同型半胱氨酸联合中性粒细胞计数对绝经后患者心肌无复流的预测价值  

Predictive value of homocysteine combined with neutrophils for myocardial no-reflow in postmenopausal women

作　　者：马娟[1] 燕茹[2] 贾绍斌[2,3] MA Juan;YAN Ru;JIA Shaobin(Ningxia Medical University,750004,China;Department of Cardiology,General Hospital of Ningxia Medical University;Institute of Medical Science,General Hospital of Ningxia Medical University)

机构地区：[1]宁夏医科大学,银川750004 [2]宁夏医科大学总医院心血管内科 [3]宁夏医科大学总医院医学科学研究院

出　　处：《临床心血管病杂志》2024年第3期230-235,共6页Journal of Clinical Cardiology

基　　金：国家自然科学基金项目(No:82260086、82060057);宁夏自然科学基金重点项目(No:2023AAC02069)。

摘　　要：目的:探讨血同型半胱氨酸(Hcy)和中性粒细胞计数(ANC)对绝经后急性ST段抬高型心肌梗死(STEMI)患者经皮冠状动脉介入治疗(PCI)术中无复流的预测价值。方法:回顾性选择绝经后首诊STEMI并于2017年12月—2019年10月在宁夏医科大学总医院接受急诊PCI治疗的126例患者,根据冠状动脉(冠脉)造影结果分为正常血流组(95例)和无复流组(31例)。比较两组基线资料,应用logistic回归分析评估Hcy和ANC对绝经后STEMI患者PCI术中无复流的影响。通过ROC曲线评估Hcy联合ANC对心肌无复流的预测价值。结果:纳入患者126例,无复流发生率为24.66%。多因素logistic回归显示,术前Hcy(OR=1.136,95%CI:1.067~1.210,P<0.001)和ANC(OR=1.280,95%CI:1.091~1.501,P=0.002)是无复流发生的危险因素。ROC曲线分析显示,ANC预测心肌无复流的曲线下面积为0.724(95%CI:0.619~0.829),截断值为9.88×10~9/L,灵敏度为64.5%,特异度为81.1%;Hcy预测心肌无复流的曲线下面积为0.783(95%CI:0.683~0.884),截断值为20.04μmol/L,灵敏度为67.7%,特异度为83.2%;Hcy联合ANC预测心肌无复流的曲线下面积为0.838(95%CI:0.753~0.922),灵敏度为90.3%,特异度为76.3%。结论:Hcy≥20.04μmol/L联合ANC≥9.88×10~9/L可用于预测绝经后STEMI患者PCI术中无复流的发生风险,具有较强的预测价值。Objective:To investigate the predictive value of blood homocysteine(Hcy) and neutrophils counts(ANC) for no-reflow during percutaneous coronary intervention(PCI) in postmenopausal patients with ST-segment elevation myocardial infarction(STEMI).Methods:A total of 126 postmenopausal patients with first-episode STEMI underwent emergency PCI in the General Hospital of Ningxia Medical University from December 2017 to October 2019 were enrolled.According to coronary angiography results,they were divided into the normal flow group(n=95) and the no-reflow group(n=31).Baseline data were compared between the two groups.Logistic regression model was used to analyze the independent factors of no-reflow,and ROC curves were performed to assess the predictive efficacy of Hcy and ANC.Results:The incidence of NRP was 24.6% in 126 included patients.After adjusting for confounding factors,logistic regression showed that Hcy(OR=1.136,95%CI:1.067-1.210,P<0.001) and ANC(OR=1.280,95%CI:1.091-1.501,P=0.002) were independent predictors of no-reflow.ROC analysis showed that the area under the ROC curve(AUC) for predicting myocardial no-reflow by ANC was 0.724(95%CI:0.619-0.829),with a cutoff value of 9.88×109/L,sensitivity of 64.5%,and specificity of 81.1%;The AUC for predicting myocardial no-reflow by HCY was 0.783(95%CI:0.683-0.884),with a cutoff value of 20.04 μmol/L,sensitivity of 67.7%,and specificity of 83.2%;The AUC of Hcy combined with ANC for predicting myocardial no-reflow was 0.838(95%CI:0.753-0.922),with a sensitivity of 90.3%,specificity of 76.3%.Conclusion:Hcy≥20.04 μmol/l and ANC counts≥9.88×10~9/L can be used to predict the risk of no-reflow during PCI in postmenopausal STEMI patients,and has high predictive value.

关 键 词：同型半胱氨酸 中性粒细胞 绝经 无复流 ST段抬高型心肌梗死 

分 类 号：R541.4[医药卫生—心血管疾病]