心肌梗死及其预后与血小板、红细胞参数的相关性研究

目的：研究血小板参数和红细胞参数与心肌梗死的关系。方法将129例冠心病患者分成3组：稳定型心绞痛组（ n ＝43）、不稳定型心绞痛组（ n ＝41）、急性心肌梗死组（ n ＝45），并将43例因“胸痛”入院但已排除冠心病的患者作为对照组。比较分析不同疾病患者的红细胞参数[血细胞比容（HCT）、平均血细胞体积（MCV）、血红蛋白量（MCH）、平均血红蛋白浓度（MCHC）、红细胞体积分布宽度（RDW）]、血小板参数[血小板计数（PLT）、血小板压积（PCT）、血小板平均体积（MPV）、血小板分布宽度（PDW）]、心肌酶谱[天冬氨酸转氨酶（AST）、乳酸脱氢酶（LDH）、肌酸激酶同工酶（CK－MB）、心肌肌钙蛋白T（cTnT）、心肌肌钙蛋白I（cTnI）]水平，对急性心肌梗死组中的红细胞参数和血小板参数的变化趋势进行分析，利用ROC曲线分析红细胞和血小板参数诊断心肌梗死的特异性和敏感性，多因素分析三种参数心在肌梗死并发症与非并发症的作用。结果急性心肌梗死组和不稳定型心绞痛组MCV、MCHC、RDW、PLT、PCT、PDW、MPV、AST、LDH、CK－MB、cTnT、cTnI与对照组比较，差异均有统计学意义（P＜0．05），急性心肌梗死后HCT呈下降趋势（P＜0．05），MCV、MCH持续升高（P＜0．05），MCHC逐渐降低但差异无统计学意义（P＞0．05），RDW在≤1 d增高，在1～7 d内持续增高并达到峰值（P＜0．05），7～30 d内逐渐减低，但幅度较小（P＞0．05）。 PLT、PCT均呈下降的趋势，MPV和PDW逐渐增高，差异均有统计学意义（P＜0．05）。红细胞参数和血小板参数中各项目的AUC分别为MCV 0．691，MCH 0．686，MCHC 0．763， RDW 0．892， PLT 0．652，PCT 0．685．MPV 0．852， PDW 0．796。血小板参数和红细胞参数和心肌酶谱均可影响发生心肌梗死后并发症。结论血小板参数和红细胞参数对诊断心肌梗死密切相关，可应用于预测评估冠心病患者患病概率和心肌梗死预后。

Correlation between myocardial infarction and platelet parameters as well as red blood cell parameters

Objective To investigate the correlation between myocardial infarction and platelets parameters as well as red blood cell ( RBC ) parameters .Methods One hundred and twenty-nine patients with coronary heart disease were divided into three groups:stable angina group ( n =43 ) , unstable angina group ( n =41 ) and acute myocardial infarction group ( n =45), besides, the other 43 patients with “chest pain” who were excluded from coronary heart disease were served as control group .The RBC parameters including hematocrit ( HCT ) , mean corpuscular volume ( MCV ) , mean corpuscular hemoglobin ( MCH) , mean corpuscular hemoglobin concentration ( MCHC) , red cell distribution width ( RDW) , and platelet parameters including blood platelet count (PLT), platelet (PCT),mean platelet volume (MPV), platelet distribution width ( PDW) , myocardial enzymograms including aspartate aminotransferase ( AST ) , lactate dehydrogenase ( LDH ) , creatine kinase (CK-MB), cardiac troponin (cTnT), cardiac troponin I (cTnI) were analyzed and compared among the four groups. Moreover the change trend of RBC parameters and platelet parameters in acute myocardial infarction group was analyzed , besides, the ROC curve was used to analyze the specificity and sensitivity of RBC parameters and platelet parameters in diagnosis of myocardial infarction , furthermore, the multiple analysis was used to evaluate the effects of these parameters on complications of myocardial infarction .Results There were significant differences in the levels of MCV , MCHC, RDW,PLT, PCT, PDW,MPV,AST,LDH,CK-MB, cTnT, cTnI between acute myocardial infarction group and unstable angina group (P<0.05).After acute myocardial infarction,the levels of HCT were significantly dereased ( P <0.05),however,the levels of MCV and MVH were continuously increased ( P <0.05).Moreover the levels of MCHC were gradually decreased ,but there was no statistical significance ( P >0.05).The levels of RDW were increased at ≤1d,which continuously increased and reached peak during 1~7d ( P <0.05),however, which were gradually decreased during 7~30d ( P <0.05).The levels of PLT and PCT were decreased , however,the levels of MPV and PDW were gradually increased ( P <0.05).The platelet parameters , RBC parameters and myocardial enzymogram could affect the incidence rates of complications after myocardial infarction.Conclusion The platelet parameters and RBC parameters are closely correlated to the diagnosis of myocardial infarction ,which can be used to evaluate the probability suffering from coronary artery disease and the prognosis of myocardial infarction .