唐刚,石文界,杨毅宁,李东泽,马依彤,李晓梅

• 1:新疆医科大学第一附属医院心脏中心冠心病一科
• 2:新疆医科大学第一附属医院导管室
• 3:新疆心血管病研究所
• 4:新疆医科大学临床医学研究院

摘要(Abstract)：

目的评估冠心病患者血液学指数与心肌血流储备分数(FFR)的相关性。方法纳入177例患者共267处病变,平均年龄(58±10)岁。按FFR值分成FFR≤0.75组和FFR>0.75组。采用相关分析、ROC曲线分析和Logistic回归分析判断血液学指数和FFR的关系。结果 FFR≤0.75组和FFR>0.75组患者的白细胞计数(WBC)[(8.6±1.6)×109/L比(6.6±1.3)×109/L,P<0.001]、中性粒细胞计数[(5.9±1.7)×109/L比(3.9±1.5)×109/L,P<0.001]、平均血小板体积(MPV)[(10.65±1.08)f L比(9.64±1.44)f L,P<0.001]、病变类型(P<0.001)和Gensini评分[24.0(12.5,34.8)比12.0(8.0,20.0),P<0.001]比较,差异均有统计学意义,且WBC(r=-0.57,P<0.001)、中性粒细胞计数(r=-0.56,P<0.001)、MPV(r=-0.42,P<0.001)和Gensini评分(r=-0.39,P<0.001)与FFR存在不同程度的相关性。ROC曲线分析提示,WBC≥8.99×109/L、中性粒细胞计数≥6.19×109/L、MPV≥10.15 f L和Gensini评分≥19分时对FFR值≤0.75有一定的判断价值。Logistic回归分析显示,WBC(OR 1.660,95%CI 1.153~2.435,P=0.001)、MPV(OR 1.658,95%CI 1.186~2.309,P=0.003)和Gensini评分(OR 1.171,95%CI 1.020~1.223,P=0.005)为心肌血流储备功能的影响因素。结论 WBC、MPV和Gensini评分与冠心病患者心肌血流储备功能存在相关性,可为初步判断心肌血流储备功能提供依据。

关键词(KeyWords)： 冠心病;血流储备分数;血液学指数

Abstract:

Keywords:

基金项目(Foundation): 国家自然科学基金(81060025);; 新世纪优秀人才支撑计划(NCET-11-1074)

作者(Author): 唐刚,石文界,杨毅宁,李东泽,马依彤,李晓梅

参考文献(References)：

• [1]Barron HV,Cannon CP,Murphy SA,et al.Association between white blood cell count,epicardial blood flow,myocardial perfusion,and clinical outcomes in the setting of acute myocardial infarction:a thrombolysis in myocardial infarction 10substudy.Circulation,2000,102:2329-2334.
• [2]Kawaguchi H,Mori T,Kawano T,et al.Band neutrophil count and the presence and severity of coronary atherosclerosis.Am Heart J,1996,132:9-12.
• [3]Huczek Z,Kochman J,Filipiak KJ,et al.Mean platelet volume on admission predicts impaired reperfusion and long-term mortality in acute myocardial infarction treated with primary percutaneous coronary intervention.J Am Coll Cardiol,2005,46:284-290.
• [4]Gasparyan AY,Ayvazyan L,Mikhailidis DP,et al.Mean platelet volume:a link between thrombosis and inflammation?.Curr Pharm Des,2011,17:47-58.
• [5]Pijls NH.Fractional flow reserve to guide coronary revascularization.Circ J,2013,77:561-569.
• [6]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.慢性稳定性心绞痛诊断与治疗指南.中华心血管病杂志,2007,35:195-206.
• [7]Haeusler KG,Schmidt WU,Foehring F,et al.Immune responses after acute ischemic stroke or myocardial infarction.Int J Cardiol,2012,155:372-377.
• [8]Totani L,Evangelista V.Platelet-leukocyte interactions in cardiovascular disease and beyond.Arterioscler Thromb Vasc Biol,2010,30:2357-2361.
• [9]Neri Serneri GG,Coppo M,Bandinelli M,et al.Exaggerated myocardial ox LDL amount and LOX-1 receptor over-expression associated with coronary microvessel inflammation in unstable angina.Atherosclerosis,2013,226:476-482.
• [10]Sezer M,Okcular I,Goren T,et al.Association of haematological indices with the degree of microvascular injury in patients with acute anterior wall myocardial infarction treated with primary percutaneous coronary intervention.Heart,2007,93:313-318.
• [11]Davies MJ.A macro and micro view of coronary vascular insult in ischemic heart disease.Circulation,1990,82:Ⅱ38-46.
• [12]Liu Y,Gao XM,Fang L,et al.Novel role of platelets in mediating inflammatory responses and ventricular rupture or remodeling following myocardial infarction.Arterioscler Thromb Vasc Biol,2011,31:834-841.
• [13]Stokes KY,Granger DN.Platelets:a critical link between inflammation and microvascular dysfunction.J Physiol,2012,590:1023-1034.
• [14]Palmerini T,Brener SJ,Genereux P,et al.Relation between white blood cell count and final infarct size in patients with STsegment elevation acute myocardial infarction undergoing primary percutaneous coronary intervention(from the INFUSE AMI trial).Am J Cardiol,2013,112:1860-1866.
• [15]Yilmaz M,Tenekecioglu E,Arslan B,et al.White blood cell subtypes and neutrophil-lymphocyte ratio in prediction of coronary thrombus formation in non-ST-segment elevated acute coronary syndrome.Clin Appl Thromb Hemost,2013.[Epub ahead of print]
• [16]Sansanayudh N,Anothaisintawee T,Muntham D,et al.Mean platelet volume and coronary artery disease:a systematic review and meta-analysis.Int J Cardiol,2014,175:433-440.
• [17]Fearon WF,Bornschein B,Tonino PA,et al.Economic evaluation of fractional flow reserve-guided percutaneous coronary intervention in patients with multivessel disease.Circulation,2010,122:2545-2550.
• [18]祖凌云,张庆华,高炜,等.白细胞计数对不稳定型心绞痛患者不良心脑血管事件的预测价值.中国介入心脏病学杂志,2008,16:163-166.