联合外周血炎症细胞分类计数和CK-MB对急性心肌梗死后心脏破裂危险性的预测价值  

Predictive value of combined peripheral blood inflammatory cell classification count and CK-MB on the risk of cardiac rupture after acute myocardial infarction

作　　者：马姗[1] 白玲[2] 刘平[2] 宋安齐[1] 杜晓军 卢群[2] MA Shan;BAI Ling;LIU Ping;SONG An-qi;DU Xiao-Jun;LU Qun(Department of Internal Medicine-Cardiovascular,Cardiovascular Hospital,the Second Affiliated Hospital of Xi'an Jiaotong University,Xi'an 710004,Shaanxi,China;Department of Internal Medicine-Cardiovascular,the First Affiliated Hospital of Xi'an Jiaotong University,Xi'an 710061,Shaanxi,China;Department of Physiology and Pathophysiology,Basic Medical College of Xi'an Jiaotong University,Xi'an 710061,Shaanxi,China)

机构地区：[1]西安交通大学第二附属医院心血管病院心血管内科,西安710004 [2]西安交通大学第一附属医院心血管内科,西安710061 [3]西安交通大学医学部基础医学院生理与病理生理学系,西安710061

出　　处：《医学研究生学报》2021年第10期1045-1051,共7页Journal of Medical Postgraduates

基　　金：国家自然科学基金(81870300);陕西省科技惠民计划(2016HM-04)。

摘　　要：目的研究表明,单核细胞和中性粒细胞在急性心肌梗死(AMI)后炎症过程中发挥重要作用。文中旨在明确联合中性粒细胞计数、单核细胞计数及CK-MB对AMI患者发生心脏破裂(CR)的预测价值。方法收集2015年1月至2019年12月首次AMI后于西安交通大学第一附属医院确诊CR的患者79例,并纳入同期入院的AMI后非CR患者316例作为对照组。收集患者入院时快速获得的相关临床指标,逐步纳入变量,构建不同的logistic回归模型。结果AMI患者总的CR发生率为1.1%(79/7159),CR患者院内病死率为77.2%(61/79),占院内AMI死亡患者的34.9%(61/175)。年龄≥65岁(OR=4.49,95%CI:2.48~8.14,P<0.001)、女性(OR=2.03,95%CI:1.06~3.89,P=0.032)、起病至入院时间>12 h(OR=2.34,95%CI:1.29~4.24,P=0.005)、入院时较高的中性粒细胞计数(OR=2.67,95%CI:1.43~4.98,P=0.002)、单核细胞计数(OR=2.08,95%CI:1.15~3.78,P=0.016)及CK-MB水平(OR=2.42,1.36~4.31,P=0.003)均为预测CR发生的独立危险因素。逐步纳进入院时获得的临床基本特征:年龄≥65岁、女性、起病至入院时间>12 h、高水平中性粒细胞计数、单核细胞计数及心肌组织特异性较高的CK-MB变量,其回归模型预测CR发生概率值的ROC曲线下面积(AUC)逐步增大,最终模型预测概率值的AUC为0.81(95%CI:0.75~0.86,P<0.001)。结论年龄≥65岁、女性、起病至入院时间>12 h、高水平中性粒细胞计数、单核细胞计数及CK-MB可影响AMI患者CR发生。联合上述指标构建回归型,可在患者入院时获得较好的高危CR患者的判断准确性。Objective Studies have shown that monocytes and neutrophils play an important role in inflammation after acute myocardial infarction(AMI).This study aims to determine the prognostic value of combined neutrophil count,monocyte count and CK-MB in patients with AMI.Methods 79 patients diagnosed with CR in the First Affiliated Hospital of Xi'an Jiaotong University after their first AMI from January 2015 to December 2019 were enrolled,and 316 non-CR patients admitted to hospital after AMI during the same period were included as the control group.Results The total incidence of CR in AMI patients was 1.1%(79/7159),and the hospital fatality rate of CR patients was 77.2%(61/79),accounting for 34.9%(61/175)of AMI deaths in hospital.Age≥65 years(OR=4.49,95%CI:2.48-8.14,P<0.001),female(OR=2.03,95%CI:1.06-3.89,P=0.032),time from onset to admission>12 h(OR=2.34,95%CI:1.29-4.24,P=0.005),higher neutrophil count at admission(OR=2.67,95%CI:1.43-4.98,P=0.002),monocyte count(OR=2.08,95%CI:1.15-3.78,P=0.016)and CK-MB(OR=2.42,1.36-4.31,P=0.003)were independent risk factors for CR.Basic clinical features acquired upon admission were gradually included:Age≥65 years,female,time from onset to admission>12 h,high neutrophil count,monocyte count,and CK-MB with high specificity of myocardial tissue.The area under the ROC curve(AUC)of the probability value of CR occurrence predicted by the regression model increases gradually,and the AUC of the final model predicted probability value was 0.81(95%CI:0.75-0.86,P<0.001).Conclusion Age≥65 years old,female,time from onset to admission>12 h,high level neutrophil count,monocyte count and CK-MB were independent risk factors for CR after AMI.Combined with the above indicators,the regression model can obtain better judgment accuracy of high-risk CR patients at admission.

关 键 词：急性心肌梗死 心脏破裂 炎症细胞 肌酸激酶同工酶 

分 类 号：R541[医药卫生—心血管疾病]