ALB-dNLR评分对急性冠状动脉综合征患者行介入治疗预后的影响  

Effect of ALB-dNLR score on the prognosis in patients with acute coronary syndrome undergoing percutaneous coronary intervention

作　　者：范文俊 刘逸翔 刘静怡[1] 张英[1] 司月乔 史菲[1] 孙 FAN Wenjun;LIU Yixiang;LIU Jingyi;ZHANG Ying;SI Yueqiao;SHI Fei;SUN Lixian(Division of Cardiology,the Affiliated Hospital of Chengde Medical University,Chengde Cardiovascular Institute,Chengde 067000,China)

机构地区：[1]承德医学院附属医院心脏内科,承德市心血管病研究所,067000

出　　处：《天津医药》2022年第11期1186-1191,共6页Tianjin Medical Journal

基　　金：河北省自然科学基金资助项目(H2021406071);河北省科学技术厅创新指导项目(202011);河北省教育厅研究生创新资助项目(CXZZSS2021138)。

摘　　要：目的分析白蛋白-衍生的中性粒细胞与淋巴细胞比值(ALB-dNLR)评分对急性冠状动脉综合征(ACS)患者行经皮冠状动脉介入治疗(PCI)预后的影响。方法连续入选确诊ACS并行PCI的患者共1744例,收集患者临床资料。患者出院后通过门诊复诊、电话等方式随访,记录其主要不良心血管事件(MACE)。采用受试者工作特征(ROC)曲线确定各炎性指标预测MACE的最佳界值。分析ALB和dNLR与各炎性指标的相关性。通过Kaplan-Meier曲线和Cox回归模型分析患者发生MACE的影响因素。结果共纳入1539例患者,中位随访时间1141 d,其中MACE组60例,Non-MACE组1479例。MACE组中性粒细胞计数、dNLR、中性粒细胞与淋巴细胞比值(NLR)、血小板与淋巴细胞比值(PLR)、单核细胞与淋巴细胞比值(MLR)、系统免疫炎性指数(SII)、肌酸激酶同工酶和肌酐水平均较Non-MACE组升高,而淋巴细胞计数、ALB水平较Non-MACE组下降。ALB、dNLR、ALB-dNLR、NLR、PLR、MLR、SII的ROC曲线下面积分别为0.619、0.600、0.645、0.619、0.576、0.587、0.611(均P<0.05)。dNLR与NLR、PLR、MLR、SII均呈正相关(均P<0.05)。ALB≤40.72 g/L、dNLR≥2.30和ALB-dNLR评分升高均为ACS患者PCI术后发生MACE的独立危险因素(P<0.05)。结论ALB-dNLR评分是ACS患者PCI术后发生MACE的独立预测因素,有望成为预后评估的新型指标。Objective To investigate the predictive values of ALB-dNLR score on long-term prognosis of patients with acute coronary syndrome(ACS)after percutaneous coronary intervention(PCI).Methods A total of 1744 patients with ACS after PCI were consecutively enrolled.The clinical and laboratory data of all the subjects were collected.After discharge,patients were followed up by outpatient visit and telephone call.Major adverse cardiovascular events(MACE)were recorded.The receiver operating characteristic(ROC)curve was used to determine the best cutoff value of each inflammatory markers for predicting MACE.The correlation between ALB and dNLR and other inflammatory markers was analyzed.Kaplan-Meier curve and Cox regression models were used to determine the influencing factors of MACE.Results A total of 1539 patients with ACS after PCI were enrolled in our study.The median follow-up time was 1141 days,including 60 patients in the MACE group and 1479 patients in the non-MACE group.The neutrophil count,dNLR,neutrophil to lymphocyte ratio(NLR),platelet to lymphocyte ratio(PLR),monocyte to lymphocyte ratio(MLR),systemic immune-inflammation index(SII),creatine kinase MB isoenzyme and creatinine levels were higher in the MACE group than those in the non-MACE group,and the lymphocyte count and ALB level were lower.The area under the ROC curve of ALB,dNLR,ALB-dNLR,NLR,PLR,MLR and SII were 0.619,0.600,0.645,0.619,0.576,0.587 and 0.611(all P<0.05).ALB was negatively correlated with dNLR,NLR,PLR,MLR and SII,while dNLR was positively correlated with NLR,PLR,MLR and SII(all P<0.05).ALB≤40.72 g/L,dNLR≥2.30 and ALB-dNLR score were found to be independent risk indicators for MACE in ACS patients after PCI(P<0.05).Conclusion ALB-dNLR score is an independent predictor of MACE in ACS patients after PCI,which is expected to be a new prognostic index.

关 键 词：急性冠状动脉综合征 经皮冠状动脉介入治疗 ALB-dNLR评分 主要不良心血管事件 

分 类 号：R541.4[医药卫生—心血管疾病]