血小板-淋巴细胞比值可预测老年急性心肌梗死患者住院期间死亡风险  

Platelet-lymphocyte Ratio Predicts In-hospital Mortality in Elderly Patients with Acute Myocardial Infarction

作　　者：王瑜 陈焱 韩元元 徐清 陈胜岳 吕智博 卢川 郑铭鑫 赵昕[1] WANG Yu;CHEN Yan;HAN Yuanyuan;XU Qing;CHEN Shengyue;LYU Zhibo;LU Chuan;ZHENG Mingxin;ZHAOXin(Department of Cardiology,the Second Hospital of Dalian Medical University,Dalian 116023,China;Neusoft Research of Intelligent Healthcare Technology,Co.Ltd,Shenyang 110170,China)

机构地区：[1]大连医科大学附属第二医院心血管内科,辽宁省大连市116023 [2]沈阳东软智能医疗科技研究院有限公司,辽宁省沈阳市110170

出　　处：《中国全科医学》2023年第33期4137-4142,共6页Chinese General Practice

基　　金：科技部国家重点研发计划(2020YFC2004701);辽宁省“揭榜挂帅”科技计划(重大)项目(2022JH1/10400004)。

摘　　要：背景既往研究表明血小板-淋巴细胞比值(PLR)对心血管疾病的不良结局具有重要的预测价值,但是较少有研究探讨PLR对老年急性心肌梗死(AMI)患者短期预后的预测价值。目的明确PLR对老年AMI患者住院期间死亡风险的预测能力。方法回顾性收集2015年12月—2021年12月在大连医科大学附属第二医院心血管内科治疗的1423例老年AMI住院患者的病史资料,主要包括性别、年龄、BMI、血压分级、糖化血红蛋白、血小板计数、中性粒细胞计数、淋巴细胞计数、估算肾小球滤过率(eGFR)、血脂相关指标,心力衰竭、糖尿病患病情况以及住院期间他汀类药物、抗血小板药物的使用情况,最终结局定义为住院期间全因死亡。根据是否死亡分为未死亡组1315例和死亡组108例。采用受试者工作特征曲线(ROC曲线)明确PLR对老年AMI患者住院期间死亡风险的预测能力,通过决策曲线分析探究PLR及其联合指标的临床应用价值。结果死亡组患者年龄、BMI、PLR、白细胞计数、中性粒细胞计数、淋巴细胞计数、红细胞计数、血红蛋白、空腹血糖、天冬氨酸氨基转移酶(AST)、三酰甘油(TG)、肌钙蛋白I(CTNI)、eGFR分级、心力衰竭比例、抗血小板类药物使用比例、降脂类药物使用比例与未死亡组比较,差异有统计学意义(P<0.05)。PLR预测老年AMI患者住院期间死亡风险的ROC曲线下面积为0.661(P<0.001);PLR联合肌酸激酶同工酶MB(CK-MB)或CTNI时ROC曲线下面积分别为0.705和0.779(P<0.001)。基于Bootstrap法绘制的决策曲线分析结果表明PLR的风险阈值在6%~82%以及PLR联合CTNI的风险阈值在2%~86%时可产生较大的净获益,具有临床应用价值。结论PLR可以有效预测老年AMI患者住院期间死亡风险,这种预测能力在联合CTNI后显著提升。Background Important predictive value of platelet-lymphocyte ratio(PLR)for adverse outcomes of cardiovascular disease has been proved in previous studies,however,the predictive value of PLR for short-term prognosis in elderly patients with acute myocardial infarction(AMI)remains to be explored.Objective To determine the predictive ability of PLR for mortality risk during hospitalization in elderly patients with AMI.Methods The medical history data of 1423 elderly patients with AMI treated in the Department of Cardiology of the Second Hospital of Dalian Medical University from December 2015 to December 2021 was retrospectively collected,mainly including gender,age,BMI,blood pressure classification,glycated hemoglobin,platelet count,neutrophil count,lymphocyte count,estimated glomerular filtration rate,lipid related indices,the combination of heart failure and diabetes,the use of statins and antiplatelet agents during hospitalization,with the final outcome defined as all-cause death during hospitalization.The included patients were divided into the non-death group(n=1315)and death group(n=108)according to the occurrence of death.ROC curve was used to determine the predictive ability of PLR for in-hospital mortality risk in elderly patients with AMI,and the clinical application value of PLR and its combined indicators by decision curve analysis(DCA).Results There were significant differences in age,BMI,PLR,white blood cell count,neutrophil count,lymphocyte count,red blood cell count,hemoglobin,fasting blood glucose level,AST,TG,CTNI,eGFR grade,proportion of heart failure,proportion of antiplatelet drugs,and proportion of lipid-lowering drugs between the death group and the non-death group(P<0.05).The area under the ROC curve of PLR for predicting the risk of in-hospital mortality in elderly AMI patients was 0.661(P<0.001);AUC when PLR was combined with CK-MB or CTNI was 0.705 and 0.779(P<0.001),respectively.The results of decision curve analysis based on Bootstrap method showed that the risk threshold of PLR between

关 键 词：心肌梗死 血小板与淋巴细胞比值 住院期间死亡 死亡 预测 

分 类 号：R542.22[医药卫生—心血管疾病]