尿酸联合炎症指标对冠心病冠脉血流储备和MACE的预测价值  

Predictive Value of Uric Acid Combined with Inflammatory Markers on Coronary Blood Flow Reserve and MACE in Coronary Heart Disease

作　　者：宋明哲 朱王亮 李建飞 许志茹 乔鑫 SONG Mingzhe;ZHU Wangliang;LI Jianfei(Inner Mongolia Autonomous Region People's Hospital,Inner Mongolia Hohhot 010000,China)

机构地区：[1]内蒙古自治区人民医院急诊心血管内科,内蒙古呼和浩特010000

出　　处：《河北医学》2024年第12期2005-2011,共7页Hebei Medicine

基　　金：内蒙古自治区公立医院科研联合基金科技项目,(编号:2023GLLH0104)。

摘　　要：目的:探讨血清尿酸(SUA)联合衍生的中性粒细胞与淋巴细胞比率(dNLR)对冠状动脉疾病(CAD)冠脉血流储备和主要心血管不良事件(MACE)的预测价值。方法:选择2020年1月至2021年12月在本院接受经皮冠状动脉介入治疗(PCI)治疗的323名稳定型CAD患者作为研究对象。dNLR定义为中性粒细胞计数/(WBC计数-中性粒细胞数)。通过冠状动脉造影术定量分析血流储备分数(FFR)。本研究的终点是MACE,包括全因死亡率和随访期间严重心力衰竭的再次住院。结果:与无MACE组相比,MACE组的WBC计数、中性粒细胞计数、dNLR、SUA、FFR≤0.92的例数显著更高(P<0.05),和FFR显著降低(P<0.05)。SUA(HR=1.886,95%CI=1.545~2.303)、dNLR(HR=1.479,95%CI=1.241~1.762)、FFR≤0.92(HR=3.208,95%CI=1.468~7.010)是CAD患者发生MACE事件的影响因素(P<0.05)。SUA与FFR呈显著负相关性(r=-0.163,P=0.003)。SUA、dNLR组合具有最大的预测接受PCI的CAD患者MACE能力,AUC为0.908,灵敏度为96.7%,特异度为79.9%。根据ROC曲线确定SUA、dNLR的最佳临界值分为亚组1(n=180)、亚组2(n=116)、亚组3(n=27),各亚组分别有1例、13例、16例发生MACE事件,发生率分别为99.4%、88.8%、40.7%。Kaplan-Meier生存曲线分析显示从亚组1到亚组3的MACE事件的发生率显著增加(Log Rank(Mantel-Cox)=94.912,P<0.001)。结论:在接受PCI的CAD患者中,dNLR和SUA增加与MACE风险高独立相关,并强调了二者联合应用作为识别CAD患者的长期MACE的潜在临床效用。Objective:To explore the predictive value of serum uric acid(SUA)combined with neutrophil to lymphocyte ratio(dNLR)on coronary blood flow reserve and major cardiovascular adverse events(MACE)in coronary artery disease(CAD).Methods:A total of 323 stable CAD patients who received percutaneous coronary intervention(PCI)in our hospital from January 2020 to December 2021 were selected as the research subjects.DNLR is defined as neutrophil count/(WBC count-neutrophil count).The blood flow reserve fraction(FFR)was quantitatively analyzed by coronary angiography.The end point of this study was MACE,including all-cause mortality and readmission of severe heart failure during follow-up.Results:Compared with the group without MACE,the cases of WBC count,neutrophil count,dNLR,SUA and FFR≤0.92 in MACE group were significantly higher(P<0.05),and the FFR was significantly lower(P<0.05).SUA(HR=1.886,95%CI=1.545~2.303),dNLR(HR=1.479,95%CI=1.241~1.762),FFR≤0.92(HR=3.208,95%CI=1.468)were the influencing factors of MACE events in CAD patients(P<0.05).There was a significant negative correlation between SUA and FFR(r=-0.163,P=0.003).The combination of SUA and dNLR had the greatest ability to predict MACE of CAD patients undergoing PCI,with AUC of 0.908,sensitivity of 96.7%and specificity of 79.9%.According to ROC curve,the optimal critical values of SUA and dNLR were divided into subgroup 1(n=180),subgroup 2(n=116)and subgroup 3(n=27).There were 1 case,13 cases and 16 cases in each subgroup,and the incidence rates were 99.4%,88.8%and 40.7%respectively.Kaplan-Meier survival curve analysis showed that the incidence of MACE events increased significantly from subgroup 1 to subgroup 3(Log Rank(Mantel-Cox)=94.912,P<0.001).Conclusion:In CAD patients receiving PCI,the increase of dNLR and SUA is independently related to the high risk of MACE,and the potential clinical utility of the combination of DNLR and SUA in identifying long-term MACE in CAD patients is emphasized.

关 键 词：尿酸 衍生的中性粒细胞与淋巴细胞比率 冠状动脉疾病 血流储备分数 

分 类 号：R541.4[医药卫生—心血管疾病]