循环单核细胞亚群联合肾功能对急性ST段抬高心肌梗死患者预后危险分层的评估  

The risk stratification value of circulating monocyte subsets and renal function in patients with ST-segment elevation acute myocardial infarction

作　　者：周颖[1,2] 汪小君[1,2] 罗燕薇 焉立方 马永强[2] 姬文婕[3] 刘新林[2] 刘军翔[2] 周欣[2] 李玉明[2] 

机构地区：[1]天津医科大学研究生院,天津300070 [2]天津市心血管重塑与靶器官损伤重点实验室、武警后勤学院附属医院心脏中心、心血管病研究所天津,300162 [3]武警后勤学院附属医院呼吸与重症医学科

出　　处：《临床心血管病杂志》2017年第6期534-539,共6页Journal of Clinical Cardiology

基　　金：国家自然科学基金项目(No:81570335);天津市心血管重塑与靶器官损伤重点实验室开放基金(No:TJC1404,TJC1408)

摘　　要：目的:探讨循环单核细胞亚群联合肾功能对急性ST段抬高心肌梗死(ST segment elevation myocardial infarction,STEMI)患者预后危险分层的评估。方法:入选发病后接受急诊冠状动脉介入治疗(percutaneous coronary intervention,PCI)的初次STEMI患者。于入院第2天抽取患者外周血进行单核细胞亚群[经典型(CD14++CD16-,Mon1)、中间型(CD14++CD16+,Mon2)和非经典型(CD14+CD16++,Mon3)]流式细胞术分析。随访患者3年内主要不良心血管事件(major adverse cardiovascular events,MACE)的发生情况。采用COX比例风险模型分析循环单核细胞亚群水平及肾功能与MACE的关系。根据循环单核细胞亚群及肾功能不全的最佳截断值对STEMI患者进行危险分层,采用Kaplan-Meier生存分析法比较各危险分层的无事件生存率。结果:3年随访221例患者中有50例发生MACE(MACE组)。与非MACE组患者相比,MACE组患者年龄更大、Mon2计数水平更高,差异具有统计学意义(P=0.009和P<0.001);估测肾小球滤过率(estimated glomerular filtration rate,eGFR)、左心室射血分数值更低(P=0.01和P<0.001)。多变量COX回归分析显示,校正了传统危险因素后,Mon2>32.1cells/μl(HR2.33,95%CI 1.24~4.38,P=0.008)、eGFR<60 ml·min^(-1)·1.73m^(-2)(HR2.43,95%CI1.01~5.85,P=0.048)是STEMI患者发生MACE的独立危险因素。以eGFR的临界值60ml·min^(-1)·1.73m^(-2)、Mon2的最佳截断值32.1cells/μl对STEMI患者进行为危险分层,相对于低危组,中危组患者发生MACE的风险增加了2.00倍(95%CI 1.65~5.30,P<0.001),高危组患者发生MACE的风险增加了3.37倍(95%CI2.44~11.5,P<0.01)。Kaplan-Meier生存分析结果同上述一致。结论:循环单核细胞Mon2联合eGFR能够预测STEMI患者3年内MACE的发生,具有潜在临床应用价值。peripheral blood was collected on day 2of STEMI onset for flow cytometry（FCM）analysis of circulation monocyte subsets[classical CD14^＋＋CD16^-（Mon1）,intermediate CD14^＋＋CD16^＋（Mon2）,and nonclassical CD14＋CD16^＋＋（Mon3）].Major adverse cardiac events（MACE）were followed for 3years. Cumulative survival rates stratified by monocyte subset count and renal function categories were estimated using Kaplan-Meier survival analysis and Cox proportional hazards regression model.Result：During a median follow-up of three years,among 211 STEMI cases recruited,50 first MACE were recorded.Compared with patients without MACE,the patients with MACE were older,more likely to have high Mon2 monocyte count（P=0.09 and P〈0.001）,and along with lower eGFR and left ventricular ejection fraction（LVEF）（P=0.01 and P〈0.001）.After adjustment of conventional risk factors,Mon2 monocyte count and renal insufficiency remained to be the independent predictive factor of MACE：HR2.33,95%CI 1.24-4.38,P=0.008 and HR2.43,95%CI1.01-5.85,P=0.048,respectively.According to stratification of Mon2 monocyte count in combination with renal insufficiency,the patients were divided into low-,intermediate-,and high-risk groups.Compared with the low-risk group,the risk of MACE increased 2.00times（95%CI 1.65-5.30,P〈0.001）in the patients of intermediate-risk group,and the risk increased 4.37times（95%CI2.44-11.48,P〈0.01）in the patients of high-risk group.Kaplan-Meier Survival Analysis supports the above results.Conclusion：Mon2monocyte and renal insufficiency are independent risk factors for predictor of MACE,which has potential clinical value.

关 键 词：ST段抬高心肌梗死 单核细胞亚群 肾功能不全 主要不良心血管事件 

分 类 号：R541.4[医药卫生—心血管疾病]