休克指数及中性粒细胞/淋巴细胞比值对急性非ST段抬高心肌梗死患者短期预后的预测价值  

Predictive value of shock index and neutrophil to lymphocyte ratio in short-term prognosis of the patients with non-ST-segment elevation myocardial infarction

作　　者：王艳飞[1] 王华荣[1] 赵春生[1] 于健[1] Wang Yan-fei;Wang Hua-rong;Zhao Chun-sheng;Yu Jian(Affiliated Hospital of Chengde Medical College,Chengde 067000,China)

机构地区：[1]承德医学院附属医院,河北承德067000

出　　处：《中国急救医学》2019年第12期1159-1163,共5页Chinese Journal of Critical Care Medicine

基　　金：承德市科技支撑计划(201801A029)。

摘　　要：目的研究休克指数(SI)与中性粒细胞/淋巴细胞比值(NLR)对急性非ST段抬高心肌梗死(NSTEMI)患者短期预后的判断价值。方法选取2016年3月至2018年3月首诊承德医学院附属医院急诊科的NSTEMI患者516例。根据患者SI、NLR水平及NSTEMI患者10 d内主要不良心脏事件(MACE)发生情况分组:①SI<0.7与SI≥0.7组;②NLR<5.0组与NLR≥5.0组;③MACE组与非MACE组。比较各组临床资料及MACE发生例数。采用受试者工作特征曲线(ROC曲线)分析比较NLR与SI对NSTEMI患者MACE发生的预测能力。结果纳入NSTEMI患者516例,其中92例(17.8%)发生MACE,包括4.3%全因病死22例、5.2%心源性休克27例和8.3%致命性心律失常43例。而且,SI≥0.7并NLR≥5.0患者56例,其中19例发生MACE,占33.92%;NLR≥5.0并SI<0.7患者104例,其中30例发生MACE,占28.88%;SI≥0.7并NLR<5.0患者48例,其中9例发生MACE,占18.75%.NLR≥5.0组患者MACE发生例数及SI水平高于NLR<5.0组(均P<0.05)。SI≥0.7组患者MACE发生例数及NLR水平高于SI<0.7组(均P<0.05)。与非MACE组比较,MACE组患者NLR与SI水平明显升高(均P<0.05),NLR、SI的ROC曲线下面积为0.734和0.681。结论NLR和SI对预测NSTEMI患者短期内MACE的发生均具有较高的价值,NLR的预测能力优于SI.Objective To study the predictive value of shock index(SI)and neutrophil to lymphocyte ratio(NLR)in short-term prognosis of the patients with non-ST-segment elevation myocardial infarction(NSTEMI).Methods NSTEMI patients(n=516)were chosen from the department of emergency in the affiliated hospital of Chengde medical college from March 2016 to March 2018.According to SI,NLR level and the incidence of major adverse cardiac events(MACE)in NSTEMI patients within 10 days,they were divided into:①SI≥O.7 group and SI<0.7 group;②NLR ≥5.0 group and NLR<5.0 group;③MACE group and non-MACE group.The clinical data of each group and the incidence of MACE were compared.The effects of SI and NLR on the short-term prognosis of NSTEMI patients were analyzed by using area under curve(AUC)of receiver operating characteristic curve(ROC).Results MACE patients accounted for 17.8%(92 cases),including 22 cases(4.3%)of all-cause deaths,27 cases(5.2%)of cardiogenic shock,and 43 cases(8.3%)of fatal arrhythmias.In addition,56 cases of SR≥O.7 combined with NLR≥5.0,19 cases of which had MACE,accounting for 33.92%.Among 104 patients with NLR≥5.0 and SI<0.7,30 patients(28.88%)developed MACE.In 48 cases of SR≥O.7 combined with NLR<5.0,MACE occurred in 9 cases,accounting for 18.75%.The MACE cases and SI level in the NLR≥5.0 group were higher than those in the NLR<5.0 group(all P<0.05).The MACE cases and NLR level in the SR≥O.7 group were higher than those in the SI<0.7 group(P<0.05).Compared with non-MACE group,NLR and SI levels in MACE group were significantly increased(all P<0.05),the area under the ROC curve of NLR and SI was 0.734 and 0.681.Conclusion SI and NLR may be indicators of short-term prognosis in NSTEMI patients,and the predictive power of NLR is better than SI.

关 键 词：休克指数(SI) 中性粒细胞/淋巴细胞比值(NLR) 非ST段抬高心肌梗死(NSTEMI) 

分 类 号：R542.22[医药卫生—心血管疾病]