中性粒细胞/淋巴细胞比值联合平均血小板体积对急性STEMI患者PCI术后发生院内主要不良心血管事件的预测价值  

Predictive Value of Neutrophil-to-lymphocyte Ratio Combined with Mean Platelet Volume for Nosocomial Major Adverse Cardiovascular Events in Patients with Acute STEMI after PCI

作　　者：陈鑫森 黄钟[1] 李桂花[1] CHEN Xinsen;HUANG Zhong;LI Guihua(Department of Emergency,the First Affiliated Hospital of the Medical College,Shihezi University,Shihezi 832000,China)

机构地区：[1]石河子大学医学院第一附属医院急诊科

出　　处：《中国全科医学》2020年第9期1117-1126,共10页Chinese General Practice

摘　　要：背景中性粒细胞/淋巴细胞比值(NLR)、平均血小板体积(MPV)均为新型的炎性反应标志物,可用来预测急性ST段抬高型心肌梗死(STEMI)患者的预后,但目前国内外鲜有研究探讨NLR联合MPV在预测STEMI患者预后方面的临床价值。目的探讨NLR联合MPV对急性STEMI患者急诊行经皮冠状动脉介入(PCI)术后发生院内主要不良心血管事件(MACE)的预测价值。方法连续选取2015年10月—2018年9月于石河子大学医学院第一附属医院明确诊断为STEMI并急诊行PCI的患者516例。依据患者急诊入院时外周血NLR、MPV的中位数将其分为低NLR且低MPV组(NLR≤2.51且MPV≤10.70 fl,n=135)、低NLR且高MPV组(NLR≤2.51且MPV>10.70 fl,n=123)、高NLR且低MPV组(NLR>2.51且MPV≤10.70 fl,n=137)、高NLR且高MPV组(NLR>2.51且MPV>10.70 fl,n=121)。依据全球急性冠脉综合征注册评分(GRACE评分)将其分为高危组(GRACE评分>140分,212例)、中危组(108分<GRACE评分≤140分,222例)、低危组(GRACE评分≤108分,82例)。依据住院期间MACE发生情况将其分为发生MACE组(n=71)、未发生MACE组(n=445)。比较不同NLR、MPV组,发生MACE组和未发生MACE组患者PCI术前临床资料、PCI术后用药情况及PCI术前和术后24 h内实验室检查、PCI术后24 h心脏彩超数据;采用多因素Logistic回归分析探究STEMI患者PCI术后发生院内MACE的影响因素;通过受试者工作特征曲线(ROC曲线)评估NLR、MPV及NLR联合MPV预测STEMI患者PCI术后发生院内MACE的价值;分析STEMI患者PCI术前NLR与MPV的相关性;比较不同GRACE评分组患者PCI术前NLR、MPV;比较不同NLR、MPV组,不同GRACE评分组患者PCI术后无复流、院内MACE发生率。结果低NLR且高MPV组患者合并前驱心绞痛率低于低NLR且低MPV组,GRACE评分高于低NLR且低MPV组(P<0.05)。高NLR且低MPV组患者合并高血压率、GRACE评分高于低NLR且低MPV组,合并前驱心绞痛率低于低NLR且低MPV组(P<0.05)。高NLR且低MPV组患者合并高血�Background Neutrophil-to-lymphocyte ratio(NLR)and mean platelet volume(MPV)are novel inflammatory response markers that can be used to predict the prognosis of patients with acute ST-segment elevation myocardial infarction(STEMI).However,there are few studies exploring the clinical value of NLR combined with MPV in predicting the prognosis of STEMI patients.Objective To investigate the predictive value of NLR combined with MPV in the occurrence of nosocomial major adverse cardiovascular events(MACE)after emergency percutaneous coronary intervention(PCI)in patients with acute STEMI.Methods A total of 516 consecutive patients diagnosed as STEMI with emergency PCI in the First Affiliated Hospital of the Medical College,Shihezi University from October 2015 to September 2018 were selected.According to the median peripheral blood NLR and MPV on emergency admission,our cohort was divided into low NLR combined with low MPV group(NLR≤2.51 and MPV≤10.70 fl,n=135),low NLR and high MPV group(NLR≤2.51 and MPV>10.70 fl,n=123),high NLR combined with low MPV group(NLR>2.51 and MPV≤10.70 fl,n=137),high NLR combined with high MPV group(NLR>2.51 and MPV>10.70 fl,n=121).Our cohort was divided into high-risk group(GRACE score>140 points,n=212),medium-risk group(108<GRACE score≤140 points,n=222),low-risk group(GRACE score≤108 points,n=82)according to baseline GRACE score.According to the occurrence of MACE during hospitalization,our cohort was divided into MACE group(n=71)and non-MACE group(n=445).Comparisons of pre-PCI clinical and laboratory data,post-PCI medication,laboratory and color Doppler echocardiography data within 24 hours after PCI were performed by NLR with MPV,and the incidence of MACE,respectively.Logistic regression analysis was used to investigate the influencing factors of post-PCI MACE.ROC curve analysis was used to evaluate the value of NLR,MPV and NLR combined with MPV in predicting the occurrence of post-PCI MACE.The correlation between NLR and MPV before PCI was analyzed.The pre-PCI NLR and MPV were

关 键 词：心肌梗死 中性粒细胞 淋巴细胞 血细胞比容 预后 影响因素分析 

分 类 号：R542.22[医药卫生—心血管疾病]