新型炎性指标对急性心肌梗死早期心力衰竭的预测价值  

Value of novel inflammatory indicators for predicting early HF in acute myocardial infarction patients

作　　者：李敬[1] 张羽[1] 李娜[1] 孙红春 李英[1] 付建平 Li Jing;Zhang Yu;Li Na;Sun Hongchun;Li Ying;Fu Jianping(Department of Cardiology,Affiliated Hengshui People's Hospital,Hengshui 053000,Hebei Province,China)

机构地区：[1]河北医科大学附属衡水市人民医院哈励逊国际和平医院心内科,053000

出　　处：《中华老年心脑血管病杂志》2022年第3期243-246,共4页Chinese Journal of Geriatric Heart,Brain and Vessel Diseases

基　　金：河北省医学科学研究课题计划(20191767)。

摘　　要：目的探讨新型炎性指标对急性心肌梗死(AMI)早期心力衰竭(心衰)的预测价值。方法选择2019年1月~2021年6月本院心内科收治的AMI患者228例,根据患者住院24 h内是否发生心衰分为心衰组107例和非心衰组121例。心衰组中KillipⅡ级43例、Ⅲ级56例和Ⅳ级8例。计算中性粒细胞与淋巴细胞比值(NLR)、中性粒细胞与高密度脂蛋白比值(NHR)、单核细胞与高密度脂蛋白比值(MHR),比较2组相关指标的差异,进行相关性分析,逐步logistic回归分析,用ROC曲线分析各指标的预测价值。结果心衰组NLR(7.55±1.12 vs 4.75±1.54)、NHR(8.33±1.20 vs 5.92±0.16)、MHR(0.90±0.03 vs 0.83±0.04)、肌钙蛋白I(cTnI)峰值、肌酸激酶同工酶(CK-MB)峰值高于非心衰组(P<0.01)。2组N末端B型钠尿肽前体(NT-proBNP)和LVEF比较,差异无统计学意义(P>0.05)。KillipⅣ级患者NLR、NHR、MHR、cTnI、CK-MB、NT-proBNP高于KillipⅡ、Ⅲ级患者。KillipⅢ级患者NLR、NHR、MHR、cTnI、CK-MB高于KillipⅡ级患者(P<0.05)。NLR、NHR、MHR与心功能程度呈正相关(r=0.884,r=0.851,r=0.839,P<0.01)。逐步logistic回归分析显示,NLR、NHR、MHR、cTnI、CK-MB、NT-proBNP升高的患者早期并发心衰的危险性增加(P<0.01)。NLR、NHR、MHR及三者联合均有预测早期并发心衰的价值,其中三者联合的预测价值最高(曲线下面积为0.797)。结论新型炎性指标与AMI早期心功能相关,有预测AMI早期心衰的临床价值。Objective To study the value of novel inflammatory indicators for predicting early HF in acute myocardial infarction(AMI)patients.Methods Two hundred and twenty-eight AMI patients admitted to our hospital from January 2019 to June 2021 were divided into HF group(n=107)and HF-free group(n=121).Of the 107 patients in HF group,43 were diagnosed with KillipⅡHF,56 were diagnosed with KillipⅢHF and 8 were diagnosed with KillipⅣHF.The neutrophil to lymphocyte ratio(NLR),neutrophil to HDL-C ratio(NHR)and monocyte to HDL-C ratio(MHR)in two groups were calculated and analyzed by correlation analysis and stepwise logistic regression analysis respectively.The value of NLR,NHR and MHR for predicting early HF in AMI patients was analyzed by ROC curve analysis.Results The NLR(7.55±1.12 vs 4.75±1.54),NHR(8.33±1.20 vs 5.92±0.16),MHR(0.90±0.03 vs 0.83±0.04)and serum levels of troponin I(cTnI)and creatine kinase isoenzyme(CK-MB)were significantly higher in HF group than in HF-free group(P<0.01).No significant difference was detected in serum NT-proBNP level and LVEF between the two groups(P>0.05).The NLR,NHR,MHR and serum levels of cTnI,CK-MB and NT-proBNP were significantly higher in patients with KillipⅣHF than in those with KillipⅡHF and KillipⅢHF,and in patients with KillipⅢHF than in those with KillipⅡHF(P<0.05).The NLR,NHR and MHR were positively related with the cardiac function in AMI patients(r=0.884,r=0.851,r=0.839,P<0.01).Sterewise logistic re-gression analysis showed NLR,NHR,MHR and serum levels of cTnI,CK-MB and NT-proBNP were risk factors for early HF in AMI patients(P<0.01).The NLR,NHR,MHR and their com-bination could predict early HF in AMI patients.The value of their combination for precting early HF in AMI patients was higher than that of NLR,NHR,MHR alone.The AUC of NLR,NHR,MHR for precting early HF in AMI patients was 0.797.Conclusion Novel inflammatory indica-tors are related with cardiac function and can thus predict early HF in AMI patients.

关 键 词：心肌梗死 心力衰竭 中性白细胞 淋巴细胞 脂蛋白类 HDL 单核细胞 

分 类 号：R542.22[医药卫生—心血管疾病] R541.6[医药卫生—内科学]