CHA2DS2-VASc评分联合中性粒细胞与淋巴细胞比值对急性STEMI患者直接PCI后无复流的关系研究  

Correlation between CHA2DS2-VASc Score Combined with Neutrophil to Lymphocyte Ratio and No Reflow after Direct PCI in Patients with Acute STEMI

作　　者：王家琦 吴路路 王禹丹 张飞飞[3] 李英肖[3] 党懿[3] 齐晓勇[3] WANG Jia-qi;WU Lu-lu;WANG Yu-dan;ZHANG Fei-fei;LI Ying-xiao;DANG Yi;QI Xiao-yong(Graduate School of Hebei North University,Zhangjiakou,075000,China;Graduate School of Hebei Medical University,Shijiazhuang,050017,China;Department of Cardiology,Hebei General Hospital,Shijiazhuang,050051,China)

机构地区：[1]河北北方学院研究生学院,张家口075000 [2]河北医科大学研究生学院,石家庄050017 [3]河北省人民医院心血管内科,石家庄050051

出　　处：《神经药理学报》2021年第6期46-52,共7页Acta Neuropharmacologica

基　　金：河北省自然科学基金项目(No.H2020307017),河北省2019年度医学科学研究课题项目(No.20190237)。

摘　　要：目的:探讨CHA_(2)DS_(2)-VASc评分联合中性粒细胞与淋巴细胞比值(neutrophil to lymphocyte ratio,NLR)与急性ST段抬高型心肌梗死(ST-segment elevation myocardial infarction,STEMI)患者直接经皮冠状动脉介入(percutaneous coronary intervention,PCI)术后无复流现象的关系。方法:以2018年09月01日~2019年12月31日就诊于河北省人民医院心血管内科行直接PCI治疗的急性STEMI患者275例为研究对象,收集患者各项临床资料及检查指标。根据患者PCI术后是否出现无复流将其分为无复流组(47例,17.1%)和复流组(228例,82.9%)。分析STEMI患者PCI术后发生无复流的独立影响因素,绘制受试者工作特征(receiver operating characteristic,ROC)曲线以分析CHA_(2)DS_(2)-VASc评分、NLR及二者联合因子对急性STEMI患者PCI术后发生无复流的预测价值。结果:无复流组患者CHA_(2)DS_(2)-VASc评分、NLR及术中预扩张例数均高于复流组(P<0.05)。二元Logistic回归分析结果显示,CHA_(2)DS_(2)-VASc评分、NLR是急性STEMI患者PCI术后无复流现象的独立影响因素(P<0.05)。ROC曲线结果显示:CHA_(2)DS_(2)-VASc评分(AUC:0.640,95%CI 0.562~0.719,P=0.002)、NLR(AUC:0.631,95%CI 0.541~0.721,P=0.005)对无复流现象有一定预测能力,但两者联合预测因子(AUC:0.675,95%CI 0.589~0.762,P<0.001)的AUC更高,可更好的预测STEMI患者直接PCI术后无复流现象的发生,分别比较联合预测因子与单独CHA_(2)DS_(2)-VASc评分和单独NLR的预测能力,均无统计学差异(P>0.05)。结论:CHA_(2)DS_(2)-VASc评分、NLR是无复流现象的独立预测因子,两者联合对急性STEMI患者PCI术后无复流现象的发生具有较好的预测价值,但并未体现出优于单一使用CHA_(2)DS_(2)-VASc评分或NLR的预测价值。Objective:To investigate the relationship between CHA_(2)DS_(2)-VASc score combined with neutrophil to lymphocyte ratio(NLR)and no-reflow phenomenon after direct percutaneous coronary intervention(PCI)in patients with acute ST-segment elevation myocardial infarction(STEMI).Methods:A total of 275 patients with acute STEMI who received direct PCI in the Department of Cardiology,Hebei General Hospital from September 1,2018 to December 31,2019 were selected as the study subjects.All clinical data and examination indicators of patients were collected.According to the results of angiography,they were divided into two groups:the reflow group(n=228)and no-reflow group(n=47).The independent influencing factors of no-reflow after PCI in STEMI patients were analyzed,and receiver operating characteristic(ROC)curve was drawn to analyze the predictive value of CHA_(2)DS_(2)-VASc score,NLR and their combined factors for no-reflow after PCI in acute STEMI patients.Results:CHA_(2)DS_(2)-VASc score,NLR and intraoperative predilation in patients no-reflow were higher than those in reflow group(P<0.05).Binary Logistic regression analysis showed that CHA_(2)DS_(2)-VASc score and NLR were independent influencing factors of no-reflow after PCI in acute STEMI patients(P<0.05).ROC curve results showed that:CHA_(2)DS_(2)-VASc score(AUC:0.640,95%CI0.562~0.719,P=0.002),NLR(AUC:0.631,95%CI0.541~0.721,P=0.005)had certain predictive power for no-reflow phenomenon,but the combined predictive factor(AUC:0.675,95%CI0.589~0.762,P<0.001)were higher in AUC,which could better predict the occurrence of no-reflow after direct PCI in STEMI patients.The predictive power of combined predictors was compared with CHA_(2)DS_(2)-VASc score alone and NLR alone.There were no statistical differences(P>0.05).Conclusion:CHA_(2)DS_(2)-VASc score and NLR are independent predictors of no-reflow.The combination of the two has a good predictive value for the occurrence of no-reflow after PCI in acute STEMI patients,but does not show a better predictive value than CHA_(

关 键 词：CHA2DS2-VASc评分 中性粒细胞与淋巴细胞比值 急性ST段抬高型心肌梗死 经皮冠状动脉介入治疗 无复流 

分 类 号：R541[医药卫生—心血管疾病]