新型炎症标志物评分与STEMI患者预后及风险模型构建  

Prognosis and Risk Model Construction of Novel Inflammatory Marker Scores and Patients with ST-segment Elevation Myocardial Infarction

作　　者：李文星 张加廷 李鑫 汪茜 LI Wenxing;ZHANG Jiating;LI Xin(Department of Emergency,Third Medical Center of Chinese PLA General Hospital,Beijing 100039,China)

机构地区：[1]中国人民解放军总医院第三医学中心急诊医学科,北京100039

出　　处：《医学研究杂志》2024年第6期124-130,共7页Journal of Medical Research

摘　　要：目的开发和评估新型炎症标志物综合评分预测ST段抬高型心肌梗死(acute ST-segment elevation myocardial infarction,STEMI)患者经皮冠状动脉介入(percutaneous coronary intervention,PCI)治疗后主要不良心脏事件(major adverse cardiac events,MACE)风险。方法选择2021年6月~2022年5月中国人民解放军总医院第三医学中心收治的256例STEMI患者。入院时收集其炎症标志物[中性粒细胞-淋巴细胞比值(neutrophil-to-lymphocyte ratio,NLR)、血小板与淋巴细胞比值(platelet-to-lymphocyte ratio,PLR)、红细胞分布宽度与血小板比值(red blood cell distribution width-to-platelet ratio,RPR)、单核细胞与淋巴细胞比值(monocyte-to-lymphocyte ratio,MLR)、单核细胞与高密度脂蛋白比值(monocyte-to-high-density lipoprotein ratio,MHR)和球蛋白与白蛋白比值(globulin-to-albumin ratio,GAR)]。采用最小绝对收缩和选择算子(least absolute shrinkage and selection operator,LASSO)确定MACE风险炎症标志物并基于回归系数构建新型炎症标志物综合评分,利用COX风险回归模型分析该评分与STEMI患者MACE风险间的关系。使用相关R包构建定量MACE风险的Nomogram模型。通过受试者工作特征(receiver operating characteristic,ROC)曲线、临床决策分析(clinical decision analysis,DCA)曲线评估模型预测性能和临床净收益。结果256例STEMI患者随访中位数为11个月,52例患者出现MACE,发生率为20.3%。基于NLR、MHR和PLR构建N.M.P评分[N.M.P评分=(0.900×NLR_(水平))+(0.102×MHR_(水平))+(0.039×PLR_(水平))]。多因素COX回归分析结果显示,N.M.P评分不受年龄和SYNTAX评分影响,与MACE风险独立相关(P<0.05)。ROC曲线分析结果显示,Nomogram模型预测半年、1年和1年半MACE风险的曲线下面积(area under the curve,AUC)分别为0.905、0.920和0.897。DCA曲线分析结果显示,Nomogram模型能提供显著意义的临床净收益。结论整合NLR、MHR和PLR开发的N.M.P评分能有效预测STEMI患者MACE�Objective To develop and evaluate a novel inflammatory marker composite score to predict the risk of major adverse cardiac events(MACE)after percutaneous coronary intervention(PCI)in patients with ST-segment elevation myocardial infarction(STEMI).Methods A total of 256 patients with STEMI admitted to the Third Medical Center of Chinese PLA General Hospital between June 2021 and May 2022 were selected.Six inflammatory markers[neutrophil-to-lymphocyte ratio(NLR),platelet-to-lymphocyte ratio(PLR),red blood cell distribution width-to-platelet ratio(RPR),monocyte-to-lymphocyte ratio(MLR),monocyte-o-high-density lipoprotein ratio(MHR)and globulin-to-albumin ratio(GAR)]were collected on admission.The least absolute shrinkage and selection operator(LASSO)was used to determine the inflammatory markers of MACE risk,and a novel composite score of inflammatory markers was constructed based on the regression coefficient.COX risk regression models were used to analyze the relationship between this scores and MACE risk in STEMI patients.Nomogram models for quantifying MACE risk were constructed using a correlation R package.The model predictive performance and net clinical benefit were assessed by receiver operating characteristic(ROC)curve and clinical decision analysis(DCA)curve.Results In 256 STEMI patients followed up for a median of 11months,52 patients developed MACE,with an incidence of 20.3%.The N.M.P score was constructed based on NLR,MHR and PLR[N.M.P score=(0.900×NLR_(level))+(0.102×MHR_(level))+(0.039×PLR_(level))].Multivariate COX risk regression analysis showed that N.M.P score was not affected by age and SYNTAX score,and was independently associated with MACE risk independent(P<0.05).ROC curve analysis showed that the area under the curve(AUC)of the nomogram model in predicting the risk of MACE at six months,one year and one and a half years were 0.905,0.920 and 0.897,respectively.DCA curve analysis showed that the nomogram model could provide a significant clinical net benefits.Conclusion The N.M.P score deve

关 键 词：中性粒细胞 淋巴细胞 急性ST段抬高心肌梗死 死亡 预后 

分 类 号：R542.2[医药卫生—心血管疾病]