ST段抬高型心肌梗死患者全身免疫炎症指数对无复流发生的影响  

Effect of systemic immune inflammatory index on the incidence of no-reflow in patients with st-segment elevation myocardial infarction

作　　者：马晨[1] 张祎[1] 张晶 刘亚东[3] 余航 MA Chen;ZHANG Wei;ZHANG Jing;LIU Yadong;YU Hang(Department of Laboratory,Xi'an Jiaotong University First Affiliated Hospital Xi'an,Xi'an 710061,China)

机构地区：[1]西安交通大学第一附属医院检验科,710061 [2]西安交通大学第一附属医院心内科,710061 [3]延安大学附属医院心脑血管病医院检验科

出　　处：《心肺血管病杂志》2023年第12期1219-1225,共7页Journal of Cardiovascular and Pulmonary Diseases

摘　　要：目的:ST段抬高型心肌梗死(ST-segment elevation myocardial infarction,STEMI)患者无复流的发生率高,同时无复流又与炎症密切相关。本研究探索全身免疫炎症指数(systemic immune inflammatory index,SII)对STEMI患者无复流发生的影响。方法:回顾性研究2020年1月至2023年1月,于西安交通大学第一附属医院诊断为STEMI患者546例。根据SII的四分位数分为四组:组1(SII<518.8)、组2(518.8≤SII<1096.2),组3(1096.2≤SII<2217.6),组4(SII≥2217.6)。研究的主要终点是无复流的发生。通过多元Logistic回归分析探究SII对无复流的影响,结果使用比值比(OR)和95%置信区间(CI)表示。使用亚组分析探究在不同亚组中SII对无复流结局的影响。绘制限制性立方样条函数(RCS)直观反映SII与无复流之间的关系。结果:随着SII的增高,患者无复流发生率显著增高[组1 vs.组2 vs.组3 vs.组4:14(10.2%)vs.20(14.7%)vs.26(19.1%)vs.36(26.3%),P=0.004]。整多元Logistic回归分析表明:随着SII的增加,患者无复流(组1作为参考;组2 OR=1.79,95%CI:0.79~4.19,P=0.169;组3 OR=2.40,95%CI:1.09~5.52,P=0.033;组4 OR=4.15,95%CI:1.97~9.28,P<0.001)的发生风险显著增加。RCS结果表明SII与无复流的关系是非线性的,无复流风险随着SII的上升而增加。亚组分析表明,所有亚组均无显著的交互作用。结论:SII作为临床易获取的指标,可预测STEMI患者无复流的发生风险,可能有助于及时识别STEMI术后无复流发生的高危患者,指导积极治疗,并改善患者预后。Objective:Patients with ST-segment elevation myocardial infarction(STEMI)have a high incidence of no-reflow,which is closely associated with inflammation.This study explored the effect of the systemic immune inflammatory index(SII)on the incidence of no-reflow in STEMI patients.Methods:This was a retrospective cohort study,enrolling 546 patients with STEMI who met the study entry row criteria.The patients were divided into four groups according to the quartiles of SII:group 1(SII<518.8),group 2(518.8≤SII<1096.2),group 3(1096.2≤SII<2217.6),and group 4(SII≥2217.6).The primary endpoint of the study was the incidence of no-reflow.The effect of SII on no-reflow was explored by multivariate logistic regression analysis,and the results were expressed using ratio(OR)and 95%CI.Subgroup analysis was used to explore the effect of SII on the adverse outcome in different subgroups.Restricted cubic spline functions(RCS)were plotted to visualize the relationship between SII and no-reflow.Results:The incidence of no-reflow increased significantly with increasing SII[group 1 vs.group 2 vs.group 3 vs.group 4:14(10.2%)vs.20(14.7%)vs.26(19.1%)vs.36(26.3%),P=0.004].Multivariate logistic regression analysis showed that:as SII increased,the risk of no-reflow was significantly increased(group 1 as reference;group 2 OR=1.79,95%CI:0.79-4.19,P=0.169;group 3 OR=2.40,95%CI:1.09-5.52,P=0.033;group 4 OR=4.15,95%CI:1.97-9.28,P<0.001).The RCS indicated that the relationship between SII and no-reflow was nonlinear,and the risk of no-reflow increased with increasing SII.Subgroup analysis revealed no significant interactions across all subgroups.Conclusions:SII,as a clinically accessible index,had the potential to serve as a valuable predictor of no-reflow risk in STEMI patients.It may aid in identifying those at high risk for this complication and guide proactive treatment strategies to improve patient outcomes.

关 键 词：急性心肌梗死 全身免疫炎症指数 无复流 冠心病 

分 类 号：R54[医药卫生—心血管疾病]