GRACE评分联合中性粒细胞与淋巴细胞比值对急性STEMI患者PCI后无复流现象的预测价值  

Predictive value of GRACE score combined with neutrophilic lymphocyte ratio on no-reflow phenomenon after percutaneous coronary intervention in patients with acute ST-segment elevation myocardial infarction

作　　者：郑士航 高曼 张飞飞[2] 李英肖[2] 党懿[2] 齐晓勇[2] ZHENG Shihang;GAO Man;ZHANG Feifei;LI Yingxiao;DANG Yi;QI Xiaoyong(Graduate School of Hebei North University,Zhangjiakou,Hebei,075000,China;Department of Cardiology,Hebei General Hospital,Shijiazhuang,050051,China)

机构地区：[1]河北北方学院研究生院,河北张家口075000 [2]河北省人民医院心内科,石家庄050051

出　　处：《临床心血管病杂志》2021年第9期810-815,共6页Journal of Clinical Cardiology

基　　金：河北省自然科学基金青年科学基金项目(No:H2020307017)。

摘　　要：目的:探讨GRACE评分联合中性粒细胞/淋巴细胞(NLR)水平与急性ST段抬高型心肌梗死(STEMI)患者接受直接经皮冠状动脉介入(PCI)治疗后无复流现象的关系及预测价值。方法:对2018年10月1日—2019年12月31日就诊于河北省人民医院心脏中心行直接PCI治疗的急性STEMI患者269例进行回顾性分析。根据冠状动脉造影结果分为复流组(225例)和无复流组(44例)。应用二元Logistic回归分析确定无复流现象的独立预测因子,绘制ROC曲线以评估GRACE评分、NLR及两者联合对无复流现象的预测价值。结果:共纳入269例患者,无复流发生率为16.3%。调整混杂因素后,二元Logistic回归分析显示GRACE评分(OR=1.011,95%CI1.002~1.020,P=0.017),NLR(OR=1.068,95%CI1.008~1.132,P=0.025)是无复流发生的独立预测因子。在无复流预测中,GRACE评分在ROC曲线下面积0.621(95%CI0.553~0.709),敏感性为79.5%,特异性为44.2%,最佳临界值为118.5;NLR在ROC曲线下面积0.614(95%CI0.512~0.715),敏感性为91.1%,特异性为38.6%,临界值为10.97。GRACE评分联合NLR(联合预测因子)在ROC曲线下面积为0.641(95%CI0.550~0.732,P=0.03)。分别比较联合预测因子与单独GRACE评分和单独NLR的预测能力,均无统计学差异(P>0.05)。结论:GRACE评分、NLR均是无复流的独立预测因子,GRACE评分联合NLR可以预测STEMI患者PCI治疗后无复流现象的发生,但并未体现出优于单一使用GRACE评分或NLR的预测价值。Objective: To explore the relationship between GRACE score combined with the neutrophilic lymphocyte ratio(NLR) and no-reflow phenomenon after primary percutaneous coronary intervention in patients with acute ST segment elevation myocardial infarction(STEMI). Methods: A retrospective analysis was performed on 269 patients with acute STEMI who received primary percutaneous coronary intervention. According to the results of angiography, they were divided into two groups: the reflow group(n=225) and no-reflow group(n=44). Binary Logistic regression analysis was used to identify the independent predictors of no-reflow, and ROC curves were performed to evaluate the predictive value of GRACE score, NLR and the combined factor. Results: A total of 269 patients were included, and the incidence of no-reflow was 16.3%. After adjusting for confounding factors, the results of binary logistic regression analysis showed that GRACE score(OR1.011, 95%CI: 1.002-1.020, P=0.017), NLR(OR1.068, 95%CI: 1.008-1.132, P=0.025) were independent predictors of no-reflow. In the predictive value of no-reflow, the area under ROC curve(AUC) of GRACE score was 6.21(95%CI: 0.553-0.709), its sensitivity was 79.5% and specificity was 44.2% and the best critical value was 118.5. The AUC of NLR was 6.14(95%CI: 0.512-0.715), its sensitivity was 91% and specificity was 38%, and the critical value was 10.97. The AUC of GRACE score combined with NLR was 6.41(95%CI0.55-0.732, P=0.03). There was no significant difference in predictive value among GRACE score combined with NLR, GRACE score alone and NLR alone(P>0.05). Conclusion: GRACE score and NLR are independent predictors of no-reflow. GRACE score combined with NLR is a better indicator to predict the no-reflow in STEMI patients after percutaneous coronary intervention, but is not superior to GRACE score or NLR alone.

关 键 词：无复流 急性ST段抬高型心肌梗死 经皮冠状动脉介入治疗 GRACE评分、中性粒细胞/淋巴细胞 

分 类 号：R542.2[医药卫生—心血管疾病]