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

目的评价初诊时的血小板平均体积（MPV）对急性心肌梗死（AMI）患者发生住院期间死亡事件的预测价值。方法回顾性地分析了415例AMI患者的住院病历，从中提取出患者初诊时临床特征的数据（包括胸痛发生时间及是否患有高血压、糖尿病和高血脂等）和实验室特征数据：心肌肌钙蛋白I（cTnI）水平、肌酐浓度和血小板计数、MPV。分析MPV与患者的临床和实验室特征之间的关系。采用受试者工作特征曲线（ROC）法评价MPV对患者发生住院期间死亡事件的总体预测价值。采用多元Logistic回归分析MPV与AMI患者发生住院期间死亡事件的关系。结果随着MPV的增加，AMI患者发生住院期间死亡事件的比例增高。MPV预测AMI患者发生住院期问死亡价值的曲线下面积（AUC）（95％可信区间）为0．77（0．72-0．82）。当将界值设定为12．55n时，MPV预测AMI患者发生住院期间死亡时间的敏感度（95％可信区间）为0．59（0．49-0．69），特异度（95％可信区间）为0．85（0．81-0．89）。在校正了cTnI、胸痛发生时间、肌酐和年龄以后，MPV〉12．55fl仍然与所有AMI患者、STEMI和NSTEMI患者发生住院期间死亡事件相关，优势比（95％CI）分别为10．87（5．08-23．25）、26．19（7．36-93．17）和5．35（1．80．15．92）。结论AMI患者就诊时的MPV值可以作为预测其发生住院期间死亡事件的指标，MPV〉12．55n是AMI患者发生住院期间发生死亡事件的独立危险因子。

The Predictive Value of Mean Platelet Volume for the In-hospital Mortality in Patients with Acute Myocardial Infarction

Objective To evaluate the predictive value of mean platelet volume （MPV）for in-hospital mortality in patients with acute myocardial infarction（AMI）. Methods The medical records of 415 AMI patients were retrospectively reviewed. The clinical characteristics （including chest pain duration, the history of hypertension, hyperlipidemia and diabetes mellitus） , as well as laboratory characteristics：including cardiac tro- ponin I （ cTnI）, MPV, platelet count and ereatinine, on admission were extracted. The relationships between MPV and the clinical or laboratory characteristics were analyzed. Receiver operating characteristic （ ROC ） curve analysis was applied to estimate the total predictive accuracy of MPV on the in-hospital mortality. The muhivariable logistic regression model was used to determine whether MPV was an independent risk factor for in-hospital mortality. Results Increased in-hospital mortality rate was observed as MPV increasing. The area under curve （ AUC ） of MPV for inhospital mortality was 0.77 （ 95 % CI ： 0.72- 0.82 ）. The predictive sensitivity and specificity of MPV of inhospital mortality were 0.59 （ 0.49-0.69 ） and 0.85 （ 0.81-0.89 ）, respectively, at the optimal threshold of 12.55 ft. In all patients and the subgroup of STEMI, as well as NSTEMI, MPV 〉 12.55 fl was an independent risk factor for in-hospital mortality with the odds ration（OR） of 10.87 （5.08-23.25） ,26. 19 （7.36-93.17） and 5.35 （ 1.80-15.92 ） respectively, as confirmed by multivariable logistic regression model. Conclusion MPV on admission was a useful indicator for predicting in-hospital mortality for patients with AMI. MPV 〉 12.55 fl was an independent risk factor for in-hospital mortality.