联合中性粒细胞与淋巴细胞比值、中性粒细胞百分比及C-反应蛋白对急性心肌梗死急诊介入治疗术预后的预测价值研究  

Predictive value of combined neutrophil to lymphocyte ratio,neutrophil percentage and C-reactive protein in patients with acute myocardial infarction after primary percutaneous coronary intervention

作　　者：于子翔[1] 穆乃外尔·萨比尔 艾尔肯·阿吉[1] 阿卜杜外力·艾尔肯 李兆勇[3] 美日班·外力 李晓梅[1] 马依彤[1] YU Zi-xiang;MUNAIWAIER Sabir;AIERKEN Aji;ABUDUWAILI Aierken;LI Zhao-yong;MEIRIBAN Waili;LI Xiao-mei;MA Yi-tong(The First Department of Coronary Heart Disease,The First Affiliated Hospital of Xinjiang Medical University/Key Laboratory of Cardiovascular Research,Urumqi 830054,China;Graduate College of Xinjiang Medical University,Urumqi 830054,China;Department of internal medicine,the Armed Police General Hospital of Xinjiang,Urumqi 830001,China;Department of Heart failure,The First Affiliated Hospital of Xinjiang Medical University/Key Laboratory of Cardiovascular Research,Urumqi 830054,China)

机构地区：[1]新疆医科大学第一附属医院冠心病一科/新疆心血管病研究重点实验室,新疆维吾尔自治区乌鲁木齐市830054 [2]新疆医科大学研究生学院 [3]武警新疆总队医院内二科 [4]新疆医科大学第一附属医院心力衰竭科/新疆心血管病研究重点实验室,新疆维吾尔自治区乌鲁木齐市830054

出　　处：《中国心血管病研究》2022年第9期821-827,共7页Chinese Journal of Cardiovascular Research

摘　　要：目的 探讨中性粒细胞与淋巴细胞比值(NLR)、中性粒细胞百分比(NEUT%)和C-反应蛋白(CRP)以及以上三个指标的组合在急性ST段抬高型心肌梗死(STEMI)接受急诊经皮冠状动脉介入治疗(PCI)患者的术后远期发生不良心血管事件(MACE)方面的预测效能。方法 连续纳入2017年1月至2019年1月,急诊入住新疆医科大学第一附属医院心脏中心,并被诊断为STEMI的患者1056例,按照纳入与排除标准,最终总共纳入急诊方式接受PCI的患者300例。记录所有患者一般基线资料,血常规、肝功组合、肾功组合、凝血功能、血脂分析、B型利钠肽(BNP)、心肌标志物、炎性因子3项、超声心动图结果、冠状动脉造影结果、冠状动脉支架置入情况以及MACE事件发生情况。随访中位时间为38月,失访20例。依据随访期间MACE发生情况分为MACE组(80例)和未发生MACE组(200例)。受试者工作特征曲线(ROC)计算出相关指标预测STEMI患者PCI术后发生MACE的最佳阈值。通过两组基线资料比较,选取有统计学意义的指标再进行分组,然后进行生存分析。结果 MACE组中,男性比例、吸烟比例、射血分数、淋巴细胞计数均低于非MACE组[(73.8%比89.5%),(43.8%比63.5%),57%(54%,62%)比61%(56%,63%),1.28(0.88,1.92)×1012/L比1.71(1.17,2.34)×1012/L],差异均有统计学意义(均P<0.05);MACE组的年龄、Gensini评分、仍有残余病变比例、中性粒细胞百分比均大于非MACE组[(62±12)岁比(55±11)岁,65(42,90)比54(35,80),77.5%比55.0%]差异均有统计学意义(P<0.05),MACE组中性粒细胞与淋巴细胞比值、BNP、肌酸激酶同工酶、门冬氨酸转移酶、降钙素原及C-反应蛋白等指标均大于非MACE组[6.65(3.50,11.77)比4.36(2.43,8.26),1056.00 ng/L(274.78,2052.50)比315.70 ng/L(73.65,843.52),204.84 ng/ml(82.25,350.00)比132.38 ng/ml(52.02,300.00),223.74 U/L(101.71,366.93)比141.25 U/L(62.69,244.25),0.05 ng/ml(0.03,0.35)比0.04 ng/ml(0.03,0.06),9.78 ng/L(2.74,30.55)比3.99 ng/Objective To investigate the value of neutrophil to lymphocyte ratio(NLR),percentage of neutrophils(NEUT%),C-reactive protein(CRP) and combinations of the three indexes in predicting the prognosis of patients with ST-elevation acute myocardial infarction after primary percutaneous coronary intervention.Methods From January 2017 to January 2019,1056 patients who were diagnosed with STEMI in the heart center of our hospital were recruited.According to the inclusion and exclusion criteria,a total number of 300 patients who underwent primary PCI were included finally.Baseline data were recorded for all the patients,including blood routine,liver function,renal function,coagulation function,lipid profile,BNP,myocardial biomarkers,inflammatory biomarkers,echocardiography index,coronary angiography results,and the incidence of MACE events.The median follow-up time was 38 months,and 280 patients were successfully followed up and 20 patients were lost to follow-up.According to MACE occurrence,280 patients were divided into the MACE group(80) and non-MACE group(200),performed receiver operator characteristic curve(ROC) analysis was conducted to calculate the optimal cut-off for MACE after primary PCI in the patients with STEMI.The baseline data of the two groups were compared,and the indicators with statistical differences were selected for survival analysis.Results In the MACE group,the proportion of male,the proportion of smoking,the median ejection fraction and lymphocyte count were lower than that of non-MACE group [73.8% vs.89.5%,43.8% vs.63.5%,57%(54%,62%) vs.61%(56%,63%),1.28(0.88,1.92) × 1012/L vs.1.71(1.17,2.34) × 1012/L],and the differences were statistically significant(P0.05).The ROC curve areas(AUC) of NLR,NEUT%,CRP and the combination of the three indicators were respectively [NLR:0.598,NEUT%:0.600,CRP:0.622,combination:0.678,P<0.05].Conclusion Combined detection of NLR,NEUT% and CRP could serve as a sensitive index to evaluate the long-term prognosis of the patients with STEMI after primary PCI.

关 键 词：ST段抬高型心肌梗死 中性粒细胞与淋巴细胞比值 中性粒细胞百分比 C-反应蛋白 主要不良心血管事件 

分 类 号：R542.22[医药卫生—心血管疾病]