系统免疫炎症指数对扩张型心肌病合并射血分数降低的心力衰竭患者左心室逆重构的预测价值  

Clinical Value of Systemic Immune Inflammation Index to Predict Left Ventricular Reverse Remodeling in Dilated Cardiomyopathy Patients With Heart Failure With Redu ced Ejection Fraction

作　　者：邵梦娇 石佳 王欢 SHAO Mengjiao;SHI Jia;WANG Huan(Department of Cardiology,The Fifth Affiliated Hospital of Sun Yat-sen University,Zhuhai 519000,China)

机构地区：[1]中山大学附属第五医院心血管病中心,珠海519000

出　　处：《中国循环杂志》2024年第7期695-702,共8页Chinese Circulation Journal

摘　　要：目的:探讨系统免疫炎症指数(SII)对扩张型心肌病合并射血分数降低的心力衰竭(HFrEF)患者左心室逆重构(LVRR)的预测价值。方法:纳入2017年1月至2022年12月于中山大学附属第五医院确诊的合并HFrEF的扩张型心肌病患者480例。根据LVRR定义将患者分为发生LVRR组(n=235)和未发生LVRR组(n=245),比较两组临床资料;同时根据SII三分位数分为SII<332.8组(n=160)、SII 332.8~563.1组(n=160)和SII>563.1组(n=160),分析不同组别LVRR及复合心血管不良事件(包括心力衰竭再住院、致死性心律失常和心原性死亡)发生情况。LVRR定义为经过最优化指南推荐的标准抗心力衰竭治疗≤6个月后,超声心动图测量左心室射血分数绝对值提高≥10%或随访时LVEF≥50%,同时左心室舒张末期内径指数(LVEDDI)降低≥10%或LVEDDI≤33 mm/m^(2)。采用Logistic回归模型进行LVRR影响因素分析。采用限制性立方样条图(RCS)评估SII与LVRR之间的剂量-反应关系。应用ROC曲线、重新分类改善指数(NDI)、综合判别改善指数(IDI)及赤池信息量准则(AIC)估计SII预测LVRR的能力,并与传统生物标志物N末端B型利钠肽原(NT-proBNP)和可溶性生长刺激基因表达蛋白2(sST2)对比诊断效能。结果:480例患者中,235例(49.0%)发生了LVRR。Logistic回归分析结果显示,基线SII是未发生LVRR的独立预测因子(OR=1.005,95%CI:1.004~1.007,P<0.01)。RCS显示SII与未发生LVRR呈正线性关系(P_(nonlinear)=0.455)。ROC曲线、NDI、IDI及AIC分析均表明SII预测未发生LVRR能力较NT-proBNP和sST2更好。中位随访16(9,33)个月期间,108例(22.5%)患者发生复合心血管病事件(包括心力衰竭再住院、致死性心律失常和心原性死亡),37例(7.7%)患者发生全因死亡,SII>563.1组患者的复合心血管事件发生率高于SII<332.8组、SII 332.8~563.1组(43.1%vs.9.4%vs.15.0%,log-rank P<0.01)。结论:入院SII可以独立预测合并HFrEF的扩张型心肌病患者不发生LVRR,且预测效�Objectives:To investigate the predictors of left ventricular reverse remodeling(LVRR)and prognosis in dilated cardiomyopathy(DCM)patients with heart failure with reduced ejection fraction(HFrEF).Methods:A total of 480 patients with HFrEF were continuously recruited.The patients were divided into LVRR group(n=235)and without LVRR group(n=245).The clinical data of patients with and without LVRR were compared.At the same time,the incidence of LVRR and complex cardiovascular adverse events in patients with different SII tripartite groups was compared.The study population was stratified according to SII tertiles:the baseline tertiles of the SII(group 1:<332.8[n=160],group 2:332.8–563.1[n=160],and group 3:>563.1[n=160]).Composite cardiac events include heart failure re-hospitalization,fatal arrhythmias,and cardiac death.Logistic regression analysis was used to analyze the predictive factors of LVRR.The dose-response relationship between systemic imnune inflammation index(SII)and LVRR were evaluated by restricted cubic spline(RCS).Receiver operating characteristic curves,net reclassification index(NRI),integrated discrimination improvement(IDI)and Akaike information criterion(AIC)were drawn to assess the performances of predictors to predict LVRR and prognosis.The predictive efficacy of these predictors were compared with traditional biomarkers(N-terminal pro-brain natriuretic peptide[NTpro-BNP]and soluble growth stimulation expressed gene 2 protein[sST2]).The survival analysis was performed using the Kaplan-Meier method.Results:A total of 235(49.0%)patients experienced LVRR.The results of logistic regression analysis showed that baseline SII was an independent predictor of non-LVRR(OR=1.005,95%CI:1.004~1.007,P<0.01).RCS showed a positive linear relationship between SII and non-LVRR(Pnonlinear=0.455).Compared with traditional biomarkers NT-proBNP and sST2,ROC,NRI,IDI and AIC results proved that SII had the best predictability regarding non-LVRR.All 480 patients completed the follow-up,there were 108(22.5%)composite ca

关 键 词：扩张型心肌病 系统免疫炎症指数 左心室逆重构 预后 

分 类 号：R54[医药卫生—心血管疾病]