CD4/CD8比值对冠状动脉粥样硬化性心脏病患者行非体外循环下冠状动脉旁路移植术预后的评估价值  

Preoperative peripheral blood CD4/CD8 ratio in predicting the prognosis of patients with coronary atherosclerotic heart disease after off-pump coronary artery bypass grafting

作　　者：储诚豪 张成鑫[1] 朱瑞[1] 李鑫[1] 葛圣林[1] CHU Chenghao;ZHANG Chengxin;ZHU Rui;LI Xin;GE Shenglin(Department of Cardiovascular Surgery,The First Affiliated Hospital of Anhui Medical University,Hefei,230022,P.R.China)

机构地区：[1]安徽医科大学第一附属医院心脏大血管外科

出　　处：《中国胸心血管外科临床杂志》2020年第1期20-25,共6页Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

基　　金：安徽省科技厅重点科研资助项目(1301043025)

摘　　要：目的探讨术前外周血CD4/CD8比值对冠状动脉粥样硬化性心脏病(CAD)患者行非体外循环下冠状动脉旁路移植(OPCABG)手术预后的评估价值。方法选择2016年9月至2017年4月在我院接受OPCABG手术的118例CAD患者,其中男82例(69.49%)、女36例(30.51%),平均年龄(62.74±4.50)岁。以发生主要不良心血管事件(MACE)为随访终点。根据术前流式细胞术检测结果将患者分为高CD4/CD8组(≥1.40,62例)和低CD4/CD8组(<1.40,56例)。分析CD4/CD8比值与CAD患者术后预后的相关性,及CD4/CD8对术后发生MACE的预测价值。结果随访时间23.25(20.91,24.70)个月,失访4例(3.39%)。21例(17.80%)患者在随访过程中发生MACE。Kaplan-Meier生存曲线分析结果表明高CD4/CD8组术后MACE发生率高于低CD4/CD8组(log-rankχ^2=5.797,P=0.02)。校正Cox比例风险回归模型分析结果表明,CD4/CD8比值(HR=3.103,95%CI 1.557~6.187,P<0.01)是CAD患者术后发生MACE的独立危险因素。受试者工作特征曲线结果显示,曲线下面积为0.778(95%CI 0.661~0.894,P<0.01),最佳截断值为2.24,灵敏度57.1%,特异度87.6%。结论术前外周血CD4/CD8比值对CAD患者行OPCABG术后发生MACE具有预测价值。Objective To investigate the role of preoperative peripheral blood CD4/CD8 ratio in predicting the prognosis of patients with coronary atherosclerotic heart disease(CAD)after off-pump coronary artery bypass grafting(OPCABG).Methods A total of 118 patients with CAD who underwent OPCABG in our hospital from September 2016 to April 2017 were included in the study,including 82 males and 36 females aged 62.74±4.50 years.The primary end point was the incidence of major adverse cardiovascular events(MACE).Patients were divided into a high CD4/CD8 group(≥1.40,62 patients)and a low CD4/CD8 group(<1.40,56 patients)according to the results of flow cytometry.The correlation between CD4/CD8 ratio and prognosis of patients after OPCABG and the value of CD4/CD8 ratio for predicting postoperative MACE were evaluated.Results Median duration of follow-up was 23.25(20.91,24.70)months,during which 21 patients(17.80%)experienced MACE and 4 patients(3.39%)were lost to follow-up.Kaplan-Meier analysis revealed that high CD4/CD8 group had a significantly higher MACE rate than the low CD4/CD8 group did(logrankχ^2=5.797,P=0.02).The results of adjusted Cox proportional hazards model showed that CD4/CD8 ratio(HR=3.103,95%CI 1.557-6.187,P<0.01)was an independent risk factor of MACE in patients with CAD after OPCABG.The receiver operating characteristic curve showed that area under curve was 0.778(95%CI 0.661-0.894,P<0.01),the optimal cut off value was 2.24,the sensitivity was 57.1%,and the specificity was 87.6%.Conclusion Preoperative peripheral blood CD4/CD8 ratio is an independent predictor of MACE after OPCABG in patients with CAD.

关 键 词：冠状动脉粥样硬化性心脏病 CD4/CD8比值 非体外循环下冠状动脉旁路移植术 预后 

分 类 号：R541.4[医药卫生—心血管疾病]