H2FPEF评分联合NLR对急性冠状动脉综合征患者PCI术中无复流/慢血流的预测分析  

Prediction analysis of H2FPEF score combined with NLR for no reflow/slow flow during percutaneous coronary intervention in patients with acute coronary syndrome

作　　者：张议丹 姜鹏 秦欣童 阴秋果 刘士超[1] 郭平 贾兴泰 简立国[1] Zhang Yidan;Jiang Peng;Qin Xintong;Yin Qiuguo;Liu Shichao;Guo Ping;Jia Xingtai;Jian Liguo(Department of Cardiology,Second Affiliated Hospital of Zhengzhou University,Zhengzhou 450003,China;不详)

机构地区：[1]郑州大学第二附属医院心内科,郑州450003

出　　处：《中国循证心血管医学杂志》2024年第10期1212-1216,共5页Chinese Journal of Evidence-Based Cardiovascular Medicine

基　　金：河南省医学科技攻关计划项目(LHGJ20200398)。

摘　　要：目的探索急性冠状动脉综合征(ACS)患者H2FPEF评分联合中性粒细胞与淋巴细胞比值(NLR)与经皮冠状动脉(冠脉)介入治疗(PCI)术中无复流/慢血流的关系及预测价值。方法纳入2022年1月至2023年1月于郑州大学第二附属医院心内科住院接受PCI的183例急性冠状动脉综合征患者,根据术中冠状动脉血流情况分为正常血流组(n=102)和无复流/慢血流组(n=81),通过ROC曲线观察H2FPEF评分、NLR及联合指标对无复流/慢血流的预测价值。结果正常血流组与无复流/慢血流组之前的体质指数(BMI)、高血压病史、淋巴细胞计数、中性粒细胞与淋巴细胞比值(NLR)、H2FPEF评分、PCI术前TIMI血流0级差异有统计学意义(P<0.05),多因素回归分析显示,H2FPEF评分和NLR是无复流/慢血流发生的独立预测因子。ROC曲线分析显示,H2FPEF评分在ROC曲线下面积0.728(95%CI:0.653~0.802),敏感性为51.9%,特异性为88.2%,最佳临界值为2.5;NLR在ROC曲线下面积0.663(95%CI:0.585~0.741),敏感性为81.5%,特异性43.1%,最佳临界值为2.31。H2FPEF评分联合NLR(联合预测因子)在ROC曲线下面积为0.756(95%CI:0684~0.829),相比二者单独预测效果更好。结论H2FPEF评分、NLR均是无复流/慢血流的独立预测因子,二者联合可更好地预测ACS患者PCI术中无复流/慢血流现象。Objective To explore the relationship and predictive value of H2FPEF score combined with neutrophil-to-lymphocyte ratio(NLR)in patients with acute coronary syndrome(ACS)and no reflow/slow flow during percutaneous coronary intervention.Methods A total of 183 patients with acute coronary syndrome who underwent PCI were divided into the normal blood flow group(n=102)and the no reflow/slow flow group(n=81)according to their intraoperative coronary blood flow.The risk factors of the no reflow/slow flow phenomenon were analyzed and determined.The predictive value of the H2FPEF score,NLR and combined indexes on no reflow/slow flow was observed by the ROC curve.Result There were statistically significant differences in body mass index(BMI),hypertension history,lymphocyte count,neutrophil to lymphocyte ratio(NLR),H2FPEF score,pre-PCI TIMI blood flow level 0 between the normal flow group and the no reflow/slow flow group(P<0.05).Multivariate regression analysis showed that,H2FPEF score and NLR were independent predictors of no reflow/slow flow occurrence.ROC curve analysis showed that the area of H2FPEF score under ROC curve was 0.728(95%CI:0.653~0.802),the sensitivity was 51.9%,the specificity was 88.2%,and the optimal critical value was 2.5.The area of NLR under ROC curve was 0.663(95%CI:0.585~0.741),the sensitivity was 81.5%,the specificity was 43.1%,and the optimal critical value was 2.31.The area under ROC curve of H2FPEF score combined with NLR(joint predictor)was 0.756(95%CI:0684~0.829),which was better than that of H2FPEF score alone.Conclusion Both H2FPEF score and NLR are independent predictors of no reflow/slow flow,and their combination can better predict no reflow/slow flow in patients with ACS during PCI than a single indicator.

关 键 词：急性冠状动脉综合征 无复流/慢血流 H2FPEF评分 中性粒细胞与淋巴细胞比值 经皮冠状动脉介入治疗 

分 类 号：R541.4[医药卫生—心血管疾病]