01712-w.
BACKGROUND
The predictors of left ventricular thrombus (LVT) formation are not well defined in the contemporary era, especially in those patients at high risk. We aimed to evaluate whether the platelet/lymphocyte ratio (PLR) is valuable in the determination of LVT formation in patients with anterior ST-elevation myocardial infarction (STEMI) and left ventricular (LV) dysfunction.
METHODS
The LVT group (n = 46) was identified from anterior STEMI patients with LV dysfunction who were treated with primary percutaneous coronary intervention (PCI) from January 2017 to December 2019 at the China-Japan Union Hospital of Jilin University. The no-LVT group (n = 92) were also selected from the same batch of patients and were age- and sex-matched to the patients with LVT. The PLR was determined at admission and was calculated as the ratio of the platelet count to the lymphocyte count using the complete blood count. The presence of LVT was determined by echocardiography.
RESULTS
The PLR were significantly higher in patients with LVT than in no-LVT group (p = 0.001). In a receiver operator characteristic curve (ROC) analysis, using a cut-off value of 118.07 (AUC 0.673, 95% CI: 0.574-0.771, P = 0.001), the PLR could independently predict the occurrence of LVT. Multivariate analysis showed that an increased PLR (OR = 1.011, 95% CI: 1.004-1.018, P = 0.002), the presence of a left ventricular aneurysm (OR = 46.350, 95% CI: 5.659-379.615, P < 0.001) and increased DTBT (OR = 1.005, 95% CI: 1.001-1.009, P = 0.012) were independent predictors of LVT formation.
CONCLUSIONS
In acute anterior STEMI patients with LV dysfunction, an increased PLR and DTBT and the presence of an LV aneurysm were independent predictors of LVT formation. A larger prospective study is warranted to evaluate this result.
TRIAL REGISTRATION
This study was registered (May 4, 2019) on Chinese Clinical Trial Registry ( ChiCTR-DDD-17011214 ).
背景
左心室血栓（LVT）形成的预测因素在当代尚未明确，尤其是在高危患者中。我们旨在评估血小板/淋巴细胞比值（PLR）在经皮冠状动脉介入治疗（PCI）治疗的前壁 ST 段抬高型心肌梗死（STEMI）合并左心室（LV）功能障碍患者中对 LVT 形成的预测价值。
方法
从 2017 年 1 月至 2019 年 12 月在吉林大学中日联谊医院接受经皮冠状动脉介入治疗的前壁 STEMI 合并 LV 功能障碍的患者中，确定 LVT 组（n=46）。同期选择无 LVT 组（n=92），并与 LVT 患者年龄和性别匹配。入院时测定 PLR，用全血细胞计数计算血小板计数与淋巴细胞计数之比。超声心动图确定 LVT 的存在。
结果
LVT 患者的 PLR 明显高于无 LVT 组（p=0.001）。在受试者工作特征曲线（ROC）分析中，使用截断值为 118.07（AUC 0.673，95%CI：0.574-0.771，P=0.001），PLR 可独立预测 LVT 的发生。多变量分析显示，PLR 升高（OR=1.011，95%CI：1.004-1.018，P=0.002）、左心室瘤的存在（OR=46.350，95%CI：5.659-379.615，P<0.001）和 DTBT 升高（OR=1.005，95%CI：1.001-1.009，P=0.012）是 LVT 形成的独立预测因素。
结论
在急性前壁 STEMI 合并 LV 功能障碍患者中，PLR 升高、DTBT 升高和左心室瘤的存在是 LVT 形成的独立预测因素。需要更大的前瞻性研究来验证这一结果。
试验注册
本研究于 2019 年 5 月 4 日在中国临床试验注册中心（ChiCTR-DDD-17011214）注册。
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